Ngati muli ndi mankhwala otchedwa hormone m'malo mwa mankhwala ena (ie, generic levothyroxine, kapena Synthroid, Levoxyl, kapena Tirosint ) ndipo osakondedwa, mwina mungapindule ndi kuwonjezera T3, kapena kusintha mankhwala a chithokomiro omwe akuphatikizapo T3.
T3 / Triiodothyronine
Levothyroxine ndi mawonekedwe a hormone thyroxine, otchulidwa monga T4.
T4 ndi hormone yosungirako ndipo iyenera kutembenuzidwa ndi thupi kukhala T3 kuti igwiritsidwe ntchito ndi maselo.
T3 ndi yochepa kwa triiodothyronine. T3 ndi chithokomiro chogwira ntchito zomwe zimagwira ntchito pamagetsi kuti zithandize pakupereka mpweya ndi mphamvu ku maselo, minofu, ndi glands m'thupi lonse.
Pamene chithokomiro chimatulutsa T4 ndi T3, T4 sichigwira ntchito. Pofuna kuti azigwiritsa ntchito thupi, T4 imasinthidwa kukhala T3.
Thandizo la Levothyroxine yokha limaonedwa kuti ndilo lamulo la chisamaliro cha madokotala odziwika bwino. Pali umboni wochuluka wa sayansi, womwe umatsimikizira nkhani zingapo zomwe zimaganizira za mankhwala a T3. Mwachitsanzo:
- Kafukufuku watsopano akuzindikiritsa zolakwika zomwe zimatchedwa kuti deiodinase polymorphisms zomwe zimapangitsa kuti odwala asamagwire bwino ntchito potembenuza T4 kukhala T3. Kafukufukuyu akusonyeza kuti levothyroxine yekha sali okwanira odwalawa.
- Kafukufuku waposachedwapa wazaka 15 afufuza levothyroxine komanso mankhwala a liothyronine a hypothyroidism. Kafukufuku wambiri anapeza kusintha kwabwino, khalidwe la moyo, ndi zidziwitso kwa odwala omwe akugwiritsa ntchito mankhwalawa, poyerekeza ndi levothyroxine okha.
- Kafukufuku wina wasonyeza kuti kugwiritsira ntchito mankhwala owonjezera a T3 kumapangitsa kuti thupi likhale lochepa, kuchepa kwakukulu kwa thupi, komanso kuthetsa bwino zizindikiro, popanda vuto linalake poyerekeza ndi levothyroxine yekha.
Phunziro lapadera la Denmark , lomwe linalembedwa mu European Journal of Endocrinology , linaphunzira kuti zizindikiro za chithokomiro zimakhudzidwa ndi mankhwala a levothyroxine okha, motsutsana ndi levothyroxine komanso T3 (pakali pano, mlingo wa micrograms 20 wa T3 tsiku ndi tsiku unagwiritsidwa ntchito).
Mayesero kuti akhale ndi moyo wabwino komanso kuvutika maganizo kunayambika kumayambiriro kwa phunziroli, komanso kachiwiri pakatha mankhwala a masabata 12. Pa nthawi yonse ya masabata 12, maphunzirowa anapatsidwa levothyroxine kuphatikizapo T3, kapena levothyroxine kuphatikizapo placebo ndikusintha kwa nthawi ya sabata 12. Ophunzirawo "anali akhungu" chifukwa sankadziwa ngati akugwiritsa ntchito T3 kapena placebo.
Makhalidwe a moyo ndi maganizo omwe adayesedwa akuphatikizidwa, mwazifukwa zina: zokhudzana ndi thanzi labwino, chikhalidwe cha anthu, thanzi labwino, umoyo, kukhudzidwa, kuvutika maganizo, ndi nkhawa. Phunziroli linasonyeza kuti pakati pa odwala, ambiri mwa iwo anali akazi, 49% mwa odwala ankakonda kusakaniza, ndipo 15% okha ndiwo ankakonda mankhwala a levothyroxine okha.
Ochita kafukufuku ndi opotologist akhala akuyenda mobwerezabwereza kwa zaka pafupifupi makumi awiri za mtengo wa T3 . Malingana ndi zochitika zawo zokhazikika ndi odwala, komanso pazowonjezera umboni wochulukirapo, madokotala ena ochiritsira, komanso owonjezera omwe akugwirizanitsa ntchitoyi akuwonjezera kuwonjezera pa T3 monga njira yothetsera chithandizo cha chithokomiro kwa odwala ena. Amawonjezera T3 m'njira zingapo:
- Kuonjezera mankhwala a T3 ku levothyroxine, kudzera pa kuwonjezera kwa mankhwala omwe amadziwika ndi dzina la T3 mankhwala a Cytomel, kapena generic liothyronine (yopangidwa ndi T3)
- Kuwonjezera kupanga T3 pogwiritsa ntchito mankhwala owonjezera mankhwala owonjezera nthawi / kumasulidwa T3 kuwonjezera pa levothyroxine
- Kuwonjezera mlingo wa chilengedwe cha chilengedwe, monga mankhwala ochiritsira Chilengedwe, Chithokomiro cha Zida , kapena chithokomiro chachibadwa (mankhwala a US ndi Acella) ku mankhwala a levothyroxine
- Kusintha odwala ku chilengedwe chodziwika ndi chithandizo cha chithokomiro
- Kuika wodwala pa mankhwala okhaokha a T3 (izi si zachilendo.)
Nkofunika kuzindikira kuti, chifukwa T3 ndi hormone yogwira ntchito, ikhoza kukhala ndi zotsatira zochititsa chidwi kwambiri pamtima ndi kupsyinjika kwa anthu ena, makamaka omwe ali ndi mbiri ya matenda a mtima, okalamba, ndi omwe ali ndi zovuta za mtima ngati mitral valve prolapse.
Madokotala a T3-savvy amafufuza chitetezo cha T3 poyerekeza ndi zomwe zingapindulitse pazomwe zilipo.
Ngakhalenso odwala omwe alibe nkhawa kapena zaka zambiri zomwe zingachititse kuti T3 zikhale zovuta, odwala ena amangoganizira kwambiri zotsatira za T3. Mtima umakhudzidwa kwambiri ndi mahomoni otchedwa thyroid, ndipo kwa anthu ena, ngakhale kuchepa kwa liothyronine, kapena kachilombo ka T3 ka mankhwala osokoneza bongo amachititsa kuti phokoso liwonjezeke.
Kwa odwalawo, madokotala ena amalimbikitsa mtundu wa T3 womwe umamasulidwa / wotulutsidwa / wotulutsidwa pang'onopang'ono, womwe umapezeka ndi mankhwala kuchokera ku mankhwala osokoneza bongo.
Madokotala ena ophatikizana, amakhulupirira kuti kutulutsidwa pang'ono kwa T3 kwenikweni ndi njira yabwino kwambiri yothandizira T3, chifukwa ikufanana kwambiri ndi kutembenuka kwa thupi ndi kumasulidwa kwa T3, ndipo chifukwa mawonekedwe otulutsira pang'onopang'ono sangachititse zotsatirapo zilizonse.
Chithokomiro Chodziwika Ndichilengedwe
Akatswiri ena apeza kuti odwala awo ali ndi kachilombo koyambitsa matendawa pamene akugwiritsa ntchito mankhwala ovomerezeka omwe ali ndi kachilombo ka HIV. NDT imadziwikanso kuti chithokomiro cha porcine, kachilombo ka chithokomiro, chithokomiro chachilengedwe kapena ngakhale "chithokomiro cha nkhumba." Ndi mankhwala osokoneza bongo a FDA, opangidwa kuchokera ku chithokomiro chouma cha nkhumba. Mankhwalawa m'gulu lino ndi Armor Thyroid, Nature-throid, ndi WP Chithokomiro ku United States, Canada Erfa Thyroid, ndi chilengedwe chachibadwa chochitidwa chithokomiro ku United States chopangidwa ndi Acella.
Chithokomiro chodziwika bwino chakhala chikugwiritsidwa ntchito kwa zaka zopitirira zana. Akatswiri ambiri a ma hormone amakhulupirira kuti mankhwalawa, omwe amapereka T4, T3, T2, T1, ndi mahomoni ena a chithokomiro komanso zakudya zamagulu, zimakhala zofanana ndi mahomoni otchedwa thyroid kuposa mankhwala osokoneza bongo. Amanena kuti peresenti ya odwala awo amamva bwino. Odwala ena amapeza kuti akumva mankhwala abwino a chithokomiro, kapena mankhwala osokoneza bongo kuphatikizapo chithokomiro chachilengedwe.
Mawu Ochokera
T3 yaulere ndikusintha mayesero a magazi a T3, pamodzi ndi zizindikiro za matenda a hypothyroidism, angathandize kudziwa ngati muli ndi T3, kapena angapindule ndi mankhwala a T3. Madokotala ena ophatikiza amakhulupirira kuti malo otere a chithokomiro amatha kukhala ndi ma t3 aulere pakati ndi theka lapamwamba la zolemba za ma laboratory.
Kumbukirani kuti kuyezetsa T3 ndi kugwiritsidwa ntchito kwa mankhwala okhudzana ndi T4 / T3 ndi mankhwala omwe amadziwika ndi mankhwala a chithokomiro ndizovuta. Ambiri okhulupirira zachipatala ndi madokotala ochiritsira amatsutsana kwambiri ndi lingaliro la kuyesa T3 ndi kuchiza ndi mankhwala osokoneza bongo T3 ngakhale kuti akupeza zofukufuku zowonjezereka. Amanena kuti nkhaŵa zambiri za T3 zingayambitse matenda a mtima kapena zotsatira zina.
Ambiri amachilendo ochiritsira amaonanso kuti mankhwala a chithokomiro ndi abwino . Amanena kuti mankhwalawa satha, osati "osagwirizana," ndipo ambiri sangawalembere.
Ngati mukufuna kuganizira mankhwala ena a T3 kapena masewera olimbitsa thupi, mungafunikire kugwira ntchito ndi dokotala wothandizira.
Komanso, ngakhale kuti zowonjezera zowonjezera zowonjezera zowonjezera zimapezeka, ndipo ena amanena kuti ali ndi "mankhwala otsekemera a chithokomiro," ameneŵa si mankhwala a chithokomiro, ndipo saloŵa mankhwala okhudza tizilombo toyambitsa matenda.
> Zotsatira:
> Celi FS, et al. "Zotsatira zamatsenga za liothyronine mankhwala mu hypothyroidism: mayesero osadziwika, aŵiri osaona, okhwima a liothyronine versus levothyroxine." J Clin Endocrinol Metab. 2011 Nov; 96 (11: 3466-74.): 10.1210 / jc.2011-1329. Epub 2011 Aug 24.
Malangizo Othandizira Amagulu a Hypothyroidism Akuluakulu : Ogwirizanitsidwa ndi American Association of Clinical Endocrinologists ndi American Thyroid Association.
> Escobar-Morreale HF, et al. "Kuchiza kwa hypothyroidism ndi levothyroxine kapena kuphatikiza kwa levothyroxine kuphatikizapo L-triiodothyronine." Best Best Clinic Clinic Endocrinol Metab. 2015 Jan; 29 (1): 57-75. lembani: 10.1016 / j.beem.2014.10.004. Epub 2014 Oct 25. Kufotokozera.
> McAninch EA, Bianco AC. "Mbiri ndi Tsogolo la Chithandizo cha Hypothyroidism." Ann Intern Med. 2016 Jan 5; 164 (1): 50-6. pitani: 10.7326 / M15-1799. Erratum mu: Ann Intern Med. 2016 Mar 1; 164 (5): 376. PMID: 26747302
> Nygaard, B et al. "Mmene mankhwalawa amathandizira ndi thyroxine (T4) ndi 3,5,30-triiodothyronine ndi T4 monotherapy kwa odwala omwe ali ndi hypothyroidism, omwe amaphunzira mobwerezabwereza." European Journal of Endocrinology (2009) 161 895-902