Kwiminyaka engaphezu kwengu-40, indlela eqhelekileyo yokunyanga i-hypothyroidism yenzelwe ukubonelela nge-thyroid i-hormone ye-drug levothyroxine (oko kukuthi, i-Synthroid, i-Levoxyl); ngenjongo yokuqinisekisa ukuba izinga le-TSH lingena kwibala lesalathisi. Oku kuye kwaqwalaselwa ngonyango olupheleleyo kwimeko.
Inyiyo emva kwendlela yokwelapha eqhelekileyo kukuba ukwelashwa nge-levothyroxine-ifom ye-thyroxine (T4) i-hormone eyenziwa yi-thyroid-gland-iya kunika i-T4 eyaneleyo, ubuyisele enye into eqhelekileyo ye-thyroid ebizwa ngokuba yi-euthyroidism-kwaye isombulula yonke i-thyroid- iimpawu ezinxulumene nazo.
Iingcali ezininzi ezikhokelayo, kuquka i- endocrinologist ebonakalayo uDkt. Anthony Weetman , sele zathi izigulane "ezineemvavanyo eziqhelekileyo zemisebenzi ye-thyroid" kodwa zifuna ukuba ziphathwe ngeempawu ezininzi ze-thyroid okanye eziqhubekayo iimpawu zineengxaki ze-somatoform. (Iziphazamiso zeSomatoform zichazwa kwiichazamazwi zonyango njenge "iingxaki zengqondo eziphawulwe zizikhalazo ezingokwenyama, apho kungekho ncazelo engokwemvelo okanye yezinto eziphilayo kunye nokuba kukho ubungqina obunzima bokuthi izinto zengqondo zichaphazelekayo.")
I-thyroid yegciwane eqhelekileyo ivelisa ama hormone amaninzi, kuquka i-hormone yokugcina i-thyroxine (T4) ne-hormone esebenzayo i-triiodothyronine (T3). Uninzi lwama-hormone olwenziwe yi-gland yi-T4, kodwa i-T4 kufuneka iguqulwe emzimbeni kwi-hormone esebenzayo ye-T3 ukuze ibe nempembelelo emzimbeni wakho. Imfundiso eqinileyo neyomeleleyo kukuba i-hypothyroidism kufuneka iphathwe kuphela nge-levothyroxine-ngamanye amaxesha ibizwa ngokuba yi-LT4 monotherapy okanye i-levothyroxine monotherapy-kwiiyiphumo ezenza ukuba ube yi-euthyroid, kunye namazinga akho e-TSH awela kwibala lesibheno.
Le mfundiso ibanga xa kukho i-T4 eyaneleyo, umzimba uya kuhlala usenza i-T3 ngokwaneleyo.
Nangona kukho inkolelo yale nkolo kwiyeza eliqhelekileyo, kwiminyaka emininzi ezinye izigulane ze-thyroid ziye zandisa ngokunyaniseka kwe-levothyroxine ekunciphiseni iimpawu zabo. Abaphandi baqikelela ukuba i-15% yezigulane ziyaqhubeka zifumana iimpawu ezixakekayo ze-hypothyroidism nangona unyango lwe-levothyroxine.
Uphando lwezigulane ze-thyroid lubonisa ukuba inani liphezulu kakhulu .
Iziphumo zophando
Ukuphonononga ukuba ukubuyisela izinga leTSH kwibala lokubhekisa i-levothyroxine liphumelele, abaphandi kwi-Rush University Medical Centre e Chicago benza isifundo ngokuthelekisa iqela elilawulayo labantu abaphilileyo, kungekho bungqina besifo se-thyroid, ngokuchasene neqela labantu babephathwa nge-levothyroxine ye-hypothyroidism. Iziphumo zabikwa ngo-Oktobha 2016 umxholo we- Journal of Clinical Endocrinology kunye neMetabolism .
Iziphumo zazimangalisa. Uphando lufumene ukuba:
- Iqela le-levothyroxine elaphathwa nge-levothyroxine linamazinga angama-20 aphezulu ama-TSH, ama-10 ekhulwini aphantsi kwamazinga eT3, kunye nama-15% aphantsi amanqanaba ama-T3 xa kuthelekiswa neqela lolawulo.
- Iqela le-levothyroxine elaphathwa ngayo linomlinganiselo ophezulu ophezulu womzimba, nangona bavakalisa ukuba badla iikhalori ezimbalwa ngosuku. Baye balinganisa iipounds ezili-10 ngaphezulu, nangona besondeza iikhalori ezimbalwa ngosuku.
- Iqela le-levothyroxine elaphathwa ngayo laliphindwe izikhathi ezili-1.6 ukuba kuthathe i-beta-blockers, esetyenziswa rhoqo ukunyanga uxinzelelo lwegazi oluphezulu.
- Iqela le-levothyroxine elaphathwa ngayo laliphindaphindiwe ngama-1.5 kangangoko ukuthatha izidakamizwa ze-statin, ezisetyenziselwa ukuphatha i-cholesterol ephakamileyo.
- Iqela le-levothyroxine elaphapathiweyo lalingama-1.46 amaxesha amaninzi okuthatha izidandlululo.
- Iqela le-levothyroxine ephathwe kakubi libi kakhulu ekusebenzeni ngokomzimba kunokuba iqela lokulawula.
- Iqela le-levothyroxine elaphazelekayo lizenzele iintsuku ezongezelelweyo kwinyanga edlulileyo apho beziva ukuba impilo yabo yengqondo neyengqondo "ayilungile."
Iingcamango
Abaphandi bathi baneengcamango ezimbini zokuthi kutheni-nangona be-euthyroid ngamanqanaba e-TSH kwinqanaba lokubhekisa-i-levothyroxine ephathwe ngayo yayingenasempilweni njengoko ilinganiselwe ngamanani eeramitha, kwaye kutheni i-levothyroxine ngokwayo ivakalise ukuba Ndivakalelwa ngokugqithiseleyo kuninzi iqela lokulawula.
- Enye imfundiso kukuba nangona iqondo eliqhelekileyo le-TSH, amanqanaba e-T3-i-hormone esebenzayo-kungenzeka ukuba ingagqityi ngokugcwele, kuba i-T4 ayiguquli ngokwaneleyo ibe yi-T3.
- Iingqungquthela zesibini zibonisa ukuba amanqanaba e-T3 efikelela kwiiseli angenakubonakaliswa ngamanqanaba okuhlolwa kwegazi le-TSH okanye i-T4, ngenxa yezenzo ze-deiodinase, ezenza indima kwinkqubo yokuguqulwa kwe-T4-to-T3.
Abaphengululi baphetha le ngxelo kwinqaku elilandelayo:
Ingcamango yokuba kusetyenziswe i-serum eqhelekileyo i-TSH ivula abantu (i-levothyroxine) i-monotherapy ye-clinic euthyroid kufuneka iphinde iphinde ibuyiselwe kwaye imilinganiselo yobomi imele ibe yinto ephambili kakhulu ekuphenyweni kwe-hypothyroidism kunye nezikhokelo zengcali.
Ingqiqo eyongezelelweyo evela kumbhali wePhroducti u-Antonio Bianco, MD
Omnye wabalobi bokufunda, u-Antonio Bianco, MD, umongameli osesikhathini esidlulileyo we-American Thyroid Association, kunye noprofesa kwiYunivesithi yaseRush, wanika udliwano-ndlebe kwi-MedicalResearch.com. Ngaloo dliwano-ndlebe, wachaza ngokuqhubekayo uphando:
Ubungakanani bombuso uphando lubonisa ukuba ukulinganisa amazinga e-TSH kwizigulane ze-hypothyroid kungenzeka ukuba akunakuncedo njengoko bekucingwe ukuba kuhlolwe unyango. Ngaphandle kwezinga eliqhelekileyo le-TSH, izigulane zisesichengeni esisemngciphekweni sokudandatheka kunye nokuxakeka komzimba okubonakaliswa ngokunyuka komzimba kunye namazinga aphezulu e-cholesterol ... Sitsho ukuba ngokwemigangatho yegazi ye-TSH zonke iimpawu ezinxulumene ne-hypothyroidism kufuneka zihambe . Oku kufuneka ukuba utshintshe.
Kwisikhululo sokupapashwa malunga nokufunda, esikhutshwe yi-Rush University Medical Centre apho uphando lwenziwa khona, uDkt. Bianco wathi kwakhona:
Ngoxa iinjongo zokwelapha kukuba izigulane zibe ngcono, iimpawu zodwa azizisetyenziswanga ukugweba ukwanela unyango. Amanqanaba e-Blood TSH. Ngamanye amazwi, umthamo we levothyroxine uhlengahlengiswa ngokusekelwe kumanqanaba e-TSH kwaye kungekhona ukuba isigulane sivakalelwa kangcono ... Into ebalulekileyo ukuyiqonda ukuba i-T4 ayikho i-hormone esebenzayo. I-T4 kufuneka iguqulwe ibe yi-T3 ngemizimba yethu nge-enzyme ebizwa ngokuthi deiodinase.
Izigulana zikhalaza ngokuxinezeleka, ukucotha kunye nengqondo engqondweni. Kunzima ukulahlekelwa ubunzima. Bakhalaza ngokuziva becebile kwaye banamandla angaphantsi. Nangona kunjalo thina oogqirha sibaxelela ukuba, "Ndikunika inani elifanelekileyo lamachiza kwaye i-TSH yakho iyinto eqhelekileyo.
Ezi ziphumo zihambelana noko izigulane zisitshele zona. La maxwebhu okufunda okokuqala, ngendlela engabonakaliyo, ukuba izigulane kwi-levothyroxine ziziva zibi kakhulu kwaye zingasebenzi kakhulu kunokuba zilawulwe, zibonisa iinjongo ze-cardiometabolic ezingaqhelekanga nangona zinamazinga eziqhelekileyo ze-TSH.
UDkt. Bianco ungomnye weenkokheli ekuhambiseni uphando ukuba iimpembelelo zomzimba kwezinye izigulane zingaphazamisa umsebenzi we-deiodinase kwaye zichithe ukuguqulwa kwe-T4-to-T3, nokuba ngaba ukongezwa kweT3 kwi-levothyroxine monotherapy kunokubangela ukulungiswa okungcono iimpawu, umgangatho wesigulane wobomi, kunye nemilinganiselo yempilo ephuculweyo kwabanye abantu baphathwa nge-hypothyroidism.
UDkt. Bianco utshilo esidlangalaleni ukuba ukholelwa ukuba kufuneka unyango olungcono kunyango lwe-hypothyroidism. Okwangoku, ucebisa ukuba oogqirha basuke kwimveli, "kulula ukuyiphatha, thabatha le pilisi kwaye uya kulungela" indlela yokunyanga, kwaye endaweni yoko, uthathe indlela eyahlukileyo xa ucebisa izigulane malunga nokuphathwa kwe-hypothyroidism. Ngokutsho kukaDkt. Bianco:
Oogqirha kufuneka baxelele izigulane zabo, "Ndiya kulungelelanisa i-TSH yakho, kodwa uya kuba mngcipheko wokufumana ubunzima, uhlangabezana noxinzelelo kunye nokukhathala. Kwenzeka kwakhona ukuba i-cholesterol yakho iya kunyuka." Yiloo nto esifanele sibaxelele izigulane, ngokusekelwe kwisifundo sethu.
Luluphi Uphando olubhekiselele kuwe
Kwiminyaka emibini, izigulane zegulane kunye nezinye iingcali zithi i-levothyroxine monotherapy ayifanele ibe yodwa. Nangona isebenza kwabanye abantu abane-hypothyroidism, i-subset ebalulekileyo yezigulane azihlali kakuhle, nangona ziphathwa nge-levothyroxine, kwaye zithathwa njenge-euthyroid ngezinga "eziqhelekileyo" ze-TSH, ngokwemivavanyo yegazi.
Ukuzibophezela kukaDkt. Bianco ukuphanda nokuphuhlisa ubungqina ngokumalunga nokufunwa kwe-T4 / T3 yonyango oluxhomekeke kwi-subset yezigulane ze-hypothyroid zithembisa kwaye ziphawulekayo. Kwaye, njengoko uDkt. Bianco uthe, kufuneka unyango olungcono lwe-hypothyroidism.
Okwangoku, nangona kunjalo, kukho ukhetho kwizigulane ukuba uDkt. Bianco akasabonakali esidlangalaleni. Unako ukufumana i-Free T3 yakho ihlolwe, kwaye ukuba iphantsi okanye ayikho i-optimal, ungasebenzisana nodokotela oza kudibanisa izidakamizwa ze-T3 - njenge-Cytomel (i-liothyronine), okanye i-compound, i-prescription, i-T3 -kunyango lwakho, okanye ngubani oya kuthi afune ukusetyenziswa kweziyobisi zendalo ezifana ne-Nature-throid okanye i-Armor Thyroid.
> Imithombo:
> Udliwano-ndlebe no-Antonio Bianco, MD. MedicalResearch.com. Oktobha, 14, 2016.
> I-Rush University Medical Centre. Ukukhutshwa kweeNkcukacha: Iimpawu ze-Hypothyroidism zihlala zide nangona kusetyenziswa unyango, iimvavanyo zegazi eziqhelekileyo. Oktobha 12, 2016. iNzululwazi yemihla ngemihla.
> USarah Peterson, uElizabeth A. McAninch, uAlexander C. Bianco. Ngaba i-TSH eqhelekileyo enegama elithi "Euthyroidism" kwi-Levothyroxine Monotherapy? Umbhalo we-Clinical Endocrinology & Metabolism, 2016; jc.2016-2660