Kafukufuku Amapeza Ambiri Ambiri Amamva Bwino ndi Kuonjezera T3
February 11, 1999 - Magazini ya February 11, 1999 ya New England Journal of Medicine inanena za zotsatira za kafukufuku amene anapeza kuti "mankhwala ndi thyroxine kuphatikizapo triiodothyronine amachepetsa moyo wa odwala ambiri [hypothyroid]."
Nkhaniyi imatchedwa:
"Zotsatira za Thyroxine poyerekeza ndi Thyroxine kuphatikizapo Triiodothyronine mwa Odwala ndi Hypothyroidism"
ndi Robertas Bunevicius, Gintautas Kazanavicius, Rimas Zalinkevicius, Arthur J Prange, Jr.
Kafukufuku anachitidwa ndi Institute of Endocrinology, University of Kaunas Medical, Kaunas, Lithuania pamodzi ndi Dipatimenti ya Psychiatry, School of Medicine, University of North Carolina, Chapel Hill.
Momwe phunzirolo linkachitikira
Mwachidule, iwo anatenga gulu la anthu 33 omwe anali hypothyroid, mwina chifukwa cha matenda a chithokomiro, kapena kuchotsedwa kwa chithokomiro chawo chifukwa cha khansa ya chithokomiro. Odwala onse anaphunziridwa kwa nthawi ya masabata awiri. Panthawi imodzi ya masabata asanu, wodwalayo analandira mlingo wake wa levothyroxine yekha. (Levothyroxine ndi dzina lachibadwa la mayina monga dzina la Euthyrox, Levoxyl, Levothroid ndi Synthroid.) Pa nthawi ina ya milungu isanu, wodwalayo analandira levothyroxine PLUS triiodothyronine (T3.) (Dziwani: Ku US, dzina la T3 ndi "Cytomel.") Mu gawo la T4 kuphatikizapo T3, 50 μg ya dovini ya levothyroxine mlingo inalowetsedwa ndi 12.5 μg ya triiodothyronine (T3).
Magazi osiyanasiyana, malingaliro, maganizo ndi zochitika za thupi zinachitidwa pazigawo zosiyanasiyana za kuyesedwa.
Zotsatira
Malinga ndi momwe thupi limakhudzidwira, kusiyana pakati pa kutuluka kwa magazi, kuthamanga kwa magazi, kuganiza bwino ndi ntchito zosiyanasiyana za T4 zokha, kuphatikizapo T4 kuphatikizapo T3, zinali zochepa kwambiri. Kuponderezedwa kwa magazi ndi cholesterol kwenikweni kunatsikira pang'ono pa T4 kuphatikizapo T3.
Kumene zotsatirazo zinali zodabwitsa zinali zogwira ntchito. Odwala amachita bwino pamagulu osiyanasiyana okhudza ubongo pa T4 kuphatikizapo T3. Chikhalidwe cha odwala chinasonyezanso kusintha kwa T4 kuphatikizapo T3.
Kumapeto kwa phunziroli, odwala anafunsidwa ngati akufuna kusankha mankhwala oyamba kapena achiwiri. Odwala 20 anati adakonda chithandizo cha T4 komanso T3, 11 analibe njira iliyonse, ndipo 2 okha ankakonda T4 okha. Odwala 20 amene ankakonda T4 kuphatikizapo T3 adanena kuti anali ndi mphamvu zambiri, amatha kusintha kwambiri, ndipo amangokhala bwino.
Ofufuzawo anapeza kuti "mankhwala opangidwa ndi thyroxine kuphatikizapo triiodothyronine amathandiza kwambiri odwala ambiri kuti akhale ndi moyo wabwino."
Ofufuzawo analimbikitsanso kuti pulogalamu yachithokomiro yowonongeka kwa munthu wina popanda chithokomiro, kapena yemwe chithokomiro chake chimakhala chosagwira ntchito, chingakhale "10 μg ya triiodothyronine tsiku lililonse mu mawonekedwe otulutsika mwamsanga ... pamodzi ndi thyroxine yokwanira kuonetsetsa euthyroidism. "
Zotsatira za Chithandizo Chake
Phunziroli liri ndi zotsatira zazikulu kwa anthu omwe samamva bwino pa mahomoni omwe alipo tsopano.
Ngati muli ndi mankhwala okhaokha a levothyroxine, ndizotheka kuti, monga maphunziro ambiri a maphunziro, inunso mukhonza kukhala bwino mwa kuwonjezera nthawi ya T3 mankhwala mu chiwerengero chovomerezeka cha mlingo.
Ngati muli pa zida za chithokomiro kapena Thyrolar, zomwe zilipo tsopano za T3 mwa mankhwalawa zingakhale zovuta kwambiri, poyerekeza ndi zofanana zomwe zafotokozedwa mu phunziro ili. Zotsatira zabwino zitha kupezeka mwa kusintha ndondomeko ya mankhwala kuti zigwirizane kwambiri ndi chiwerengero chovomerezeka chomwe chafotokozedwa m'nkhaniyi.
Ngati muli ndi mahomoni otere ndipo simukumverera bwino, ndikupemphani kuti mudziwitse dokotala nthawi yomweyo za kafukufukuyu, ndipo mupeze nokha bukuli.
Ngati mugawana chidziwitso chilichonse kwa dokotala, panthawi yomweyi, mungafunenso kugawira buku la British Medical Journal lomwe limasonyeza kuti ziyeso pamwamba pa TSH ya 2 mwina sizikhala "zachizolowezi," koma zikuyimira Maonekedwe osadziwika amachititsa kuti chithokomiro chichitike kale pakutha.
Mungathe kuitanitsa bukuli poitanitsa Dipatimenti ya Customer Service ya New England Journal pa 1-800-THE-NEJM
Chithunzi Chachikulu cha Odwala Chithokomiro
Izi ndizovuta kwambiri kufufuza, ndikutsimikiziranso pa malo ofufuza omwe odwala ambiri, ine nawo pamodzi, ndi madokotala ena, akhala akudzinenera kwa zaka zingapo: levothyroxine-kokha kachilombo kamene kamatulutsa kachilombo kamene sichimasiya odwala ambiri omwe amamva bwino, ndipo odwalawa amamverera bwino ndikugwira ntchito bwino pamene T3 yowonjezeredwa ku mahomoni awo.
Chochititsa chidwi n'chakuti izi zikufotokozera chifukwa chake odwala akhala akudandaula nthawi zonse pa mankhwala ena a chithokomiro monga chida cha Tirosi, Westhroid ndi Naturethroid, chomwe chiri ndi T4 ndi T3 mwachibadwa, komanso mankhwala a Thy4lar T4 / T3, omwe ndi mankhwala omwe ine tengani. Nthawi zina, odwala amawonjezera Cytomel (yokhazikika T3) kapena kutulutsa nthawi T3 kuyeza levothyroxine mankhwala komanso amakhala ndi zotsatira zabwino.
Kwa zaka, odwala auzidwa kuti zonse zomwe akufunikira ndi mankhwala a levothyroxine kuti awathandize kukhala "a TSH osiyanasiyana," ndipo chithandizo cha chithokomiro chimatengedwa kukhala chokwanira. Nthawi ndi nthawi, anthu omwe adakali ndi zizindikiro - kuphatikizapo kutopa, kupsinjika maganizo, mavuto amalingaliro, ndi zina - adamuwuza kuti kamodzi kokha ma chithokomiro awo anali achilendo, mavutowa sanali okhudzana ndi chithokomiro, , nkhawa, PMS, kapena "mumutu mwanu." Odwala omwe anali atachita bwino kwa zaka zambiri zankhondo, kenako anasintha kupita ku Synthroid, ndipo anadandaula chifukwa chosamva bwino anauzidwa kuti "akukalamba."
Taganizirani chilengezo chatsopanochi mu Bridge, tsamba lokhazikika pamtunda kuchokera ku Thyroid Foundation of America, bungwe limene likuyenera kukhala pamapeto pa nkhani za odwala ndi kulengeza:
"Mayeso a TSH ndi ofunika kwambiri, ndipo ngati TSH yanu ndi yachibadwa, ndiye kuti kutentha kwa chithokomiro si chifukwa cha zizindikirozi."
Douglas Ross, Waphungu wa Zamankhwala ku Chithokomiro Chachikulu cha America
Ndizosamvetsetseka kuti odwala asamanyalanyazidwa, amanyalanyazidwa, amanyalanyazidwa, ndipo amawasokoneza malinga ngati akhala akugwiritsidwa ntchito ndichipatala, magulu a chithokomiro ndi magulu ochipatala.
Pakalipano, madokotala omwe adayankha mankhwala a chithokomiro achilengedwe ngati Armor - kapena chiyanjano chanu Thyrolar - analembedwa monga quacks, kapena osasamala, kapena nthawi zina, ngakhale ataperekedwa ndi a levothyroxine okha zealots m'mabungwe awo azachipatala .
Tiyeni tiwone kuti nkhaniyi imapangitsa wodwalayo ndi mabungwe azachipatala, komanso dokotala, kuti ayambe kumvetsera kwambiri odwala - osati kwa makampani opanga mankhwala.
Mwachiwonekere, wakhala malo ogulitsira makampani monga Knoll Pharmaceutical, manufactuer ya Synthroid, kuti levothyroxine yekha ndizofunikira aliyense. Kutsatira kumbuyo ndikusuntha mawu alionse omwe akhala magulu a akatswiri a zachipatala omwe amapindula mokondwera ndi Knoll ndi othandizira omwe amapikisana nawo ndalama, ndalama zothandizira polojekiti, malipiro a msonkhanowo, ndi ufulu waufulu, ndipo sakufuna kuwombera bwato la levothyroxine.
Kutsogolera anthuwa anali anzake monga Richard Guttler, yemwe amadzitcha "katswiri wa chithokomiro" ndipo amaimba mlandu ndalama zokwana madola 150 kapena kuposa - "akufunikira pasadakhale" - chifukwa cha utumiki wake wa "Second Opinion". Chaka chatha, adakalipira odwala omwe adandaula za zizindikiro zosayesedwa ndi chilakolako choyesera mankhwala awa omwe tsopano akupezeka kuti agwire ntchito bwino. Chaka chatha, wowerenga webusaiti anamulembera kuti amudziwe kuti kusakhala kwa Synthroid patadutsa masiku atatu kapena anayi okha kunamuthandiza kuti akhale ndi chifuwa chokhazikika chomwe anali nacho kwa zaka makumi awiri (kapena kuposa). Iye anamuuza iye kuti wasintha kukhala Zida. Iye analembera kwa iye kuti: "kupeza moyo! Synthroid siyi yomwe imayambitsa mavuto anu." Chaka chatha, Guttler anandichititsa ndi "njira yogona" (kusowa ndalama zoyenera komanso zizindikiro zake):
"Ndine wokondwa" zonsezi "zikudzaza imelo yanu, osati yanga. Zimandipangitsa kuti moyo wanga ukhale wosavuta ndi odwala okhawo omwe sangaganize zogwiritsa ntchito zida kapena combo thyrolar kapena cytomel. Kodi mungatani kuti atenge kachilombo kakoti pamsika? Kenaka padzakhala kansalu yakutchire yomwe imasakanizidwa pa webusaiti yanu ... dr.g "
Akulingalira kuti odwala onse akuthamanga mofulumira monga momwe angathere ndi dinosaurs ngati "dr g" adzakhala akuyandikira kuchuluka kwa "mphonje" - madokotala odziwa bwino, omwe ali ndi luso omwe amvetsera odwala, akudziganizira okha, atapitirirabe ngakhale kuti anzawo kupanikizika ndi kampani yogulitsira malonda, nthawi zonse pochita zomwe akudziwa kuti mankhwala a T3 amagwira ntchito bwino kwa ambiri a ife.
Ndipo madokotala omwewo kwa nthawi yaitali atatsutsidwa ku "mphepo" tsopano akutsimikiziridwa molondola ndi chimodzi mwa zofunikira kwambiri za mankhwala ochiritsira, New England Journal of Medicine