Ukujonga kwi-Natural Thyroid, i-Levothyroxine, kunye neNew New Treatment Options
Umphandi owaziwayo uDkt. Wilmar Wiersinga, kwiphepha likaJanuwari 2014 lwephepha lezonyango Uhlolo lweMvelo I-Endocrinology , lunomxholo okhangeleleneyo lwezinye iiprodigm zokutshintshela kwi-thyroid ye-hormone yonyango yokubuyisela i- hypothyroidism kwiminyaka yamuva. Ndiyishwankathele ezinye zezinto ezinomdla kakhulu kwinqaku.
Iimpawu ezine zeParadigm
UDkt. Wiersinga ubonakalisa iinguqu ezine ezineparafayili.
- Ukuqala kweParadigm Shift: I- Hypothyroidism yayingenakugula kwaze kwaba ngowe-1891 eLondon, uDkt. George Murray wabuya wathintela kakhulu i-hypothyroidism kwisigulane ngokunika umjovo wezimvu ze-thyroid. Emva koko, umhlaba okanye i-sheep edibeneyo ye-thyroid okanye iipilisi zamathambo e-thyroid ezomileyo zaqala ukusetyenziswa njengonyango lokuqala lwe-hypothyroidism.
- I-Second Paradigm Shift: Ukususela ngo-1960 ukuya ku-1988, ukusetyenziswa kwezilwanyana ze-thyroid ezichongiweyo zancipha ngokukhawuleza, njengoko ukusetyenziswa kwe-levothyroxine kwanda. Ngowe-1978, inani leemfuno ze-levothyroxine zagqithisa imiqathango yemvelo echongiweyo. Ngo-1988, i-84% yezigulane zithatha i-levothyroxine.
- I-Third Paradigm Shift: UDkt. Wiersinga uchaza indlela iimvavanyo zezilwanyana ezivela kwiminyaka yama-1990 zibonise ukuba i-euthyroidism - ukufezekisa iimeko eziqhelekileyo ze-T4 kunye ne- T3 kumzimba womzimba - emva kokukhishwa kwe-thyroid gland ayikwazanga ukufunyanwa kwi-levothyroxine kuphela, kodwa ifuna i- liothyronine (T3) . Izigulane kunye nabagqirha baye babika izigulane zenza ngcono ngokudibanisa i- T3, okanye kwi-thyroid ecetywayo , kodwa ezininzi izilingo kunye nophando oluqhutyelwe ngeli xesha alifumananga ngokugqibeleleyo ukuba ezo zonyango zihlangene. UDkt. Wiersinga ucacisa ukuba kukho izidalwa ezenza izifo ezenza izigulane ziphendule ngakumbi kwiinkqubo zonyango - kunye nokuba "ukuba ezinye izifundo ziyakwazi ukuchonga le nkqutyana ethile yezigulane ze-hypothyroid, ukutshintsha kweparafini yesithathu kwonyango ye-hypothyroidism kunokwenzeka-mhlawumbi ukuphilisa ukusetyenziswa kweyeza elenziwe ngabanye kule ndlela. "
- I-Fourth Paradigm Shift : Uphando olwenziwa ngo-2012 oluchazwe ngokokuqala ngqa ukuba ukusebenza kweetysiyiti ezinokwenziwa kwe-thyroid kungenziwa kumaseli e-embryonic stem. UDkt. Wiersinga ucacisa ukuba "lo msebenzi ungadlulisela ekutshintsheni kwekota yesine, apho izigulane ze-hypothyroid zingaphathwa ngama-cell stem cells".
Levothyroxine kuphela unyango
Ekuxubusheni ukutshintshwa kweparadigm, uDkt. Wiersinga wabheka ngokugqithiseleyo ukusetyenziswa kwe- levothyroxine (T4) kuphela unyango . Wachaza ukuba kukho iiphando ezininzi ezibonisa ukuba unyango lwe-levothyroxine ludibaniswa nenani lezinto ezimbi ngenxa yezigulane, eziquka:
- ukwanda kwengqondo kwengqondo
- zizinzileyo
- ukunciphisa umgangatho wobomi obunxulumene nempilo
- ukuphazamiseka kwisantya se-psychomotor speed, ukunakekelwa, ukufunda nokukhumbula
- ukwandiswa kwexhala
- umsebenzi weengqondo osweleyo, imemori yokusebenza kunye nokufunda imoto
Ngokukodwa, ngokutsho kukaDkt. Wiersinga, "Ukukhubazeka kwengqondo, ukuxinezeleka okanye ukuxhalaba kubonakala kwi-5-10% yezigulane ze-hypothyroid ezitholayo i-levothyroxine, naphezu kwezinga eliqhelekileyo le-TSH ."
UDkt. Wiersinga uphinde uchaze ngoluvo olutshandayo lweScotland olufumene ukuba ingozi yeengxaki zentliziyo, i-arrhythmias, kunye neengxaki zethambo zonyuka kwizigulane ezinezinga elikhutshweyo le- TSH (ngaphantsi kwe -03), nakwizigulane ezinezinga eliphezulu kwi-TSH (ngasentla 4.0) kodwa kwakungekho mngcipheko ophezulu ohambelana namazinga "asezantsi" eTSH (.04 ukuya .4).
UDkt. Wiersinga unikeze uphando olubonisa ukuba "amazinga aqhelekileyo e-TSH ngenxa yoko akaqinisekisi i-euthyroidism kuzo zonke iifom ezijoliswe kwi-hormone ye-thyroid." Yilula nje: unyango lwe-levothyroxine kuphela lunokuba luyonyango olufanelekileyo lwezilwanyana ezine-hypothyroidism. Endaweni yoko, ukongezwa kwe-t3 kunokuncedisa ukwenza umsebenzi we-thyroid kuzo zonke izicubu.
Levothyroxine Plus Liothyroinine (T4 + T3)
Uninzi lwezifundo ezijongene ne-levothyroxine-kuphela yonyango, ngokubhekiselele kwongezwa kwe-T3 zibonise ukuba, ngokutsho kukaDkt. Wiersinga, "inqanaba eliphezulu kakhulu lezigulane (ngokwemitha engama-48%) likhetha ukonyango oluxubeneyo ... Ukungafani kwi-serum yokugqibela Amanqanaba e-TSH akakwazanga ukuchaza oku khethwe ngumguli. "
Izigqibo
UDkt. Wiersinga ugqiba ukuba "ingxoxo ekholisayo ingenziwa ukuba unyango oludibeneyo lunokuba luncedo ukuba i-levothyroxine: i-liothyronine dose ratios isetshenziselwa ukuphumela kwizinga eliqhelekileyo le-TSH ye-TSH kunye ne-T4 yamahhala. Imiba yemfuza echaphazela ukukwazi ukuguqula i-T4 ukuya kwi-T3.
Ukwacebisa ukuba i- endocrinologists kufuneka ijonge iindlela zokukhetha, kubandakanywa ukongezwa kwe-T3, ukunceda izigulane ze-hypothyroid ezinempawu eziqhubekayo nangona zifunyenwe i-levothyroxine.
Ngokutsho kukaDkt Wiersinga, enye inketho kukulandela izikhokelo ze-European Thyroid Association (ETA) ezibizwa ngokuthi "ukulinga" kweT4 + T3 unyango , olubandakanya umlinganiselo we-levothyroxine ukuya kwi-liothyronine malunga ne-17: 1 Ngokutsho kwinqaku, "umzekelo, i-TSH-normalizing levothyroxine i-100 μg, i-150 μg kunye ne-200 μg ngexesha le-monotherapy liguqulelwe kwi-combination ye -rapy ye-85 μg levothyroxine kunye ne-5 μg i-liothyronine, i-125 μg levothyroxine kunye ne-7.5 μg i-liothyronine kunye ne-175 μg levothyroxine kunye ne-10 μg i-liothyronine, ngokulandelanayo).
Bakhuthaza ukuba bahlule i-dose yemihla ngemihla e-T3 emibini (umthamo omncinci owenziwe kusasa kunye nenani elikhulu elinikezwe ngexesha lokulala, ukulingana ngokuthe ngqo ngokubhekiselele kukuphi ukulungiselela amaconronine asekuhlaleni kusetyenziswe) "ukunceda ukulinganisa isigqirha se-circadian amazinga e-T3 akhululekileyo, afikelele ekuphakameni kwawo ngo-3 "
I-ETA iphinda icebise ukulungiswa kwe-T3 ngokukhawuleza.
Amanye amaphulo anomdla
Nazi ezinye ezimbalwa iingongoma zomdla ezivela kwinqaku.
Izikhokelo zonyango ze-hypothyroidism ezipapashwe kuma-1980s nakwama-1990 "ngokungaqinisekanga" zincoma i-levothyroxine (i-synthetic T4) kwaye ingakhankanyi naluphi na olunye unyango lwezonyango. Inomdla, zonke izikhokelo zonyango lwe-hypothyroidism ezipapashwe kuma-2000s ziyakhuthaza i-levothyroxine njengonyango oluqhelekileyo, kodwa ziqulethe nezicatshulwa ngokuthi kutheni i- levothyroxine kunye ne-liothyronine (iT4 + T3) .
Kukho ukwanda kwonyango lwe-hypothyroidism. ENgilani, imiqathango yehomoni ye-thyroid iphindwe kabini phakathi ko-1998 no-2007. E-Netherlands, inani labantu basebenzisa i- thyroid hormone izidakamizwa landa ngo-53% phakathi ko-2005-2011 - inani lamaDutch landa kuphela 2.1% ngeli xesha.
Inani lezigulane ezisekwe-levothyroxine kuphela yonyango liye lancipha kancane ukusuka ngo-2005 ukuya ku-2011 - kwaye kuye kwanda ukwanda kwamanani kwizigulane kwi-T4 + T3 unyango.
Umthombo
Wiersinga, Wilmar. "Iiparadigm zitshintsha kwi-hormone ye-thyroid ye-hypothyroidism." Uhlolo lweNdalo I-Endocrinology (2014), ipapashwe nge-intanethi 14 Januwari 2014