Kuzindikira Kumadalira Kwambiri Mayesero A Magazi
Ngati inu kapena wokondedwa wanu muli ndi zizindikiro za chithokomiro chopanda mphamvu (chotchedwa hypothyroidism), ndikofunika kuti muwone dokotala wanu kuti awonetsetse kwathunthu. Kuti muwone vuto la chithokomiro, dokotala wanu adzakufunsani mafunso okhudza mbiri yanu yachipatala yaumwini ndi ya banja, kukayezetsa thupi, ndikuyesa kuyesera magazi (makamaka, hormone ya stimulating, kapena test TSH).
Ngati dokotala akukudziwani ndi hypothyroidism, afunanso kudziwa chomwe chimayambitsa vuto lanu la chithokomiro, chifukwa izi zidzakonzekera dongosolo lanu la mankhwala. Pofuna kufotokoza "chifukwa chake" kumbuyo kwa matenda a hypothyroid, mungafunikire kuyesedwa, monga mayeso a magazi a antibody.
Pezani Dokotala
Anthu ambiri amapezeka ndi hypothyroidism ndi dokotala wawo kapena internist. Komabe, madokotala oyamwitsa amatha kusamalira matenda a chithokomiro mosiyanasiyana.
Ntchito yanu yoyamba iyenera kukhala kuti mudziwe ngati dokotala wanu wamkulu akukuthandizani, kapena ngati mufunsane ndi katswiri wamagetsi (dokotala yemwe amadziwika bwino pa matenda a mahomoni).
Pamapeto pake, mukhoza kuwona katswiri wina wamagulu amodzi, ndipo kenaka khalani ndi chisamaliro chapamwamba kwambiri kuchipatala chanu. Mwinanso, katswiri wanu wamakono amatha kuchita chithandizo chanu chonse cha chithokomiro chaka ndi chaka ngati ndi choncho.
Phunzirani
Mukawona dokotala kwa nthawi yoyamba ndi zizindikiro kapena zizindikiro zoganiza za hypothyroidism, mutha kuyembekezera kuti mupite mbiri yakale ya zamankhwala ndi kuunika kwanu.
Pambuyo poyang'ana zizindikiro zatsopano zomwe zimasonyeza kuti thupi lanu limachepetsa (mwachitsanzo, khungu lotupa, lovuta, kusasalana, kapena kuvomereza), dokotala wanu adzafunsa mafunso okhudza mbiri yanu yachipatala, monga:
- Kodi muli ndi matenda ena omwe amachititsa kuti thupi lanu likhale ndi matendawa (mwachitsanzo, nyamakazi yamagazi kapena shuga ya mtundu wa 1?)
- Kodi muli ndi mamembala onse a m'banja omwe ali ndi hypothyroidism?
- Kodi munayamba mwachitidwa opaleshoni ya chithokomiro?
- Kodi mukugwiritsa ntchito mankhwala omwe amachititsa hypothyroidism ngati amiodarone kapena lithiamu?
- Kodi mukutenga zowonjezera zamtundu uliwonse wa ayodini?
- Kodi munayamba mwakhala ndi miyendo m'khosi mwanu, kuti muzitha kuchiza lymphoma kapena khansa ya mutu ndi khosi?
Kuphatikiza pa mbiri yachipatala, dokotala wanu adzayang'ana chithokomiro chanu kuti chikulitse (chotchedwa goiter) ndi mitsempha (mitsempha). Dokotala wanu adzafunsiranso zizindikiro za hypothyroidism monga kutsika kwa magazi, kutsika kwa thupi, khungu louma, kutupa, ndi malingaliro opusa.
Mapulogalamu ndi Mayesero
Kupezeka kwa hypothyroidism kumadalira kwambiri kuyesera magazi.
Hormone yotulutsa chithokomiro (TSH)
Mayeso a TSH ndiwo mayesero oyambirira omwe amagwiritsidwa ntchito pofufuza ndi kusamalira hypothyroidism . Koma mabala osiyanasiyana nthawi zambiri amakhala ndi mfundo zosiyana ndi zomwe zimatchedwa "TSH reference range."
Pa mabala ambiri, bukhuli la TSH limayenda kuyambira 0.5 mpaka 4.5. Mtengo wa TSH wosachepera 0.5 umatengedwa ngati hyperthyroid, pamene mtengo wa TSH wa zoposa 4.5 umaonedwa kuti ndi hypothyroid.
Mabala osiyanasiyana angagwiritse ntchito malire amtundu uliwonse kuchokera ku 0.35 mpaka 0.6, ndi kumtunda kwina kulikonse kuyambira 4.0 mpaka 6.0.
Mulimonsemo, nkofunika kuti muzindikire za zolembera zalabu yomwe mwazi wanu umatumizidwa, kotero mumadziwa zomwe mukuzipeza.
Ngati kachilombo koyamba ka TSH kowonjezereka, kawirikawiri imabwerezedwa, ndipo mayeso a thyroxine T4 amamasulidwa.
Thyroxine yaulere (T4)
Ngati TSH ilipamwamba ndipo T4 yaulere ili yochepa, matenda a primary hypothyroidism amapangidwa.
Ngati TSH ili pamwamba, koma T4 yaulere ndi yachibadwa, matenda a subclinical hypothyroidism amapangidwa. Chithandizo cha subclinical hypothyroidism chimadalira pa zifukwa zingapo.
Mwachitsanzo, dokotala wanu angagwiritse ntchito kachilombo ka hypothyroidism ngati muli ndi zizindikiro monga kutopa, kudzimbidwa, kapena kupsinjika maganizo, kapena muli ndi matenda ena, mwachitsanzo, matenda a celiac.
Zaka, komanso, zidzathandiza pa chisankho cha dokotala wanu. Kawirikawiri, pamakhala malo apamwamba kwambiri popanga mankhwala a chithokomiro m'malo okalamba; izi ndi chifukwa TSH yawo yoyamba idafika pamtunda wapamwamba.
Kukhalapo kwa ma TPO (onani pansipa) kumathandizanso pa chisankho cha dokotala wanu. Ngati muli ndi subclinical hypothyroidism ndi zabwino TPO ma antibodies, dokotala wanu mwina amayambitsa mankhwala a chithokomiro, kuti asapitirire kukula kwa subclinical hypothyroidism mu overt hypothyroidism.
Chidziwitso chosowa cha hypothyroidism chapakati kapena chachiwiri ndi chochepa kwambiri. Central hypothyroidism imapereka chithandizo cha pituitary kapena hypothalamus. Mitundu ya ubongo imayendetsa chithokomiro ndipo imatha kuonongeka ndi zotupa, matenda, mazira, ndi matenda opatsirana monga sarcoidosis, pakati pa zifukwa zina.
Pakatikati mwa hypothyroidism, TSH ndi yochepa kapena yachibadwa ndipo T4 yaulere nthawi zambiri imakhala yochepa kapena yochepa.
TPO Matenda
Matenda a chithokomiro otchedwa peroxidase (TPO) amasonyeza kuti matenda a chithokomiro cha Hashimoto, omwe ndi omwe amachititsa kuti hypothyroidism iwonongeke ku United States. Mankhwalawa amathamanga pang'onopang'ono ndi chithokomiro, choncho chitukuko cha hypothyroidism chimachitika mofulumira, monga chithokomiro chimakhala chochepa kwambiri chopatsa kutulutsa mahomoni.
Izi zikutanthauza kuti munthu akhoza kukhala ndi "mankhwala abwino" a TPO, koma ntchito ya chithokomiro yachibadwa kwa nthawi ndithu; Ndipotu, zingatenge zaka kuti chithokomiro cha munthu chikhale chopitirira mpaka kufika pokhala ndi hypothyroid. Anthu ena ngakhale ali ndi ma antibodies abwino a TPO ndipo sapitiriza kukhala hypothyroid.
Ngakhale kuti dokotala wanu sangakuchititseni mankhwala am'madzi a chithokomiro ngati mankhwala anu otetezeka a TPO ali abwino koma TSH yanu ili m'ndondomeko yoyenera, adzatha kuyang'anitsitsa TSH yanu pakapita nthawi.
Kujambula
Pamene mayeso a magazi ndiwo mayeso oyambirira kuti mupeze matenda a hypothyroidism, dokotala wanu akhoza kulamula khungu la chithokomiro ngati akulemba (kapena kungofuna kuti awonetsere) goiter kapena mitsempha pamaphunziro anu. An ultrasound ingathandize dokotala kudziwa kukula kwa chiguduli komanso ngati chiri ndi zokayikitsa chifukwa cha khansa. Nthawi zina, chingwe cha singano (chomwe chimatchedwa chabwino cha singano, kapena FNA) chimapangidwira kuti chipeze chitsanzo cha maselo omwe ali mkati mwake. Maselowa amatha kuyang'anitsitsa mosakayikira pansi pa microscope.
Pankhani ya central hypothyroidism, kujambula kumachitika kuti muyese ubongo ndi chifuwa cha ubongo. Mwachitsanzo, MRI ya gland ya pituitary ikhoza kuvumbulutsa chotupa, monga adenoma pituitary.
Kusiyanitsa kusiyana
Zizindikiro za hypothyroidism ndizosiyana kwambiri ndipo zingatheke mosavuta kapena zolakwika chifukwa cha matenda ena.
Kupeza Njira Zina Zogwiritsa Ntchito Zizindikiro
Malingana ndi zizindikiro zanu zosiyana, dokotala wanu adzakuyang'anirani njira zina zamankhwala (makamaka ngati TSH yanu ndi yachibadwa). Izi ziphatikizapo:
- Anemia
- Matenda a tizilombo (mwachitsanzo, mononucleosis kapena matenda a Lyme)
- Kulephera kwa Vitamini D
- Fibromyalgia
- Kusokonezeka maganizo kapena nkhawa
- Kugonana ndi mpweya
- Matenda a chiwindi kapena impso
- Matenda ena omwe amachititsa kuti munthu asatenge matenda (monga matenda a leliac kapena nyamakazi ya nyamakazi)
Kupeza Njira Zina Zotsatira Zotsatira Zotsatira za Magazi
Ngakhale kuti hypothyroidism yapachiyambi ndi yomwe imakhala ikupangika kumbuyo kwa TSH yokwezeka, palinso zina zomwe dokotala wanu akuziganizira. Mwachitsanzo, mayeso a magazi a chithokomiro omwe amawathandiza kudziwa kuti pakati pa hypothyroidism amatha kukhala ndi matenda osokoneza bongo.
Osthyroidal lllness
Anthu omwe ali kuchipatala chodwala matenda aakulu kapena omwe adwala matenda opatsirana mafupa, opaleshoni yaikulu, kapena matenda a mtima akhoza kukhala ndi machitidwe a chithokomiro a magazi omwe ali pakati pa hypothyroidism (otsika TSH ndi otsika T4) -ndipo "matenda awo oshyroidal" sachita osati kawirikawiri mankhwala ovomerezeka.
Pachifukwa ichi, kuyeretsa kuyezetsa magazi kotchedwa reverse T3, tetabolite ya T4, kungakhale kothandiza kusiyanitsa pakati pa zoona pakati hypothyroidism ndi matenda oshyroid. Chotsatira T3 chikukwera mu matenda oshyroidal.
Mu matenda osayroidroid, matenda a chithokomiro amayenera kuwonetsa nthawi yomwe munthu akuchira matenda awo. Ngakhale, anthu ena amayamba kukhala ndi TSH yokwera pambuyo pochira. Mwa anthu awa, kubwereza TSH mu masabata anayi kapena asanu nthawi zambiri amasonyeza TSH yachibadwa.
Kusamvetsetsa kwa Adrenal Kulephera
Mankhwala a hyperothyroidism ndi adrenal insufficiency angakhale pamodzi, monga momwe amachitira ndi matenda omwe amadziwika kuti autoimmune polyglandular syndrome. Matendawa amachokera kuzinthu zomwe zimagwiritsa ntchito mitundu yambiri, makamaka chithokomiro (kutulutsa hypothyroidism) ndi adrenal glands (kuchititsa adrenal insufficiency).
Imodzi mwa zoopsya zazikulu zomwe zimagwirizanitsidwa ndi matendawa ndi kuchiza hypothyroidism (kupereka mankhwala a chithokomiro m'malo mwake) musanapange chinyengo (chomwe chimafuna chithandizo cha corticosteroid), chifukwa izi zingachititse kuti pakhale vuto loopsya. Mwamwayi ndi matenda awa, chinyengo chingawonongeke chifukwa cha TSH yokwera ndi zizindikiro zosadziwika zomwe zikugwirizana ndi zomwe zimawonedwa mu hypothyroidism.
TSH-kupanga Pituitary Adenoma
Ngati TSH ikukwera, ndikofunika kuti T4 yaulere iwonenso. Mu primary hypothyroidism, T4 yaulere iyenera kukhala yotsika, koma ngati munthu ali ndi chotupa cha TSH-secreting pituitary, T4 yomasuka idzakwezedwa.
> Zotsatira:
> American Thyroid Association. (2013). Kabuku ka Odwala ndi Mabanja Awo .
> Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL / Wolters Kluwer; 2012.
> Garber J et al. Malangizo Othandizira Amagulu a Hypothyroidism Aakuluakulu: Olembedwa ndi a American Association of Clinical Endocrinologists ndi American Thyroid Association. Chitetezo cha Endocrine . 2012 Nov-Dec; 18 (6): 988-1028.
> Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: ndizosintha. Am Phys Physician. 2012 Aug 1; 86 (3): 244-51.
> Upala S, Yong WC, Sanguanke A. Msinkhu wodalirika wosagwiritsidwa ntchito monga matenda a hypothyroidism wodwala ndi matenda a polyglandular. N Am J Med Sci . 2016 May; 8 (5): 226-28.