Unyango lwe-Thyroid ye-Hypothyroidism
Iindaba ezilungileyo kwizigulane ze-thyroid: uphando olupapashwe kwiphephancwadi ye-endocrinology ehloniphekileyo kwaye elihloniphekileyo lithetha ukuba ukuhlanganiswa kweT4 / T3 kuphezulu kuneT4 kuphela / levothyroxine unyango lwe-hypothyroidism! Nazi iinkcukacha.
Ucwaningo lwehlabathi oluchazwe kwi- European Journal ye-Endocrinology lubhekisele kwinkinga enokwenziwa ngonyango nge-synthetic T3 njengesongezelelo kwi-T4-kuphela (levothyroxine) unyango lwe-hypothyroidism.
Olunye uphando olubuyela emva ngaphezu kweminyaka elishumi lubonise ukuphakama koxilongo oluhlangeneyo. Ezinye izifundo, nangona kunjalo, akufumani nantlukwano. Ukungahambelani kwezi ziphumo zophando kwi-T3 kuye kwabangela ezinye iingcali-ingakumbi, abo baxhaswa ngokuxhomekeka kwe-levothyroxine-kuphela yonyango - ukugqiba ukuba akukho nzuzo yokongezwa kweT3. (Ezinye zezo "ngcaphephe" ezifanayo zize zenze ukukhwabanisa okukhulu, kwaye ngokugqithiseleyo zigqitywe ukuba i-levothyroxine / iT4 kuphela yonyango iphezulu kuneyonyango yokudibanisa i-T4 / T3.)
Kwimeko nayiphi na into, kwiphando, abaphandi baseDanish baqhube isifundo esiphambanisekayo, esicatshulwa ngokuphindaphindiweyo-esithathwa njengefomathi esemgangathweni yegolide yoogqirha-izigulane ezingama-59. Kwiqela lesigulane, i-microgramgram ezingama-50 ze-dose eziqhelekileyo ze-T4 zatshintshwa nge-20 mcg ye-T3 okanye i-50 mcg ye-T4 kwiiveki ezili-12. Izigulane zenza "ukunqumla," ukwenza okuchasene nezinye iiveki ezili-12.
I-dose ye-T4 yayilawulwa xa kufuneka ukuba kugcinwe amazinga e-TSH.
Uvavanyo lwekhwalithi yobomi (i-QOL) kunye nokudandatheka kwenziwa ekuqaleni, kwaye emva kweemviwo ezimbini zeeveki ezili-12. Umgangatho wobomi kunye nemeko yengqondo ehlolwe iquka, phakathi kwezinye izinto: impilo jikelele, ukusebenza kwezenhlalakahle, impilo yengqondo, ubunzima, ukuqonda, ukuxinezeleka kunye nokuxhalabisa.
Oko abaphandi bafumanisa kukuba phakathi kwezigulane - abangama-55 kubo ababengabesifazana-kwakukho ukungafani okwe-7 kwi-11 ye-QOL kunye neengxaki zokudandatheka, ezibonisa imiphumo emihle ehambelana nokuxhatshazwa kweT4 / T3.
Ingqikithi ye-49% yezigulane zikhethe ukonyango, kwaye kuphela i-15% ekhetha ukwelashwa kuphela kwe-levothyroxine.
Abaphandi baphetha ngelithi, kwiphando apho amazinga e-TSH agcinwa ahambisanayo, unyango lwe-T4 / T3 oludibeneyo olubandakanya i-20 mcg ye-T3 imihla ngemihla ephezulu kunonyango lwe-levothyroxine kuphela, xa uvavanya ubuninzi bomgangatho wobomi, ukuxinezeleka nokuxhalabisa izikali, kunye nokhetho lomonde.
Oogqirha bahlala bebhekisela kumngcipheko weempembelelo nge-T3 unyango njengesizathu sokungasebenzisi i-T3, kodwa olu pho nonongo lubonise ukuba akukho mmahluko malunga nemiphumo emibi. Ngokubhaliweyo bombhali, ngexesha le-T4 / T3 yonyango lwenyango, abantu abahlanu bafumana imiphumo emibi ebandakanya iipilpitations, ukujuluka okukhulu, kunye nokungazinzi kwengqondo. Ngexesha le-T4 kuphela, abantu abayisithoba babika imiphumo efanayo.
Ngokuthakazelisayo, abaphandi baseDanish babhekisela iingxaki ngezinye zezifundo zangaphambili zeT4 / T3 zokwelapha ezingazange zithole nzuzo kwiyeza T3, zithi: "Izifundo ezibandakanywe ekuhlalutyweni kweemeta zazingumxube wezigulane ezahlukeneyo zezigulane, kubandakanya izigulane kunye nomdlavuza wangaphambili we-thyroid, i-autoimmune hypothyroidism, kunye ne-subclinical kunye ne-hypothyroidism. "
Kwaye, ngokutsho kwabaphandi baseDanish, kwelinye lezinto eziphambili, "... [abalobi] babengenakukwazi ukugcina amazinga e-TSH e-serum kumgangatho ofanayo kumacandelo amayeza amabini, ithetha i-TSH ye-serum ibe ye-3 kwiqela elidibeneyo kunye 1.5 mU / l kwiqela le-monotherapy.
Abaphandi bathi uphando lwabo lubonisa ukuba iqela legulane libonakala lizuza kwi-T4 / T3. Ngokukodwa, bacetyisa ukuba kunokubakho izizathu ze-physiologic ukuba kutheni iqela lempendulo liphendula-okanye iimfuno-i-T3, ngokukodwa ukuba:
... i-polymorphism esandula kutshatyalaliswa kwi-gene edibanisa uhlobo lwesibini lwe-deiodinase, i-enzyme ejongene nokulawulwa kwe-T3 ukufumaneka kwiimfucu, icetywayo ukwenzela ukukunceda ukuchonga amaqela amaninzi anokufumana inzuzo kwi-T4 / T3. Enye i-polymorphism, e-OATP1C1, i-hormone ye-thyroid yomshumbisi echazwe kwi-barrier-brain obstruction, iye yadibana nokukhathala nokuxinezeleka.
Uhlobo oluthile lwe-Endocrinologist yaseDutch uWilmar Wiersinga uthi Uxhaswa ngokuKhululwa kweT3 Mhlawumbi ube ngowona mhle, abanye abantu banokuba ne-Genetic Propensity ukwenza ngcono kwi-T3
Udokotela wama-endocrinoloji waseDutch uWilmar Wiersinga wabhala i-editorial ehamba phambili, ebizwa ngokuthi "Ngaba sifuna iimvavanyo ezingakumbi kwiT4 kunye neT3 yokwelapha inxube kwi-hypothyroidism?"
Ngokutsho kukaDkt. Wiersinga, ezinye izifundo zangaphambili zagqiba ukuba akukho nzuzo yokongeza iT3. Sekunjalo, into yokuba, ngokwe-Wiersinga, ubuninzi be-10% yezigulane ze-hypothyroid abanelisekanga ngendlela abavakalelwa ngayo kwinto oogqirha abaya kuthiwa "umthamo owaneleyo" we-levothyroxine ukutshintshwa kukhokelela ekupapapheni isifundo seDanish.
Umhleli, opapashwe ngokugcwele kwi-intanethi, ukhankanya iimpazamo kwizifundo zangaphambili kunye nohlalutyo lwe-T4 / T3. UDkt. Wiersinga ugqiba ukuba kukho izizathu ezibini zokwenza izilingo ezongezelelweyo ezilawulwa ngokungaqhelekanga ngokuthelekisa i-levothyroxine / T4 kuphela unyango lwe-monotherapy, kwi-T4 / T3 yonyango:
Okokuqala, izilingo kude kube nzima kakhulu ukulinganisa i-serum FT4-FT3 iiyure kwi-24 h. Ukuphuhliswa kwamalungiselelo okukhululwa kwe-T3 okuqhubekayo kunokubaluleka ukuze kufinyelele injongo yokuguqula i-hormone ye-thyroid. Okwesibini, inani elinyukayo le-polymorphisms kwi-deiodinases kunye ne-thyroid hormone abathumeli banxulumene nentlalo yengqondo, ukuxinezeleka, ukukhathala, kunye nokukhetha ukonyango. Ingaba ngaba ngaba izifundo ezinganelisekanga nge-monotherapy zihlala zihamba nazo zithatha iipolymorphisms, kwaye ziya kuba neempendulo ezingcono kwiyeza zokudibanisa?
Ngokutsho kukaDkt. Wiersinga, ukuphuhliswa kokulungiswa okuqhubekayo kwe-T3, okwenziwe njenge-dose nighttime (kunye kunye nevothyroxine kanye nentsuku zonke) kungahle kukugcine ukulungelelaniswa kwemvelo ye-Free T4 kunye ne-Free T3 kwezinye izigulane ze-thyroid ngaphezu kweeyure ezingama-24.
Qaphela: Ngoko makhe sibuyele kwakhona kwakhona. Isiqingatha sezigulane zikhetha ukudibanisa i-T4 / T3 - kuphela i-15% ekhethekileyo ye-levothyroxine kuphela, NAKUBE, umgangatho wobomi kunye nezinye izinto ziphuculwe. KUNYE, i-T4 / T3 yonyango yayingekho nemiphumo emibi kuneT4-yedwa. (Enyanisweni, kulolu cwaningo, unyango lwe-T4 kuphela lubangele iziphumo ezingaphezulu kweminye imiphumo.) Ndikulindele ukuba ezinye zeengcali ezibizwa ngokuba yi-thyroid - ezisoloko zikho kwi-payroll ye-levothyroxine abenzi - mhlawumbi baya bawa phantsi bezama ukucacisa izinto ezifunyenweyo, kwaye kuya kuba mnandi bebukele bezama!
Inqaku elibhaliweyo leendaba kwiphepha elipheleleyo lokufunda, kodwa ngelishwa, ayithunyelwe kwi-intanethi ngokupheleleyo. Kodwa ke, ungathenga ikopi kwi-intanethi ye-$ 25 kwi-website ye- European Journal ye-Endocrinology website. Le nto ngokuqinisekileyo ukuba ufuna ukuba ugqirha uyifunde ngokunjalo, ngoko qiniseka ukuba umenze amazi ukuba athole ikopi kwakhona. Enyanisekileyo, kusenokufanelekile ukuba uthenge ikopi ukunika ugqirha wakho, ukuba akafuni ukufunda malunga nophuhliso lwe-thyroid.
Ulwazi olungakumbi kwi-T4-kuphela Vs. I-T4 / T3 Yonyango Yokuxhatshazwa kwe-Hypothyroidism
- Ukujonga i-T4 kuphela ngokubhekisana ne-T4 / T3
- I-T3 i-Triiodothyronine Iziyobisi Ukuphucula Ubunjani boBomi kwi-Hypothyroidism: Uphando lubona abaninzi abanezigulane baziva ngcono ngeZongezo zeT3 / iNew England Journal of Medicine Study of 1999
- Isifundo Sifumana Izigulane Zikhetha Ingxube yeT4 / T3 Ukonyango: Uphando lweeMvavanyo Ulwaphulo lweCombo oluhlanganiswe noTywala lokulahlekelwa / 2005
> Imithombo:
> UBirte Nygaard, u-Ebbe Winther Jensen, uJan Kvetny, u-Anne Jarløv noJens Faber. "Impembelelo yeNyango yeTyroxine (T4) kunye ne-3,5,3'-Triiodothyronine Versus T4 Monotherapy kwizigulane ezine-Hypothyroidism, i-Double-Blind, i-Randomized Cross-over Study," I- European Journal ye-Endocrinology , Vol 161, Issue 6, 895-902, uDisemba 2009 Abstract, (Umbhalo opheleleyo ($ 25))
> Wiersinga, Wilmar "Ngaba Siyadinga Iimvavanyo Ezininzi kwiT4 kunye noT3 Unyango loNyango kwi-Hypothyroidism?" I-European Journal ye-Endocrinology , Vol 161, Issue 6, 955-959. Isicatshulwa esigcwele (samahhala)