Ukulawula izifo ze-Thyroid ngexesha kunye nangemva kokukhulelwa kwakho

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Ukulawula izifo ze-Thyroid ngexesha kunye nangemva kokukhulelwa: Izikhokelo

Isifo se-Thyroid siyaziwa ukuba sichaphazele iinkalo ezininzi zokukhulelwa kunye ne-postpartum yempilo, kunye nempilo yengane yakho. Kwimizamo yokuhlela iindlela ezahlukeneyo kunye namaxesha aphikisanayo ngokubhekiselele kwizifo ze-thyroid nokukhulelwa, izikhokelo zeklinikhi zokulawula iingxaki ze-thyroid ekukhuleleni kunye nexesha lokuhamba emva kwenyanga zashicilelwe ngasekupheleni konyaka ka-2011, kwaye ngo-2016, zithathwa njengeziphakamiso zangoku.

Iphephabhuku le- Thyroid lanyathelisa izikhokelo njengesiqendu sephepha-47, esithi "Izikhokelo ze-American Thyroid Association ye-Diagnosis kunye nokuLawula izifo ze-Thyroid ngexesha lokukhulelwa kunye ne-Postpartum" . Eli nqaku liquka ezinye zeengcebiso eziphambili zezikhokelo, ezinempembelelo ebalulekileyo xa uhlakulela isifo se-thyroid ngexesha okanye emva kokukhulelwa kwakho, okanye wena onesifo se-thyroid ngaphambi kokuba ukhulelwe.

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Oko Kufuneka Ukwazi Ngayo Ukuhlolwa Kwe-Thyroid ekukhulelweni

Ngokuqhelekileyo, ukuhlolwa kwe-thyroid kwindalo yabasetyhini abakhulelweyo akuthathwa njengelungileyo ngokulandela izikhokelo. Iingcali zibonisa ukuba kunjalo, ukuba ukuhlolwa nokuhlolwa kuqhutywe phakathi kwabasetyhini abajongene nomngcipheko ophezulu we-thyroid.

Unobungozi obukhulu besifo se-thyroid ngexesha lokukhulelwa ukuba:

• unembali yomntu onobungozi be-thyroid kunye / okanye utyando lwe-thyroid
• Unomdla wentsapho yesifo se-thyroid
• ne goiter
• vavanyo oluhle lwezilwanyana eziphezulu ze-thyroid
• baneempawu okanye iimpawu zeklinikhi ezingabonisa ukuba i-hypothyroidism
• udidi lwesifo sikashukela
• unembali yokukhulelwa okanye ukuhanjiswa kwangaphambili
• nezinye izifo ezihamba ngokuzenzekelayo ezixhomekeke kwiingxaki ze-thyroid, ezifana ne: vitiligo, ukungakwazi ukuzaliseka, ukungena kwe-hypoparathyroidism, igastritis ye-atrophic, i-anemia, i-systemic sclerosis, i-systemic lupus erythematosus kunye ne-Sjogren's syndrome
• baye bafumana ukungabikho
• sele ifumene imitha ephezulu entloko okanye entanyeni njengonyango lomhlaza, okanye unama-ra-rays amaninzi
• zigqithise kakhulu, ezichazwa njenge-index mass mass (BMI) engaphezu kwama-40, okanye ubunzima bomzimba obunama-20% okanye ngaphezu kobunzima bomzimba obuhle
• baneminyaka engama-30 okanye ngaphezulu
• ziye zaphathwa nge-amiodarone (iCordarone) ngeenzitho zentliziyo
• baye baphathwa nge-lithium
• ziye zavezwa kwi-iodine kwindawo yokuvavanya uvavanyo lwezokwelapha kwiiveki ezidlulileyo ezintandathu,

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Oko Kufuneka Ukwazi Ngohlobo lwe-Hypothyroidism nokukhulelwa

I-Hypothyroidism ngelixa ukhulelwe unokuba nemiphumo ebalulekileyo yempilo enganeni engakazalwa, kwaye kufuneka ukuba i-hypothyroidism yomama ingagwenywa.

Ukuba u-hypothyroid ngaphambi kokukhulelwa, izikhokelo zincoma ukuba i- dosage yakho iguqulwe ukwenzela ukuba iTSH ingaphantsi kwe-2.5 mIU / L ngaphambi kokuba ukhulelwe . Oku kunciphisa umngcipheko we-TSH ophakanyisiweyo kwi-trimester yokuqala.

Kufuneka uqinisekise kwakhona ukukhulelwa kwakho ngokukhawuleza, kwaye wenze isicwangciso endaweni ukuze ukwandise umlinganiselo wakho weyeza , ukwenzela ukukhusela ukukhulelwa kwakho ngokuxhasa umsebenzi wakho we-thyroid.

Ukuba ufumanisa ukuba u-hypothyroid ngexesha lokukhulelwa, kufuneka uphathwe ngaphandle kokulibaziseka, ngenjongo yokubuyisela amanqanaba akho e-thyroid ngokuqhelekileyo ngokukhawuleza. Ngethuba lekota yokuqala, i- TSH ifanele ilondolozwe kwinqanaba eliphakathi kwe-0.1 kunye ne-2.5 mIU / L, i-0.2 ukuya kwi-3.0 mIU / L ngelixa lesibini, kunye ne-0.3 ukuya kwi-3.0 mIU / L kwi-trimester yesithathu .

Ngexesha elide ukuya kwiiveki ezintandathu ezikhulelwe, iyeza lakho leyeza lonyango liza kufuneka linyuswe, mhlawumbi libe ngama-50 ekhulwini .

Ukuba unesifo sesifo se-thyroid, umzekelo, ubuye wavavanya uvavanyo lwe-antibodies ye-thyroid, usemngciphekweni wokuba u-hypothyroid nanini na ukukhulelwa. Kufuneka uhlolwe rhoqo ngokukhulelwa kwe-TSH ephakamileyo.

Uya kufuna kwakhona ukuqaphela ukutshintsha ukulindela kwi-thyroid ngexesha lokukhulelwa .

Esinye isiluleko esibalulekileyo: qiniseka ukuba i- vitamin yakho yokubeletha iquka iodine, isondlo esibalulekileyo kwisenzo se-thyroid ngexesha lokukhulelwa.

Bona isishwankathelo esicacisiweyo seZikhokelo ze-Hypothyroidism, izifo zikaHashimoto kunye nokukhulelwa .

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Oko Okufuneka Ukwazi Ngokwe-Hyperthyroidism nokukhulelwa

Ukuba unamazinga e-TSH aphantsi-aqhelekileyo, kufuneka uhlolwe ukuba ubone ukuba i- hyperthyroidism ngexesha lokukhulelwa lixesha elifutshane le-hyperthyroidism / i-hyperemesis gravidarum- imeko yokukhulelwa ebangela ukugula okusa- kusasa kakhulu okanye isifo se-Graves . Uxilongo lwenziwe ngokuqwalasela ukuba unayo i-goiter, kunye / okanye uvavanyo oluchanekileyo lwe-antibodies.

Ukuba ukhulelwe, kwaye ube yi-hyperthyroid ngenxa yezifo ze-Graves okanye iigununu, kufuneka uqale unyango lwe-hyperthyroidism kwangoko. Ngokuqhelekileyo, uza kufumana unyango lweziyobisi (uma ufumene unyango), okanye, ukuba sele usuphethwe, i-dosage yakho iya kutshintshwa ukuze amazinga akho e-T4 akhoyo ahlale ehlelekile kumntu ongakhulelwe.

Isidakamizwa se-antithyroid ekhethiweyo (ngokukodwa ngexesha le-trimester yokuqala) yipropylthiouracil, kuba i-methimazole inomngcipheko ophezulu (nakuba uncinci kakhulu) wokubangela ukukhubazeka kwintsana yakho. Izikhokelo zincoma ukutshintshela kwi-methimazole kwi- trimesters yesibini neyesithathu .

Ukuba unempembelelo engalunganga kumachiza e-antithyroid, kufuna amaqondo aphezulu kakhulu ukulawula i-hyperthyroidism yakho, okanye ungayilawulanga i-hyperthyroidism nangona unyango, utyando lunokucetyiswa . Ukuhlinzwa kwakuqhelekileyo kunconywa ngexesha lakho lesibini, xa kungenakunokwenzeka ukubeka engozini ukukhulelwa kwakho.

Inqaku elibalulekileyo: unyango lwe-iodine ye-radioactive akumele linikezwe ukuba unakho okanye ukhulelwe.

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Oko Kufuneka Ukwazi Ngama-Antibodies e-Thyroid, i-Graves 'kunye neNtsana yakho

Ukuba unesifo se-TSH-reception-stimulating okanye i-TSH-receptor-binding antibodies, ziyakwazi ukuwela i-placenta, kwaye zichaphazele i-thyroid yakho. Ukuba unesiqinisekiso malunga nalezi zikhuhlane xa ukhulelwe, umntwana wakho unokuzalwa ene hyperthyroidism okanye hypothyroidism . Ezi ngqungquthela kufuneka, ngoko ke, zilinganiswe ukuba unesi sifo se-Graves, okanye ukuba sele unesandul 'ukuzalwa. Kwakhona kunokuba kunyanzelekile ukunyanga ngezilwanyana zamathambo ngexesha lokukhulelwa ukuze unciphise umngcipheko wengane yakho.

Ukuba uphakanyisile i-TSH-stimulating or TSH-reception-binding antibodies kwaye uphathwa ngamachiza e-antithyroid, ukuhlolwa kwe-fetal ultrasound kuqhutyelwe. Le ultrasound kufuneka ikhangele ubungqina be-thyroid ekusebenziseni umntwana, kuquka ukukhula okucothayo kunye ne-thyroid eyandisiweyo, phakathi kwezinye iimpawu.

Ukuba ungumama omtsha kunye nesifo se-Graves, umntwana wakho osandul 'ukuzalwa kufuneka ahlolwe ukungasebenzi kwe-thyroid emva kokuzalwa, njengoko kunomngcipheko wemeko eyaziwa ngokuba yi- neonatal hyperthyroidism: eneempembelelo ze-serioos eziza kusana .

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Oko Kufuneka Ukwazi Ngokugula Kwekusasa kunye ne-Hyperthyroidism ekukhulelweni

Bonke abafazi abakhulelweyo abane-hyperemesis gravidarum (ukugula okusa kusasa okubandakanya ukulahleka kwesisindo kunye nokunyuka kwamanzi) kufuneka kube nokuhlolwa kwe -roid.

Ukuba unesifo esibi sekusasa, kunye ne-hyperthyroidism ngenxa yesifo se-Graves, kunye ne-hyestthyroidism enamaqabane ngamanqanaba e-thyroid ephakamileyo kakhulu - i-T4 yamahhala apha ngentla ye-reference and TSH ngaphantsi kwe-0.1 μU / ml - unokufuna unyango olufutshane neziyobisi ezichasayo.

Funda kabanzi malunga ne- hyperthyroidism / i-hyperemesis gravidarum .

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Oko Kufuneka Ukwazi Ngama-Nodules ye-Thyroid kunye neChrotic Cancer ekukhulelweni

Ngokutsho kweZikhokelo, ukuba ukhulelwe kwaye unamaqhubu e-thyroid, kufuneka ube ne-TSH kunye ne-Free T4. Ukuba unembali yentsapho ye-medullary thyroid carcinoma okanye i-endocrine neoplasia (i-MEN) 2, amazinga e-calcitonin kufuneka alinganiswe.

Izikhokelo zincoma kwakhona i-ultrasound ukucacisa iimpawu ze-nodule, kwaye zijonge ukukhula. Ukuba i-nodule ingaphantsi kwe-10mm ngobukhulu, i-aspection-needle aspiration (FNA) ye-biopsy yakho ye-thyroid ayifuni ngaphandle kokuba kukho izibakala zokusola.

Ukuba i-nodule ikhula, okanye unomkhuhlane oqhubekayo okanye iingxaki zezwi, okanye nayiphi na isalathisi esikhankanya embali, izikhokelo zincoma ukuba kwenziwe i-FNA. I-FNA ithathwa njengekhuselekile ngexesha lokukhulelwa.

Xa iigulane ze-thyroid zomhlaza zifunyenwe ngethuba lekota yokuqala okanye yesibini, utyando kufuneka lunikezwe kwi-trimester yakho yesibili. Iingcingo ze-thyroid ezihlukene kakuhle zikhula ngokukhawuleza, ngoko ukuba ukuvavanya kubonisa ukuba umhlaza ngumpapa okanye ulandelelwano, kwaye akukho bungqina bobuchopho obuphambili, unokufumana ithuba lokulinda de emva kokuba umntwana wakho azalwe ngaphambi kokuhlinzwa.

Ukuba ngoku kwaye ufumanisa ukuba ungumhlaza we-thyroid, kwezinye iimeko ugqirha wakho uya kukuncoma ukulinda de emva kokunikezelwa kokuhlinzwa. Kodwa unako ukufumana unyango ngeziyobisi ze-hormone zokutshintsha indawo, ukugcina i-TSH yakho iphantsi, kodwa isabonakala. Ngokufanelekileyo, i-T4 yakho yamahhala okanye ama-T4 amanqanaba onke kufuneka ahlale kwindawo eqhelekileyo yokukhulelwa.

Iodod i-radioactive ayifanele ifakwe xa ukhulelwe okanye uncelisa.

Emva kokuba ufumane i-dose yokwelapha ye-iode yomsakazo, kufuneka ulinde inyanga ezintandathu ukuya kunyaka ukuba ukhulelwe, ukuqinisekisa ukuba umsebenzi wakho we-thyroid uzinzile, kwaye umhlaza wakho we-thyroid uxoxwa.

Funda kabanzi malunga neNyroid Nodules kunye neChrotic Cancer ekukhulelweni .

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Oko Kufuneka Ukwazi Ngeengxaki Ze-Postpartum Thyroid

Ukuba unembali ye- postpartum thyroiditis , usengozini enkulu yokwenza i-hypothyroidism. Kufuneka ube nokuhlolwa kwe-thyroid yonyaka.

Ngokuqhelekileyo, iziyobisi ze-antithyroid azikhuthazwa kwixesha le-hyperthyroid ye-postpartum thyroiditis. Ukuba unayo i-postpartum thyroiditis kwaye ingumqondiso, i-beta blocker ingasetyenziswa. I-beta blocker ekhuthazwayo ipropranolol, kwinqanaba elisezantsi kunazo zonke ukunciphisa iimpawu.

Izikhokelo zincoma ukuba emva kwesigaba sakho se-hyperthyroid, i-TSH yakho kufuneka ihlolwe rhoqo emva kweenyanga ezimbini ukuya kutsho emva konyaka emva kwe-postpartum, ukukhusela i-hypothyroidism.

Ukuba iimpawu zakho zinzima, okanye ukuba uceba ukukhulelwa, i-hypothyroidism ebangelwa yi-postpartum thyroiditis kufuneka iphathwe. Ukuba ungeyinto engathandekiyo, izikhokelo zincoma ukuba iTSH yakho ichithwe rhoqo emva kweeveki ezine ukuya kweebhozo.

Ukuba i-hyperthyroidism ibonakala emva kokukhulelwa kwakho, izikhokelo zincoma ukuba unyango lwakho lwe-hyperthyroid lube luncedo, kodwa lucebisa ukuba xa kuyimfuneko, ukhetho lokuqala lwamachiza luba yiziyobisi ezibizwa ngokuba yi-methimazole (igama lomthi uTapazole). Amanani ukuya kuma-20 ukuya ku-30 ​​mg / d abonwa njengakhuselekile kumama onesihlengikazi kunye nosana lwakhe. Ikhefu lesibini kwiyeza zamathambo emva kokukhulelwa yipropylthiouracil (eyaziwa ngokuba yi-PTU), kumanani ukuya kuma-300mg / d. Iingcali zinenkxalabo ephezulu malunga nokusetyenziswa kwe-PTU ngenxa yeengxaki zobunyoyi besibindi ezihambelana neziyobisi.

Ukuba unonyameko kwaye uthatha iziyobisi ezichasene ne-antithyroid, izikhokelo zincoma ukuba amayeza ayeza kulwahlula, kwaye athathwe ngamanye amaxesha elandelayo emva kokuncelisa. Ukuba uthatha izidakamizwa ze-antithyroid kunye nokuncelisa, umntwana wakho kufuneka ahlolwe rhoqo ngeemvavanyo zemizimba ye-thyroid, ngokulandela izikhokelo.

Ngolwazi olungakumbi, bonani:

• Postpartum Thyrotoxicosis / Hyperthyroidism
• Postpartum Thyroiditis

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Oko Okufuneka Ukwazi Ngokusondeza Ngezifo Ze-Thyroid

Uninzi omama abatsha bakhetha ukuncelisa. Ukuba unesifo se -roid, unokuzibuza ngokukhuseleka kokuncelisa.

Ukuba uphathwa nge-hypothyroidism ngelixa uncelisa , ungakwazi ukuqhubeka ngokukhuselekileyo ukuthatha imishanguzo ye-hormone ye-substmone kwi-dosage yakho efanelekileyo ngaphandle kokulimaza umntwana wakho .

Umbuzo wokuthatha izidakamizwa ze-antithyroid nge-hyperthyroidism ngelixa ukuncelisa kunomngcipheko , kwaye unokuba ufuna ukuhlola iingxaki kunye neengxaki.

Kwakhona kufuneka uqaphele izikhokelo kunye nezinye iingcebiso malunga nendlela onokuphepha ngayo i-thyroid ngenkathi uncelisa .

> Umthombo:

> Stagnaro-Green, Alex, kunye. al. "Izikhokelo ze-American Thyroid Association ye-Diagnosis kunye nokuLawula izifo ze-Thyroid ngexesha lokukhulelwa kunye ne-Postpartum." Thyroid . Umqulu 21, iNombolo 10, 2011 (i-Intanethi)