Kuyang'ana Mankhwala Osokoneza Bongo la Antithyroid, Iodine Yowonjezera Mavitamini, ndi Opaleshoni
Chithandizo chabwino kwambiri cha hyperthyroidism chimadalira pazinthu zingapo, chifukwa cha nkhani yanu mpaka msinkhu wanu, kuopsa kwa nkhani yanu ku thanzi lanu lonse. Ngakhale mankhwala osokoneza bongo (Tapazole, mwachitsanzo) angagwiritsidwe ntchito kuthandiza chithokomiro kawirikawiri, mankhwala ena monga beta-blockers-angaganizidwe kuti athetse zizindikiro za hyperthyroid.
Zosankha monga kupatsirana kwa chithokomiro ndi ayodini zamagetsi kapena opaleshoni kuchotsa vutoli (chithokomiro) zingathenso kuganiziridwa.
Ngakhale kuti njira zitatuzi zili zothandiza, aliyense amakhala ndi mavuto osiyanasiyana komanso zotsatira zake. Ichi ndi chifukwa chake kukambirana mozama ndi dokotala ndikofunikira musanasankhe dongosolo la chithandizo.
Malemba
Mankhwala a mankhwalawa ndi omwe amachiza matenda a hyperthyroidism. Mungathenso kuuzidwa mankhwala ena kuti akuthandizeni kusamalira zizindikiro zogwirizana.
Kuchiza Mankhwala Osokoneza Bongo
Cholinga cha mankhwala ophera tizilombo toyambitsa matenda ndichokwaniritsa chithokomiro chodziwika mkati mwa mwezi umodzi kapena ziwiri kuchokera kuchipatala. Ndiye munthu angapitilize ndi zotsatirazi:
- Lembani mankhwalawa ndi ayodini kapena opaleshoni ya radioactive
- Pitirizani kumwa mankhwala osokoneza bongo kwa chaka chimodzi kapena ziwiri, ndikuyembekeza kuti mudzakhululukanso (zomwe zimakhala mwa anthu omwe ali ndi hyperthyroidism yochepa komanso mochepa mwa anthu omwe ali ndi goiter yaikulu komanso omwe amasuta)
- Tengani mankhwala osokoneza bongo nthawi yaitali
Ngakhale mankhwala osokoneza bongo a antityroid ndi othandiza (muli ndi mwayi wokhululukidwa, mankhwala amatha kusinthidwa, ndipo mukhoza kupewa ngozi ndi ndalama zomwe zimachitika opaleshoni), chodetsa nkhaŵa ndicho chakuti ochita kafukufuku amati pafupifupi 70 peresenti ya anthu adzabwerenso pambuyo Mankhwala osokoneza bongo amasiya.
Mankhwala awiri omwe amapezeka ku United States ali Tapazole (methimazole, kapena MMI) ndi propylthiouracil (PTU). Chifukwa chakuti MMI imakhala ndi zotsatira zochepetsetsa ndipo imasintha kwambiri hyperthyroidism kuposa PTU, MMI ndi kusankha kosankhidwa.
Izi zinati, PTU imagwiritsidwa ntchito pochiza hyperthyroidism pa nthawi yoyamba yachitatu ya mimba komanso anthu omwe ali ndi mkuntho wa chithokomiro . Zingaperekedwe kwa anthu omwe adayanjanitsidwa ndi methimazole ndipo safuna kukhala ndi ayodini kapena opaleshoni ya radioactive.
Zina mwa zotsatira zochepa zazing'ono zokhudzana ndi kutenga MMI kapena PTU zikuphatikizapo:
- Kuyabwa
- Rash
- Kupweteka kumodzi ndi kutupa
- Nausea
- Fever
- Kusintha kwa kukoma
Chofunika kwambiri, kuvulala kwa chiwindi ndi MMI kapena PTU (zomwe zimagwirizana ndi zotsirizira) zingachitike. Zisonyezero za kuvulala kwa chiwindi zimapweteka m'mimba, jaundice, mitsempha yamdima, kapena zojambula zadongo. Nthawi zambiri, chikhalidwe chowopsya chotchedwa agranulocytosis (kuchepa kwa maselo olimbana ndi matenda m'thupi lanu) chikhoza kuchitika ndi MMI kapena PTU. Ndikofunikira kuti anthu atenge mankhwalawa adziwe madokotala awo nthawi yomweyo ngati ali ndi zizindikiro za matenda monga fever kapena zilonda zam'mimba.
Thandizo la Blocker la Beta
Ngakhale si mankhwala a hyperthyroidism, anthu ambiri omwe ali ndi hyperthyroidism amalembedwa kuti amatsutsana ndi beta-adrenergic receptor (omwe amadziwika kwambiri ngati beta-block).
Matenda a beta amagwira ntchito m'thupi kuti achepetse zotsatira za mahomoni otentha a mtima ndi kusindikizidwa, makamaka kuthamanga kwa mtima, kuthamanga kwa magazi, kuthamanga kwa magazi, kutenthedwa, ndi zizoloŵezi zosasinthasintha. Olemba mabeta amachepetsanso mlingo wa kupuma, kuchepetsa kutaya thukuta komanso kusagwirizana kwa kutentha, ndipo nthawi zambiri amachepetsa mantha ndi nkhawa.
Mankhwala a Thyroiditis
Kwa kanthawi kochepa kapena "kosadziletsa" mawonekedwe a hyperthyroidism (mwachitsanzo, subacute thyroiditis kapena postpartum thyroiditis ), makamaka makamaka pakuchiza zizindikiro. Kupweteka kwapweteka kungaperekedwe chifukwa cha ululu wa chithokomiro ndi kutupa, kapena beta blockers angaperekedwe kwa zizindikiro zokhudzana ndi mtima.
Nthaŵi zina, mankhwala osokoneza bongo amatchulidwa kwa kanthaŵi kochepa.
Ablation
Iodine yamagetsi (RAI) imagwiritsidwa ntchito kuthetsa matenda a chithokomiro, chomwe chimadziwika kuti ablation. Amagwiritsidwa ntchito pochitira anthu ambiri omwe ali ndi matenda a Graves ku United States, koma sangagwiritsidwe ntchito kwa amayi omwe ali ndi mimba kapena kuyamwitsa, kapena anthu omwe ali ndi khansa ya chithokomiro kuphatikizapo hyperthyroidism.
Pa mankhwala a RAI, ayodini ya radioactive amaperekedwa ngati mlingo umodzi, mu capsule kapena mwa njira yankho. Pambuyo pake munthu atayambitsa RAI, zizindikiro za ayodini ndi kulowa mu chithokomiro, kumene zimatulutsa maselo a chithokomiro, kuwononga ndi kupha. Chotsatira chake, chithokomiro chimachepa ndipo ntchito ya chithokomiro imachepetsanso, kutembenukira kwa hyperthyroidism ya munthu .
Izi zimachitika mkati mwa masabata asanu ndi limodzi kapena 18 mutatha kumwa mankhwala odzola, ngakhale kuti anthu ena amafunikira mankhwala achiwiri a RAI.
Kwa anthu omwe ali achikulire, omwe ali ndi thanzi labwino monga matenda a mtima, kapena omwe ali ndi zizindikiro zazikulu za hyperthyroidism, mankhwala osokoneza bongo (methimazole, kawirikawiri) amagwiritsidwa ntchito kuimiritsa chithokomiro asanayambe kuchipatala. Methimazole imaperekedwanso masiku atatu mpaka asanu ndi awiri pambuyo pa chithandizo cha RAI mwa anthuwa, ndipo pang'onopang'ono amawoneka ngati chithokomiro chawo chimakhala chokhazikika.
Zotsatira Zotsatira ndi Zokhudzidwa
RAI ikhoza kukhala ndi zotsatira zina, kuphatikizapo kunyoza, kupweteka kwa pakhosi, ndi kutupa kwa mapira, koma izi ndizochepa. Ochepa peresenti ya odwala ali pachiopsezo cha mvula ya chithokomiro yakupha pambuyo pa RAI.
Komanso, pali umboni wa sayansi wosonyeza kuti chithandizo cha RAI chingayambitse chitukuko kapena kuwonjezeka kwa matenda a maso a Graves '(orbitopathy). Ngakhale kuti kuwonjezeka kumeneku kawirikawiri kumakhala kofatsa ndi kochepetsetsa, malangizo a American Thyroid Association samalimbikitsa kupereka chithandizo cha RAI kwa anthu omwe ali ndi matenda oopsa kwambiri.
Ngati muli ndi RAI, dokotala wanu adzakambirana za msinkhu wa ma radiation ndi zizindikiro zilizonse zomwe mungachite kuti muteteze banja lanu kapena anthu. Izi zimati, khalani omasuka kuti kuchuluka kwa mankhwala omwe akugwiritsidwa ntchito pa mankhwala a RAI ndi ochepa ndipo si chifukwa cha khansa, kusabereka, kapena kulephera kwa kubadwa.
Kawirikawiri, mu maola 24 oyambirira pambuyo pa RAI, pewani kugwirizana ndi kukupsompsona. M'masiku asanu oyambirira kapena pambuyo pa RAI, kuchepetsa kuwonetseredwa kwa ana aang'ono ndi amayi apakati, ndipo makamaka kupewa kupeleka ana m'njira yoti awonekere ku dera lanu la chithokomiro.
Opaleshoni
Opaleshoni ya chithokomiro (yotchedwa thyroidectomy) kawirikawiri ndiyo njira yosankha yosamalirako chithokomiro chowonjezera. Pamene kuchotsa chithokomiro n'chothandiza kwambiri kuchiza hyperthyroidism, opaleshoni ndi yopweteka, yotsika mtengo, komanso yoopsa kwambiri.
Kwachidziwikire, opaleshoni ikulimbikitsidwa pazifukwa izi:
- Ngati mankhwala osokoneza bongo ndi / kapena RAI sakulephera kuthetsa vutoli
- Ngati munthu ali ndi mankhwala osokoneza bongo komanso sakufuna mankhwala a RAI
- Ngati munthu akukayikira, mwina akudwala khansa ya kanseri
- Ngati munthu ali ndi goiter yayikulu kwambiri (makamaka ngati ikuletsa kuyendetsa ndege kapena zimavuta kumeza), zizindikiro zoopsa, kapena matenda a maso a Graves
Pamene mukuchitidwa opaleshoni ya dokotala, dokotala wanu adzasankha ngati achotsa chithokomiro chonse (kutchedwa kachiprotectomy) kapena gawo la chigoba (chomwe chimatchedwa thyroidectomy). Kusankha izi sikophweka nthawi zonse ndipo kumafuna kukambirana ndi kulingalira bwino.
Nthawi zambiri, opaleshoni yamtundu umene mumayendera imadalira chifukwa cha hyperthyroidism yanu. Mwachitsanzo, mimba yokhayokha yomwe imapangitsa kuti majeremusi a chithokomiro akhale pambali ya kumanzere kwa chithokomiro chanu akhoza kuthandizidwa ndi chithokomiro chochepa (mbali yamanzere ya chithokomiro imachotsedwa). Komano, goiter yaikulu yomwe imatenga mbali zonse za chithokomiro ikhoza kupatsidwa chithokomiro chonse.
Kusamalira Zolemba Zofufuza ndi Mavuto
Ngati muli ndi chithokomiro chokwanira, mankhwala a chithokomiro a moyo wanu wonse amafunikira. Kumbali inayi, ndi chithokomiro chochepa, pali mwayi wochuluka kuti simudzakhala ndi mankhwala a chithokomiro osatha, malinga ngati muli ndi mankhwala okwanira okwanira kuti mukhale ndi mavitamini ambiri a chithokomiro.
Monga momwe mukuchitira opaleshoni iliyonse, nkofunika kuwonanso zoopsa zomwe zingakhalepo ndi dokotala wanu. Kuchita opaleshoni ya chithokomiro, ngozi zomwe zingakhalepo zimaphatikizapo kutuluka magazi, komanso kuwonongeka kwa mitsempha yowonongeka (yochititsa mantha) ndi / kapena chiwalo cha parathyroid (chomwe chimayang'anira kukhazikika kwa calcium mu thupi). Komabe, ndi dokotala wodziŵa chithandizo cha chithokomiro, ngozizi ndizochepa.
Pakati pa Mimba
Kawirikawiri amalangizidwa kuti ngati mkazi ali ndi hyperthyroid ndipo akufuna kuti pakhale mimba posachedwa kuti aganizire chithandizo cha RAI kapena opaleshoni miyezi isanu ndi umodzi asanakwatire.
Azimayi oyembekezera omwe ali ndi zizindikiro komanso / kapena odwala-hyperthyroidism amafunika chithandizo. Thandizo lovomerezeka ndi mankhwala osokoneza bongo, kuyambira ndi PTU mu trimester yoyamba ndikusintha kwa methimazole mu 2 ndi 3 trimesters (kapena kukhala pa PTU).
Ngakhale kuti mankhwalawa amanyamula ngozi kwa amayi apakati, ntchito ya dokotala ndi kuigwiritsa ntchito mochepa kuti athetse mphamvu ya hyperthyroidism ndikuchepetsera zoopsa zomwe zimakukhudzani inu ndi mwana wanu.
Kawirikawiri, madokotala amalimbikitsa mlingo wawung'ono kwambiri womwe ungathetsere vutoli. Popeza mankhwala osokoneza bongo amatha kuwoloka pamtunda, komabe, ndikofunika kwambiri kutsatira malangizo ovomerezeka ndi kupitiriza kuyendera bwino (kumachitika masabata awiri kapena anayi).
Pa maulendo a zaumoyo, kuwonjezera pa kuyesedwa kwa chithokomiro, kupsa kwanu, kulemera kwake , ndi kukula kwa chithokomiro kudzayang'aniridwa. Pulse iyenera kukhala pansi pa 100 kugunda pa mphindi. Muyenera kuyesetsa kuti phindu lanu likhale lopanda pakati pa mimba, choncho lankhulani ndi dokotala wanu za zakudya zoyenera komanso zochitika zolimbitsa thupi zomwe zili zoyenerera pakali pano. Kukula kwa fetal ndi kuyamwa kumafunikanso kuyang'aniridwa mwezi uliwonse.
Mu Ana
Monga kwa akuluakulu, hyperthyroidism kwa ana akhoza kuchiritsidwa ndi mankhwala osokoneza bongo, mankhwala a iodine, kapena thyroidectomy.
Chithandizo cha kusankha kwa ana omwe ali ndi hyperthyroidism ndi MMI ya mankhwala osokoneza bongo, chifukwa imakhala yoopsa kwambiri poyerekeza ndi RAI kapena opaleshoni, ndipo imakhala ndi zotsatira zochepa poyerekeza ndi PTU. Ngakhale RAI kapena opaleshoni kapena njira zochiritsira zovomerezeka, RAI imapewa ana osapitirira zaka zisanu.
Mankhwala Ophatikiza (CAM)
Ku China ndi m'mayiko ena, nthawi zina zitsamba za Chitchaina zimagwiritsidwa ntchito pochizira hyperthyroidism, mwina pokha kapena pamodzi ndi mankhwala osokoneza bongo. Ngakhale njira yosadziwika bwinoyi, ena amakhulupirira kuti zitsamba zimagwira ntchito poletsa kutembenuka kwa thyroxine (T4) ku triiodothyronine (T3) ndi kuchepetsa zotsatira za T4 pa thupi.
Phunziro lalikulu la kafukufuku, lomwe linayesedwa mayesero khumi ndi atatu a anthu oposa 1700 omwe ali ndi hyperthyroidism, kuwonjezera kwa zitsamba za ku China ku mankhwala osokoneza bongo zimathandiza kuthetsa zizindikiro ndi kuchepetsa zotsatirapo zonse za mankhwala osokoneza bongo komanso kubwerera m'mbuyo (kutanthauza kuti kachilombo ka hyperthyroidism) mwa anthu ena. Olemba a phunziroli, adanena kuti mayesero onsewa sanakonzedwe bwino. Chifukwa cha khalidwe lawo laling'ono, olembawo akunena kuti palibe umboni wamphamvu wokwanira wothandizira kugwiritsa ntchito mankhwala a zitsamba za Chitsamba pochiza hyperthyroidism.
Popeza zitsamba zachi China (kapena njira zina zothandizira) zingakhudze mankhwala anu ndi mazira a chithokomiro, ndizofunikira kuti muzingowatenga motsogoleredwa ndi wanu wambiri.
Kuwonjezera pa zitsamba zachi China, vitamini D yathandizidwa kwambiri ndi chithokomiro. Ngakhale kugwirizana kwapezeka pakati pa kuchepa kwa vitamini D ndi matenda a chithokomiro (onse a Graves 'ndi matenda a Hashimoto), sikudziwikiratu zomwe bungweli likutanthawuza, ngati vuto la vitamini D ndilopangitsa kuti chithokomiro chisamayende bwino.
Tikudziwa kuti hyperthyroidism ikhoza kufooketsa mafupa (osteoporosis), motero kuonetsetsa kuti vitamini D ndi calcium ndizofunikira. Institute of Medicine imalimbikitsa mavitamini D a maiko angapo (600) a vitamini D tsiku lililonse kwa anthu akuluakulu azaka 19 mpaka 70 ndi 800 UU kwa anthu akuluakulu oposa zaka 70. Izi zati, ndibwino kutsimikizira mlingo wanu wa vitamini D ndi dokotala wanu. Angalimbikitse kuyang'ana mlingo wanu wa vitamini D ndi kuyesa magazi; ngati simukusowa, mungafunike mlingo waukulu kusiyana ndi izi zikuwonetseratu.
> Zotsatira:
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