I-Hypothyroidism (i-thyroid engekho ngaphantsi) yimeko enzulu yonyango echaphazela kakhulu impilo yakho. Ukongeza ngaphezu kokubangela iimpawu ezininzi ezinengxaki (kubandakanya ukunyuka kwesisindo, iinwele kunye nokuguquka kwesikhumba, ukuzithemba okanye uhudo, ukungabikho komzimba, ukukhathala, kunye neentlungu kunye neentlungu), i-hypothyroidism inokuvelisa iingxaki zempilo ezinzulu ezibandakanya intliziyo nemiphunga, isimiso sesisu, inkqubo yesifo, amehlo kunye nezihlunu.
Ukongeza, kunokubangela ukuba utshintsho oluthile olubandakanya i-hyponatremia (i-concentum ephantsi ye-sodium concentration), amazinga e-cholesterol ephakamileyo, kunye nokunyuka kwi-serum creatinine (umlinganiselo wezenzo zesifo). I-hypothyroidism ephezulu ibenokubangela ukuba utshintsho, ingqondo kunye nokufa.
Ukuba unayo i-hypothyroidism, kubalulekile kuwe kunye nogqirha wakho ukuba unyame ngokwaneleyo imeko ukuze ukhulule iimpawu zakho, kunye nokunciphisa nokukhusela iingxaki ezahlukeneyo zonyango.
Ziziphi Iinjongo Zonyango?
Iinjongo zokunyanga i-hypothyroidism zilula. Bazi:
- ukulungelelanisa ama-hormone e-thyroid (ngokukodwa, amazinga e-T4, T3 kunye ne-TSH)
- ukuqeda iimpawu ze-hypothyroidism
- ukumisa nokuguqula nayiphi na imiphumo ye-hypothyroidism ingaba neenkqubo ezahlukeneyo zesebe
- ukuba i-goiter ikhoyo (njengamanye amaxesha kwimeko yesifo sikaHashimoto , umzekelo), ukunciphisa ubukhulu bayo
Uphi unyango olufezekileyo?
Kwiphepha, unyango lwe-hypothyroidism luhle kakhulu.
Iphathwe ngokumisela i-thyroid i-hormone yokulungiselela (ngokuqhelekileyo i- levothyroxine, ithengiswa njengeSystemroid , ukulungiswa kwe-T4), yesilinganiso esaneleyo sokubuyisela izinga eliqhelekileyo le-hormone ye-thyroid, ngaphandle kokuvelisa i-hormone ephezulu kakhulu ye-thyroid.
Nangona kunjalo, ekusebenziseni unyango oluphezulu lwe-hypothyroidism kuye kwavelisa ubungakanani obufanelekileyo bokuphikisana.
Iingxabano eziphambili zimbini:
- Umele uphantsi kangakanani amazinga e-TSH ngaphambi kokuba ucinge ukuba i-hypothyroidism yonyango ngokwaneleyo?
- Ngaba ukuthatha i-T4 yodwa ngokwaneleyo, okanye kufuneka i-T3 ibhalwe kwakhona?
(Ukukunceda ukugcina i-hormone ye-thyroid iqonde, funda uhlaziyo olukhawulezayo lwe-thyroid gland, iT4, T3, kunye ne-TSH .)
Siza kujonga iimbambano zombini emva kokuba siqale sijonge kwi-"standard" yonyango ye-hypothyroidism.
'Uhlobo' lweZonyango lwe-Hypothyroidism
I-Endocrinologists (iingcali kwiingxaki ze-hormone) phantse kwihlabathi lonke licebisa ukuphatha i-hypothyroidism kunye ne-T4 yodwa. Kwabancinci, oogqirha babantu ophilileyo baya kuqalisa oko kuqikelelwe ukuba "i-dose epheleleyo yokutshintsha" ye-T4 (oko kukuthi, umthamo ofuneka ukubuyisela ngokupheleleyo umsebenzi we -roid kwizinto eziqhelekileyo). I-dose epheleleyo yokutshintshwa iqikelelwa ngokutsho komzimba, malunga ne-1.6 mcg ngekg. Kubantu abaninzi oku kuza kuba phakathi kwe-50 no-200 mcg ngosuku.
Kubantu abadala okanye abantu abane- coronary artery disease , ukuqaliswa kwe-thyroid esikhundleni sonyango ngokuqhelekileyo kwenziwa ngokuthe ngcembe; ukuqala nge-25-50 mcg imihla ngemihla, kwaye ukwandisa umyinge ngexesha.
Abantu kufuneka bathathe i-T4 kwisisu esingenalutho, ngaphandle koko ukuxothwa kwamachiza kuya kuphazamiseka.
Ngokuqhelekileyo, oogqirha batusa ukuba bathathe imithi yokuqala into yokuqala, emva kokulinda ubuncinane iyure yokutya kwasekuseni (okanye ukusela ikofi). Ukuthatha amayeza ngexesha lokulala, emva kweeyure ezimbalwa emva kokutya kokugqibela, kubonakala kusebenza, kwaye ingaba yindlela elula ngakumbi kubantu abaninzi. Funda ngakumbi malunga nexesha lokuthatha unyango lweyeza .
Amanqanaba e-TSH aya kujongwa ukuze ancedise ukwandisa umthamo we-T4. I-TSH-thyroid evuselela i-hormone-ikhiqizwa kwi-pituitary gland ekuphenduleni ama-hormone e-thyroid. Ngoko, xa ama-hormone ye-thyroid ephantsi (njengama-hypothyroidism), amazinga e-TSH ayaphendula ngokunyuka, kwizame "zokubetha" i-hormone ephezulu ye-thyroid gland.
Xa i-hypothyroidism iphathwa ngokufanelekileyo, amanqanaba e-TSH ngokuphindaphindiweyo ahlehla abuyele kwibala eliqhelekileyo. Ngoko ke, i-mainstay ekuqaliseni iqondo elifanelekileyo le-T4 kukulinganisa amanqanaba eTSH .
Nangona iimpawu ze-hypothyroidism zihlala ziqala ukusombulula kwiiveki ezimbini zokuqalisa unyango, kuthatha malunga neiveki ezintandathu kwiinqanaba ze-TSH zokuzinza. Ngoko, amanqanaba e-TSH ngokubanzi alinganiswa iiveki ezintandathu emva kokuba unyango luqaliswe. Ukuba amazinga e-TSH ahleli ngaphaya kwecandelo elijoliswe kulo, i-dose ye-T4 yanda nge-12-25 mcg ngosuku, kwaye amazinga eTSH aphindaphindiwe emva kweeveki ezintandathu. Le nkqubo iqhutyelwa kude kube yinqanaba le-TSH lifikelela kwibanga elifunayo, kwaye iimpawu ziyazisombulula. Xa i-dose ephezulu yeT4 ihlaziywe, amazinga e-TSH alinganiswa minyaka yonke okanye emva koko, ukuqinisekisa ukuba unyango luhlala lulungiswe.
Kukho iintlobo ezahlukeneyo ze-T4 ezenziwe ngabavelisi abahlukeneyo. Nangona zonke iifom ezigunyazisiweyo ze-FDA zigwetywa zifanelekile, uninzi lweengcali zincoma ukuba zibambelele ekuqulunqeni okufanayo, kwaye zingatshintshi, kuba ukulingana kwemilinganiselo kuyahlukahluka phakathi kwamalungiselelo ahlukeneyo.
Oku, ke, yindlela efanelekileyo yokuphatha i-hypothyroidism, kwaye kwakhona, kulungele ngqo. Kubonakala kusebenza kubantu abaninzi; oko kukuthi, le ndlela yokwelapha ibangela ukugqitywa kweempawu kunye nokubuyiselwa kwamazinga e-hormone eqhelekileyo kubantu abaninzi abane-hypothyroidism.
Kodwa kungekhona kuzo zonke. Yaye yilapho iingxabano zingena khona.
Ingxabano: Iyiphi i-Target efanelekileyo kwiTSH?
Njengoko sibonile, ukulinganisa amazinga e-TSH yinto ephambili ekuhloleni ukwanela kwe-thyroid yonyango.
Kodwa akusiwo wonke umntu ovuma ukuba "uluhlu oluqhelekileyo" lungakanani amazinga eTSH . Uninzi lweentlobo ze-endocrine zijonga ukuba uluhlu oluqhelekileyo luphakathi kwe-0.5-4.5 (okanye i-5.0) i-MIU / L. Nangona kunjalo, iqela elikhulu eliphikisayo (i-American Association of Endocrinologist Clinic) liye lachaza ukuba uluhlu oluqhelekileyo oluqhelekileyo lufanele linciphise libe ngu-3.0 mIU / L. Abantu abanamazinga e-TSH aphezulu kunaloo mkhawulo ongaphezulu, baye bathi, ngokwenene bangaba yi-hypothyroid.
Lo mbuzo ubalulekile ngezizathu ezininzi, kodwa (njengoko sibonile) omnye wabo kukuba, xa uphatha i-hypothyroidism, kubalulekile ukwazi ukuba izinga le-TSH ngelixa kunyango luqhelekileyo, okanye cha. Ukuba izinga lakho le-TSH liphathwe yi-4.2 mIU / L, ngokobuninzi be-endocrinologists uphathwe ngokwaneleyo; kodwa ngokwemfuno ebalulekileyo kufuneka udinga oluphezulu lwe-hormone ye-thyroid.
Ngoko, ukuphikisana okuqhubekayo kunokubakhokelela ekunyangeni kwe-hypothyroidism.
Ingxabano: Ngaba i-T4 yedwa iyanele okanye ingafanele i-T3?
I-T4 iyona nto ibalulekileyo yokujikeleza i-hormone ye-thyroid, kodwa ayikho i-hormone esebenzayo. I-T4 iguqulwa ibe yi-T3 kwiifom, njengoko kufuneka. Kwaye i-T3 yi-hormone ye-thyroid eyenza yonke imisebenzi. (I-T4 "nje" yiphormone-indawo yokugcina i-T3, indlela yokuqinisekisa ukuba i-T3 ngokwaneleyo ingadalwa ngokusisigxina ukuya kumzuzu njengoko kuyimfuneko.)
Xa sinika i-T4 kwaye kungekhona i-T3, "sithemba" izicubu zomntu nge-hypothyroidism ukuguqula inani elifanelekileyo le-T4 ukuya kwi-T3, kwindawo efanelekileyo, kwaye ngexesha elifanelekileyo. (Enyanisweni, oku kuyingcamango ephezulu ye-endocrinologists isebenzisa ukunika i-T4 yedwa-umzimba uyazi "kakuhle" nini kwaye apho ifuna khona i-T3, kwaye nje kuphela xa unikezela nge-T4 ngokwaneleyo iya kwenza umsebenzi ngokufanelekileyo. ukongeza kwi-T4, "baqala ukuqikelela" umzimba womzimba.)
Nangona kunjalo, ubungakanani obuninzi bobuchule obuye baveliswa bubonisa ukuba, ubuncinane kwabanye abantu abane-hypothyroidism, ukuba ukuguqulwa kakuhle kweT4 ukuya kwi-T3 kunqongophala. Ngamanye amagama, nangona amazinga abo angama-T4 aqhelekileyo, amazinga abo angama-T3 angaphantsi-ngokukodwa kwimizimba, apho i-T3 imenza umsebenzi wayo.
Kutheni ukuguqulwa kwe-T4 ukuya ku-T3 ukungaqhelekanga kwabanye abantu, ngeli nqanaba, ngokubanzi becinga-nangona ubuncinane iqela legulane liye lachongwa nge-varitic genetic (kwi-diodinase 2 gene) eyanciphisa ukuguqulwa kwe-T4 ukuya kwi-T3. Kwimeko nayiphi na, kubonakala ukuba oogqirha kufuneka baphathe ubuncinane abanye abantu abane-hypothyroidism kunye ne-T4 kunye ne-T3.
Ukunika ixabiso elifanelekileyo le-T3 lincinci kunokuba ulandele ngokufanelekileyo i-T4. T4 ayisebenzi; Ukuba unika kuninzi akukho mveliso yangoko, ngokukodwa kufuneka iguqulwe ibe yi-T3 phambi kokuba izicubu zichaphazelekayo). I-T3 ibali elihlukile; yi -hormone ye-thyroid esebenzayo, ngoko ke xa unika kakhulu, unokuvelisa iziphumo ze- hyperthyroid ngqo-ingozi, ngokomzekelo, kubantu abanesifo senhliziyo.
Xa ufaka i-T3 ukuya kwi-T4 ngexesha lonyango olutshintsho lwe-thyroid, uninzi lweengcali zincoma ukulawula umlinganiselo we-T4: T3 phakathi kwe-13: 1 ukuya ku-16: 1, oyingqinisiso ekhoyo kubantu abangenayo isifo se-thyroid. Le nxalenye ephezulu ye-T4: T3 ngaphezu kokuba isetyenziswe kwiinkqubo ezininzi zonyango.
Izilingo ezingaqhelekanga ngokuthelekiswa neziphumo kunye ne-T4 yedwa ukuya kwi-T4 + T3 ngokubanzi azibonanga inzuzo ebalulekileyo ekusebenziseni unyango oluhlanganyelweyo kwizigulane ezine-hypothyroidism. Nangona kunjalo, ezi zilingo azizange zenzelwe ukuba zilandelelanise ukuba kunokwenzeka ukuba iinzuzo zonyango oludibaniselwano zingagqithwa kwi-subset ethile yabantu abane-hypothyroidism. Kwaye nangona kukho ukungabikho kovavanyo oluqinileyo lwezonyango, cishe zonke iingcali zivuma ukuba kukho abantu abathile abane-hypothyroidism abafanele ukufumana i-T4 kunye ne-T3.
Ukunyanga i-Hypothyroidism: Indlela efanelekileyo
Ukubone oko esikuziyo malunga ne-hypothyroidism, amazinga e-TSH, kunye nolwalamano oluphakathi kwe-T4 ne-T3, kuba ezininzi iingcali indlela efanelekileyo yokunyango le meko ibonakala ngathi:
Qala ngeendlela "eziqhelekileyo", usebenzisa iyeza leT4 kuphela, ukuvavanya ngokucophelela amanqanaba ama-TSH kunye nenqanaba lokunceda impawu, kwaye ulungelelanise umlinganiselo we-T4 ngokufanelekileyo. Kubantu abaninzi, le ndlela iza kusebenza kakuhle.
Ukuba iimpawu ze-hypothyroidism ziyaqhubeka nangona zifikeleleke kumanqanaba e-TSH kwibala eliqhelekileyo (okungaphezulu, ngaphezu kwe-3 mIU / L kodwa ngaphantsi kwe-5.0 mIU / L), mhlawumbi okanye zombini iindlela ezimbini ezifanelekileyo kufuneka ziqwalaselwe:
1) Ukwandisa umthamo we-T4 ngokwaneleyo ukunyusa izinga le-TSH ukuya ngaphantsi kwe-3 mIU / L.
2) Yongeza i-T3 kwirejimeni yonyango, kunye nezilumkiso ezifanelekileyo.
Ngaphambi kokukhetha enye i-2, iingcali ezininzi zincoma ukulinganisa amazinga e-serum ye-T3, kunye nokubhala ukuba bahlala kufuphi nomgca ophantsi lwesalathiso sesiganeko, okanye ngaphantsi. Ukuba amazinga e-T3 aphakathi kwinqanaba eliqhelekileyo ukuya phezulu, akungathandabuzeki ukuba ukongeza i-T3 kwi-regimen yonyango kuya kuphucula izinto. ( Funda ngaphezulu malunga nokulinganisa i-hormone ye-thyroid .)
Ngoko: Ukuba uphathwa nge-hypothyroidism usebenzisa indlela "yokumgangatho" kwaye iimpawu zakho azizange zinciphise, kufuneka uxoxe nodokotela wakho ngokubhekisisa enye okanye zombini le ndlela.
ILizwi
Unyango lwe-hypothyroidism ngokwenene lukhangeleka, ubuncinane kwimfundiso. Kwaye abaninzi kubantu abanalo meko, indlela echanekileyo, "ejwayelekile" yonyango isebenza kakuhle.
Kodwa ukuba umgangatho osemgangathweni awuzange ukhulule iimpawu zakho ze-hypothyroidism, lixesha lokuqwalasela "indlela engekho emgangathweni," indlela efanelekileyo-mhlawumbi ukunyusa amazinga e-TSH ngaphantsi kwebala eliqhelekileyo, okanye ukongeza i-T3, okanye zombini.
> Imithombo:
> Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, et al. UKUVUYISWA: Ukwelashwa kwe-Hypothyroidism kunye nama-Combination of Levothyroxine Plus Liothyronine. J Clin Endocrinol Metab 2005; 90: 4946.
> Jonklaas J, Bianco AC, uBauer AJ, et al. Izikhokelo zoLonyango lwe-Hypothyroidism: Lulungiswe nguMbutho we-American Thyroid Association Task Force kwi-Hormone Replacement. Thyroid 2014; 24: 1670.
> Panicker V, uSarvanan P, Vaidya B, et al. Utshintsho oluqhelekileyo kwi-DIO2 Gene uqikelela isiseko sokuSebenza kwengqondo kunye nokuphendula kwiMidiya ye-Thyroxine Plus Triiodothyronine kwii-Hypothyroid izigulane. J Clin Endocrinol Metab 2009; 94: 1623.