Mtundu wa TSH: Buku la Odwala Chithokomiro

Chilichonse Chimene Muyenera Kudziwa Ponena za Kuyambitsa Kachilombo ka Horoni

Chithokomiro choyambitsa mayeso a hormone-omwe amadziwikanso ngati mayeso a TSH-ndiyo mayeso ofunika kwambiri omwe amagwiritsidwa ntchito ndi madokotala omwe amadziŵa ndi kuchiza matenda a chithokomiro. Ndikofunika kuti ngati wodwala wa chithokomiro, mumvetsetse mayesero awa, tanthauzo la zotsatira zanu, ndi mikangano yomwe ili pafupi ndi mafotokozedwe a TSH.

Chiyeso cha TSH ndi chiyani?

Mayeso a TSH amachititsa kachilombo koyambitsa timadzi kapena TSH.

TSH ndi hormone imene imatulutsidwa ndi chifuwa chanu choyambitsa matendawa pogwiritsa ntchito mahomoni a chithokomiro m'magazi anu. Pamene mavitamini otere apezeka, shuga imatulutsanso TSH kuti ikulimbikitseni chithokomiro chanu kutulutsa mahomoni ambiri. Pamene mahomoni ambiri amatha kutuluka, kachilomboka kamachepetsa kutulutsa TSH.

Mayeso a TSH ndi mayeso oyamba a magazi omwe amagwiritsidwa ntchito kuti apeze matenda a chithokomiro komanso athetse chithandizo cha chithokomiro. Pachikhalidwe chofunikira kwambiri, TSH yapamwamba imatengedwa ngati umboni wa hypothyroidism, chithokomiro chosagwira ntchito. Maseŵera otsika a TSH amawonedwa ngati umboni wa hyperthyroidism, chithokomiro chopitirira muyeso.

Mapulogalamu a TSH

A reference range amapezeka mwa kutenga gulu lalikulu la anthu, kuyesa mayesero ena, kuwerengera zoyenera, ndi kupanga zosiyanasiyana zomwe zikuyenera kuimira "zachibadwa" magulu a anthu amene alibe matenda ena kapena osadziwika .

Mndandanda wa TSH umayimira magulu osiyanasiyana a TSH omwe amadziwika kuti alibe matenda a chithokomiro komanso omwe ali ndi chithokomiro choyenera.

Pakalipano, ku ma laboratories ambiri ku US, mafotokozedwe otengera kwa TSH amayesa pafupifupi 0,5 mpaka 5.0 mU / l. Malinga ndi labu, mungaoneke kusiyana, monga 0,4 mpaka 5.5 mU / l, kapena 0,6 mpaka 4.5 mU / l, ndi zina zotero, koma kawirikawiri, 0,5 mpaka 5.0 mU / l amawoneka ngati mabala ambiri.

Kawirikawiri, dokotala wanu amatanthauzira mlingo pansipa 0.5 mU / l monga chisonyezero cha hyperthyroidism (chithokomiro chopitirira muyeso), ndi mlingo pamwamba pa 5.0 mU / l monga chisonyezero cha hypothyroidism ( chithokomiro chopanda mphamvu ).

Chithunzi chotsatira chikuwonetsera mtundu wa ma laboratory wa TSH:

TSH Reference Range	Kutanthauzira
0,5 mpaka 5.0 mU / l	- Mzere pansipa 0.5 mU / l chiwonetsero cha hyperthyroidism - Mndandanda pamwamba pa 5.0 mU / l chizindikiro cha hypothyroidism

Zolemba Zotsutsana Zotsutsana

Mndandanda weniweni wa reference wa TSH wakhala wotsutsana kwa zaka zoposa khumi. Kubwerera mu 2003, pambuyo pa umboni wawonetsa kuti odwala omwe anali ndi matanthwe a TSH pamapeto apamwamba a TSH reference range amayamba kupitiriza kupanga hypothyroidism kawirikawiri kuposa omwe ali kumapeto kwenikweni, American Association of Clinical Endocrinologists (AACE) adalimbikitsa kuti madokotala "awononge chithandizo kwa odwala omwe amayesa kunja kwa malire a m'mphepete mwa chiwerengero cha TSH cha 0.3 mpaka 3.0 mU / l. Pa nthawiyi, AACE inakhulupirira kuti zatsopanozi " zidzatengera matenda oyenerera mamiliyoni ambiri Anthu a ku America amene amadwala matenda a chithokomiro, koma sanamvere. "

Malinga ndi purezidenti wa AACE Hossein Gharib, MD,

Kufala kwa matenda a chithokomiro osadziwika ku United States akudabwitsa kwambiri ... TSH yatsopano ikuchokera ku malangizo a AACE amapatsa madokotala chidziwitso chomwe akufunikira kuti adziwe matenda a chithokomiro chosavuta asanatengere zowopsa kwambiri pa thanzi la wodwala, monga cholesterol, matenda a mtima, kufooketsa matenda, kusabereka, ndiponso kuvutika maganizo. "

Panthaŵiyo, kulengeza kwa AACE kunawoneka ndi ambiri ngati kusintha kwakukulu komanso kofunika kwambiri kwa odwala.

Mwatsoka, zomwe zinkaonedwa kuti ndizochitika bwino kwa odwala chithokomiro sizinachititse chidwi, pa zifukwa zingapo:

• Ma laboratori sanatenge mtundu watsopano monga zolembera, zomwe zikutanthauza kuti masitepe omwe sali okalamba, osiyana nawo anali olembedwa ngati osazolowereka.
• Olemba zachipatala anapitirizabe kusagwirizana ponena za mtundu wa zolemba za TSH, monga zikuwonetseredwa ndi nkhani ziwiri zazikulu zomwe zinatuluka mu Journal 2005 ya Clinical Endocrinology ndi Metabolism , pofotokoza mbali ziwiri za mkangano.

Madokotala Martin Surks, Gayotri Goswami ndi Gilbert Daniels adanena kuti mafotokozedwewa ayenera kukhala chimodzimodzi m'nkhani yawo "Mtsutso mu Clinical Endocrinology: Mapulogalamu Anu a Chitrotropin Ayenera Kukhala Osasintha." Iwo amatsutsana ndi mfundo zawo ponena kuti "chifukwa chakuti mankhwala a levothyroxine sagwirizana ndi subclinical hypothyroidism, ndithudi sichiyenera kwa anthu omwe ali ndi TSH" m'magulu a 2.5 mpaka 4.5 mU / l.

Madokotala Leonard Wartofsky ndi Richard Dickey anatsutsa m'nkhani yawo, "Umboni Wachidule wa Zotchulidwa Zanu ndi Zokakamiza," kuti mayendedwe ovomerezedwa kale sali ovomerezeka chifukwa malemba omwe poyamba ankawoneka kuti ndi abwino "adayanjetsedwa" ndi anthu omwe ali ndi magawo osiyanasiyana wa matenda a chithokomiro. Iwo ankanena kuti ubwino wa chithandizochi umaposa pangozi iliyonse yochepa.

Madokotala Wartofsky ndi Dickey anateteza kusinthana kumeneku, akuti:

Sitiyenera kukhala ndi cutoff yamtengo wapatali ya TSH kusiyanitsa zachilendo ndi zachilendo, koma kuzindikira kuti tanthauzo la chikhalidwe cha TSH ndilopakati pa 1.18 ndi 1.4 mU / l ndipo anthu oposa 95% omwe ali ndi chiwerengerochi adzakhala ndi chiwerengero chochepa cha TSH Kuposa 2.5 mU / l kumatanthawuza momveka bwino kuti aliyense yemwe ali ndi mtengo wapamwamba ayenera kufufuzidwa mosamalitsa kuti asayambe khungu la chithokomiro.

Pofika m'chaka cha 2006, magulu a magulu otchedwa endocrinology anasiya malangizowo kuti afotokoze mtundu wa TSH wowerengera, Komabe, kukangana komwe kumbuyo ndi kutsogolo kwapitirira kwa zaka zopitirira khumi, ndipo mu 2017, kutsutsana kukupitirirabe. Komabe, ambiri omwe amagwira ntchito zachipatala akulangizidwa kuti agwiritse ntchito TSH yowonjezereka pofufuza ndi kuchiza odwala chithokomiro.

TSH yozolowereka ndi Hypyothyroidism

Ndikofunika kwa odwala a chithokomiro kudziwa kuti kafukufuku wasonyeza kuti:

• Mu ayodini-okwanira anthu, kutanthauza TSH ndi 1.5 mU / l
• Pofufuza za magulu a anthu omwe ali ndi chiwerengero chochepa cha chithokomiro cha Hashimoto, amatanthauza TSH ndi 1.18 mU / l
• Pamene anthu omwe ali ndi ma antibodies kapena antchito omwe ali ndi kachilombo koyambitsa matenda a chithokomiro sagwiritsidwa ntchito kuwerengera, zizindikiro zochokera ku 0,4 mpaka 2.5 mU / l
• Pakati pa mimba, malangizo amasonyeza kuti magulu a TSH sayenera kukwera pamwamba pa 3.0, kuti ateteze thanzi la amayi ndi mwana.
• Maseŵera a TSH pamapeto apamwamba a zolemberazi amathandizidwanso ndi zoopsa za khansa ya chithokomiro, cholesterol yowonjezera, kusabereka, matenda a mtima, mtundu wa shuga, ndi zina zambiri zaumoyo.
• Maseŵera a TSH amayamba kukhala apamwamba kwambiri masana. Mayeso a TSH omwe amachitidwa mtsogolomu patsiku akhoza kusonyeza momwe mumagwirira ntchito, pamene mayeso oyambirira amatha kusonyeza hypothyroidism.

Ngati zotsatira zanu zowunikira TSH zimalowa mkati mwazomwe mukuwerenga ndipo mukuuzidwa kuti "TSH yanu ndi yachibadwa," kodi mungakhalebe hypothyroid? Ambiri ochiritsira odwala amakhulupirira kuti ayi, ndipo ochita zambiri ndi ogwira ntchito ambiri amati inde. Kaya mungathe kukhala hypothyroid ndi yachibadwa TSH mlingo potsiriza amakhalabe nkhani yokangana.

Mawu Ochokera

Monga mwaphunzira, tanthawuzo la chikhalidwe cha TSH "choyenera" chimadalira dokotala yemwe mukumufunsa komanso maganizo ake pa matenda a chithokomiro. Pa nthawi yomweyi, mayeso a TSH ndi ma TSH omwe amawunika ndi ofunika kwambiri pa thanzi lanu ndi chithandizo cha chithokomiro. Zotsatira zake, pali zinthu zofunika kuzikumbukira.

1. Muyenera kufunsa kuti TSH amadziwa kuti dokotala akukulangizani chifukwa chiyani. Mutha kukhala ndi dokotala yemwe amakhulupirira kuti kukusungani pamwamba pazomwe mukukhalira ndi cholinga chokha kapena amene akuganizira za TSH yapafupi ndi kupumula kwa zizindikiro zanu. (Komanso, madokotala amagwiritsa ntchito maseŵero a TSH ochepa kapena okhudzidwa ndi odwala khansa ya kanseri, monga njira yothetsera matenda a khansa.) Madokotala ambiri, komabe, akugwiritsabe ntchito TSH zowerengera zapakati pa 0.5 mpaka 5.0 kuti azindikire ndi kusamalira matenda anu a chithokomiro.
2. Simuyenera kulandira mayankho "mwachibadwa," "okwera," kapena "otsika" monga lipoti la kuyesa kwanu magazi. M'malo mwake, funsani nambala yeniyeni ndikufunsani zolemba za ma laboratory. Ngakhale zili bwino, pemphani zotsatira zowunika magazi.
3. Ngati mayeso anu a TSH ali m'ndandanda, ndipo muli ndi zizindikiro zofanana ndi hypothyroidism, mungafune kupempha mayeso ena kuti muthandizidwe bwinobwino. Ngakhale madokotala ochiritsira nthawi zambiri amadalira mayeso a TSH okha, ena amatha kuyerekezera mahomoni otchedwa thyroxine (T4) ndi triiodothyronine (T3) -ndipo tizilombo toyambitsa chithokomiro ndi T3. Madokotala awa akuyang'ana miyezo yowonjezereka kuti apeze matenda. Mwachitsanzo, pamene ma toni anu a T4 ndi T3 ali otsika, amakhulupirira kuti hypothyroidism, ndipo akakwera, hyperthyroidism akukayikira. Matenda a antibodies-makamaka ma chithokomiro a peroxidase (TPO) omwe amatha kudziwa matenda a Hashimoto-amakhalanso nthawi zina. Akatswiri ena amakhulupirira kuti chithokomiro chomwe chimayambitsa vuto la autoimmune-monga momwe chiwonetsero cha TPO chotetezera thupi-chingayambitse hypothyroidism zizindikiro zisanachitike kuti hypothyroidism iwonetsedwe mu TSH, kapena Free T4 ndi Free T3. Amakhulupiriranso kuti mankhwala opangidwa ndi chithokomiro cha mankhwala a chithokomiro amathandizira kuthetsa zizindikiro zanu, kuchepetsa ma antibody, komanso kukulepheretsani kukhala odwala hypothyroid.
4. Ngati ma test level anu a TSH akugwa pamapeto otalikira, ndipo muli ndi zizindikiro zogwirizana ndi hypothyroidism, ganizirani kukambirana zachilendo cha mankhwala a chithokomiro ndi dokotala wanu.
5. Ngati dokotala akukana kuyesa mayesero ena kapena kukana kukuchitirani, ganizirani kupeza dokotala watsopano pa chithandizo chanu cha chithokomiro. Madokotala ogwira ntchito komanso ogwira ntchito nthawi zambiri amaphatikizapo mayesero ambiri kuphatikizapo kuyesedwa kwa TSH, ndikutengera mbiri yanu yachipatala ndi zizindikiro, ndi cholinga chopeza TSH yotetezeka komanso yotetezeka yomwe ingathandize kuthetsa zizindikiro zanu.

> Zotsatira:

> Anderson et. Zolemba Zenizeni Zomwe Zidasinthika mu Seramu T4 ndi T3 M'zinthu Zowiririka: Chinthu Chothandiza Kumvetsetsa Matenda a Chithokomiro, "Journal of Clinical Endocrinology ndi Metabolism, 87 (3): 1068-1072.

> Garber J, Cobin R, Gharib H, et al. Njira zothandiza kuchipatala kwa hypothyroidism kwa anthu akuluakulu: Zinalembedwa ndi bungwe la American of psychological endocrinologists ndi chikhalidwe cha chithokomiro cha ku America. Chitetezo cha Endocrine. 2012; 18 (6): 988-1028. lembani: 10.4158 / ep12280.gl.

> Guber HA, Farag AF. Kufufuza kwa endocrine kugwira ntchito. Mu: McPherson RA, Pincus MR, eds. Henry's Clinical Detection and Management ndi Njira Zamagetsi. 22nd. Philadelphia, PA: Elsevier Saunders; 2011: mutu 24.

> Surks, et.al. "Kutsutsana mu Clinical Endocrinology: The Thyrotropin Reference Range Uyenera Kukhala Osasintha," Journal of Clinical Endocrinology ndi Metabolism 90 (9) / 5489-5496.

> Wartofsky & Dickey, "Kutsutsana mu Clinical Endocrinology: Umboni Wophiphiritsira wa Thyrotropin Reference Range ndi Wovuta," Journal of Clinical Endocrinology ndi Metabolism.