UDkt. Theodore C. Friedman, MD, Ph.D. nguNjingalwazi woMnxeba wezeMpilo-i-UCLA, iCandelo le-Endocrinology, kunye ne-endocrinologist yangasese. Ukufumana ulwazi olungakumbi malunga nokusebenza kwakhe, khangela www.goodhormonehealth.com.
Kule nqaku, uxoxa ngeengxaki ze-hypothyroidism kunye nokunyangwa.
I-Hypothyroidism Diagnosis
I-Hypothyroidism yimiba eqhelekileyo.
Ichaphazela abanye abafazi njengamadoda, kodwa ndiyenzeka ukuba ngenye yamadoda ayenayo. Iimpawu ze-hypothyroidism zibandakanya ukukhathala, ukunyuka kokunciphisa umzimba, ukunyangwa, ukunyamezela, ukuxhala, ukunyamezela, ukunyameka, ukunyuka kweenwele , owomileyo, isikhumba esibandayo kunye nexesha elithathayo. Izigulane ezininzi ziya kuba ne-goiter (i-thyroid ekhulisiweyo). Nangona ifumene ingxoxo enkulu, ndiyakholelwa ukuba ukushisa komzimba ophantsi akuyona into engathembekiyo ye-hypothyroidism.
Isiganeko se-hypothyroidism sanda ngokukhula. Ngamanye amagama, omdala esiwafumanayo, ukulahleka kwe-thyroid kuya kubonakala. Isizathu esona siqhelekileyo se-hypothyroidism eyinhloko ( hypothyroidism ephuma kwi-thyroid gland ngokwayo), nguHashimoto's Thyroiditis. I-Hashimoto yimeko ehamba ngokuzenzekelayo . Iimpawu zomzimba zomzimba zihlasela i-thyroid gland kwaye ziyichithe, zikhokelela kwi-hypothyroidism. I-Hashimoto's Thyroiditis ingaba yimbonakalo ye-syndromes ezininzi ze-autoimmune kwaye ingenzeka kwiintsapho.
I-Hypothyroidism inokubangelwa neengxaki zokubamba (i-hypothyroidism ephakathi).
Ukufumanisa zonke iintlobo ze-hypothyroidism kubalulekile, kuba unyango nge-hormone ye-thyroid luya kuphucula iimpawu kwizigulane ezine-hypothyroidism, kodwa akunakwenzeka ukuba kuncede abo bangenayo i-hypothyroidism. Kwi-hypothyroidism ephambili, i-thyroid gland, esentanyeni, ayikwazi ukuvelisa i-hormone ye-thyroid , i-T4 ne-T3.
I-pituitary gland, ephakathi kwentloko, iphendula ngokusilela ngokufihla i-TSH ngaphezulu. Ngaloo ndlela, kwiimeko ezincinci kakhulu ze-hypothyroidism eziphambili, ama-T4 kunye nama-T3 amanqanaba aqhelekileyo, kodwa i-TSH iphakamileyo. Kwiimeko ezinzima kakhulu, amazinga e-T4 kunye ne-T3 ahla. Nangona udidi oluqhelekileyo lwe- TSH luhlala luphakathi kwe-0.5 kunye ne-5 mU / mL, ixabiso kwiqondo eliqhelekileyo loluhlu oluqhelekileyo lungaqhelekanga. I-T3 i-hormone engaphezulu ye-bioactive i-T4, kodwa i-T4 iyomelele ngakumbi kwi-circulation.
Indlela yam yokufumanisa i- hypothyroidism kukuqala ngembali ngokucophelela kunye nomzimba. Emva koko u-Endocrinologist kufuneka enze i-test-on-examination ye-thyroid ukuqinisekisa ukuba isigulane sinalo. I-Blood TSH, i-T4 yamahhala, i-T3 yamahhala kunye ne-anti-TPO antibodies kufuneka ihlolwe. Izigulane ezine-thyroid ezandisiweyo kunye / okanye i-positive anti-TPO yovavanyo lwe-antibody kunye ne-TSH enkulu kune-4.0 mU / mL kufuneka ithathelwe ingqalelo ukuba ine-hypothyroidism eyona nto. Izigulane ezingenayo i-thyroid eyandisiweyo kwaye ngaphandle kokuhlolwa kwe-anti-TPO yokuphikisa ulwaphulo-mzimba kodwa i-TSH ephezulu kune-7.5 mU / mL nayo kufuneka ithathelwe ingqalelo ukuba ine-primary hypothyroidism. Izigulane ezine-T4 yamahhala ezingaphantsi kwe-0.9 mg / dL kunye ne-TSH ngaphantsi kwe-1.0 mU / mL zinokuba ne-hypothyroidism ephakathi. Izigulane ezineempawu ze-hypothyroidism kodwa ezingayithobeli le miqathango kufuneka zibukwe kwaye ziphinde zenziwe emva kweenyanga ezintandathu.
Hypothyroidism Treatment
Emva kokuba i-hypothyroidism ifunyenwe, kukho iindlela ezininzi zokonyango , kubandakanywa amalungiselelo e-L-thyroxine (T4) amanyathelo (Synthroid, Levoxyl kunye ne-Unithroid), amalungiselelo e-L-triiodothyronine (T3) amalungiselelo (i-Cytomel), ukuhlanganiswa kwe-T4 / T3 (Thyrolar) kunye ne-dessro amalungiselelo e-thyroid (i-Armor, Naturethroid, i-Bio-Throid, ne-Westhroid). Zonke izilungiselelo ze-L-thyroxine ziqulethe isithako esifanayo, kodwa ziqulethe iifom ehlukeneyo kwaye zineendlela ezihlukeneyo zokulawula umgangatho. Kuze kube kutshanje, i-Synthroid yayingenayo imvume ye-FDA, kodwa ngoku yonke i-L-thyroxine ilungiselelo i-FDA imvume.
I-Thyrolar kunye namalungiselelo e-thyroid okonkcisiweyo mhlawumbi anomlinganiselo ophezulu weT3 / T4 kunokuba uyinqwenela kwaye ngoko, ndisoloko ndinika inani elincinci lala macebo ancediswa yi-T4.
Uninzi lwe-endocrinologists lisebenzisa i-L-thyroxine amalungiselelo ophulo lokuqala lwezo zonke i-hypothyroidism. Nangona ukusetyenziswa kwe-L-thyroxine (T4) kuthelekiswa no-L-triiodothyronine (T3) kunokumangalisa ukuba i-T3 iyona-hormone ye-thyroid ye-bioactive, iT4 isetyenziswa rhoqo. Oku kungenxa yokuba izicubu ziguqulela i-T4 ukuya kwi-T3 ukugcina amanqanaba e-physiologic ye-T3. Ngaloo ndlela, ukuphathwa kwe-T4 kuphumela kwi-T3 ne-T4. Njengoko i-T4 igxininise ngakumbi kuneT3, iT4 unyango linika namanqanaba egazi, ngelixa i-T3 unyango lukhokelela kumazinga aphezulu emva kokuthatha iyeza kunye namanqanaba aphantsi ngaphambi kweso esilandelayo. Isixhobo se-thyroid sisona silungiselelo esincinci. Ngenxa yokuba i-thyroid ye-Army ifika ifomu yengulube yee-pig, ezinye i-Endocrinologists zivakalelwa kukuba kukho ipilisi ephezulu kwipilisi yokuhluka, kodwa oku akunakwenzeka ukuba yinyani.
Uphando olupapashwe kwi- New England Journal of Medicine ngo-1999 lucebise ukuba ubuchopho be-T4 ukuya ku-T3 ukuguquka lunokuthi lukhuphe kwezinye izigulane kwaye iqela elikhethiweyo lezigulane kufuneka liphathwe kunye ne- T4 kunye ne-T3 . Ezinye iipapasho ezipapashwe kwiNcwadi ye-Clinical Endocrinology kunye neMetabolism ngo-2003 ( jonga umhlathi ngoku ) iphakamisa ukuba ukongezwa kweT3 ukuya kwi-T4 unyango akudingeki kwiigulane ezininzi ezine-primary hypothyroidism. Ndiyincoma ukuba izigulane ezininzi ziqaliswe kulungiso lwe-T4, oluphucula iimpawu kwiininzi zezigulane. Ndifumene ukuba ezininzi izigulane zikhetha i- Levoxyl okanye i-Unithroid kwi-Synthroid , kodwa oku kuhlukahluka nesigulane ngasinye. Emva kokuqala unyango kunye ne-T4, ndiyilungisa i-dose ye-T4 de ibe i-TSH yabo iphakathi kwe-0.5 ne-2 mU / mL. Ukuba bahlala besigxina nangona i-TSH ehambelanisiweyo, koko i -T3 ephantsi i -T3 inikwe amabini okanye kathathu ngosuku ingafakwa ngokuqaphelekayo kwi-T4. Ukuba izigulisi ziqala ngezinga eliphantsi legazi le-T3, ke ndizimisele kakhulu ukuwaphatha nge-T4 kunye ne-T3. Kwi-T4 kunye ne- T3 yonyango , ndisebenzisa iimvavanyo zegazi ukuqinisekisa ukuba i-T4 yamahhala kunye ne-T3 yamahhala zikwinqanaba eliqhelekileyo. Ixabiso le-TSH lisoloko linyanzeliswa ngonyango oludibeneyo .
Ipesenteji yezigulane ziza kuphuculiswa ngokuphawulekayo kwi-T4 kunye neyeza iT3. Kwalawo angaphuculwayo, ngamanye amaxesha ndincoma unyango ngamalungiselelo e-thyroid okonkcenkceshe, ngokuqhelekileyo Izixhobo, kunye nokudibanisa i-T4. Olu dibano luyadingeka njengoko amalungiselelo e-thyroid acacisiwe anesilinganiselo esiphezulu se-T3 / T4 kunokuba sifanele kwaye sifanele songezelelwe nge-T4 yokwenziwa ukufezekisa izigaba eziqhelekileyo zama-hormone. Kwakhona, ndijolise i-T4 yamahhala kwaye ndikhulula i-T3 kwinqanaba eliqhelekileyo. Izigulane ezine-central hypothyroidism zingaphathwa ngayo naziphi na izilungiselelo ezikhoyo kwizigulana ezine-hypothyroidism eziphambili. Umahluko kukuba unyango kufuneka lubekwe iliso ngokujolise kwi-T4 yamahhala kunye ne-T3 ekhululekile kwibala eliqhelekileyo, njengoko i-TSH igxothwa ngonyango olufanelekileyo. Izigulane ezinezibini eziphambili kunye neziphambili ze-hypothyroidism nazo zafuneka ziphathwe ngokujolisa kwi-T4 yamahhala kunye ne-T3 ekhululekile kwibala eliqhelekileyo. Ndafunyaniswa ukuba ndine-primary hypothyroidism ngoFebruwari 2003. I-endocrinologist yenza uvavanyo lwe-thyroid gland kwaye ndafunyanwa ukuba ne-goiter. Amanani egazi lam libonisa i-TSH ye-8 mU / mL kunye ne-anti-TPO ezinamandla. Ndineenkcukacha ezinobungqina bentsapho kaHashimotos Thyroiditis kodwa ndenenhlanhla ukuba ndibe nempumelelo phambi kokunyanga. Ngoku ndi-150 mg ngosuku lweLevoxyl, ube ne-TSH ye-1.9 mU / mL kwaye uzive ukhulu. Ndilahlekelwe iipounds ezimbalwa kwi-T4 unyango kwaye iphrofayli yam ye-cholesterol iphucule.
Ekuqaleni yashicilelwa kwi-intanethi, ngo-2003