Dr. Theodore C. Friedman, MD, Ph.D. ndiye Muongorori Purofesa weMishonga-UCLA, Endocrinology Division, uyewo ane chirongwa chekupedzisira mune zvekuchengetedza. Kuti uwane mamwe ruzivo pamusoro pemabasa ake, ona www.goodhormonehealth.com.
Muchikamu chino, anogovera pfungwa dzake nezve hypothyroidism kuongororwa uye kurapwa.
Hypothyroidism Diagnosis
Hypothyroidism chirwere chinowanzojairika.
Inobata vakadzi vakawanda ipapo varume, asi ini ndinoitika kuva mumwe wevarume vanove nazvo. Zviratidzo zve hypothyroidism zvinosanganisira kuneta, kupera zvishoma, kuvharana, kunzwa kunotonhora, kusava nemwedzi, kusava nemvere, kurasikirwa kwemvere , yakaoma, ganda rinotonhora uye kunonoka kupindura nguva. Varwere vazhinji vachave ne goiter (utachiona hwakawedzerwa). Kunyange zvazvo yakagamuchira hurukuro yakawanda, ndinotenda kutsika muviri wekushisa kwete chiratidzo chechokwadi che hypothyroidism.
Chiitiko che hypothyroidism chinowedzera nekukura kwezera. Mune mamwe mazwi, vakuru vatinowana, kunyanya kukanganiswa kwetachiona kucharatidza. Chikonzero chinonyanya kukanganisa chepakutanga hypothyroidism ( hypothyroidism inobva murosiyo gland pachayo), inonzi Hashimoto's Thyroiditis. Hashimoto's is an autoimmune condition . Mumuviri wemuviri pachake anokonzera chirwere chetrojeni uye achiiparadza, zvichiita kuti hypothyroidism. Hashimoto's Thyroiditis inogona kunge iri kuratidzwa kwevamwe autoimmune syndromes uye inogona kuitika mumhuri.
Hypothyroidism inogonawo kunge yakakonzerwa nechinetso chepituitary (central hypothyroidism).
Kuongorora zvirwere zvose zve hypothyroidism zvakakosha, nokuti kurapwa nehutachiona hormone kuchavandudza zviratidzo zvevarwere vane hypothyroidism, asi hazvigone kubatsira avo vasina hypothyroidism. Mukutanga hypothyroidism, chirwere chetachiona, chiri mumutsipa, hachikwanise kubudisa mahomoni eTroid , T4 uye T3.
Iyo plandishi gland, iri mumusoro, inopindura kushayikwa uku nokuvhara TSH yakawanda. Nokudaro, mumatambudziko akawanda ekutanga hypothyroidism, T4 uye T3 mazinga akajairika, asi TSH yakakwirira. Mumatambudziko akaoma, T4 uye T3 mazinga anodonha. Kunyange zvazvo hutano hwakanaka hweTSH huri pakati pe2,5 uye 5 mU / mL, hutsika pamucheto wepamusoro wehutano hwakanaka hunogona kunge husina kunaka. T3 ndiyo inowedzera bioactive hormone inofananidzwa neT4, asi T4 yakanyanyisa mukupararira.
Nzira yangu yekutsvaga hypothyroidism ndeyokutanga nekunaka kwepanyika uye yepanyama. Zvadaro An Endocrinologist anofanirwa kuita maoko-pamusoro peongororo yehutano kuti aone kana murwere ane goiter. Ropa TSH, T4 yakasununguka, T3 yakasununguka uye anti-TPO ma antibodies inofanira kuongororwa. Varwere vane utachiona hwakawedzerwa uye / kana chiratidzo chakanaka-TPO antibody uye TSH yakakura kupfuura 4.0 mU / mL inofanira kuonekwa seine primary hypothyroidism. Varwere vasina utachiona hwakawedzerwa uye vasina anti-TPO antibody test asi vane TSH yakakura kupfuura 7.5 mU / mL inofanirawo kufungwa seine primary hypothyroidism. Varwere vane T4 vakasununguka vanopfuura 0.9 mg / dL uye TSH pasi pe 1.0 mU / mL vanogona kunge vane central hypothyroidism. Varwere vane zviratidzo zve hypothyroidism asi vasingakwanisi kuita izvi zvinotarisirwa kuongororwa uye vadzorerwa mumwedzi mitanhatu.
Hypothyroidism Treatment
Kana imwechete hypothyroidism ichionekwa, pane maitiro akawanda ekurapa , kusanganisira yakagadzirirwa L-thyroxine (T4) kugadzirira (Synthroid, Levoxyl neUnithroid), maitiro ekugadzira L-triiodothyronine (T3) (Cytomel), maitiro ekugadzira T4 / T3 (Thyrolar) uye yakagadzirwa utachiona hwekuita (Armor, Naturethroid, Bio-Throid, uye Westhroid). Zvose zve-L-thyroxine mazano ane zvimwe zvakafanana zvinoshandiswa, asi ane zvizere zvakasiyana uye ane hutano hwakasiyana. Kusvikira munguva pfupi ichangopfuura, Synthroid yakanga isina FDA inogamuchirwa, asi iye zvino zvose zvinogadzirwa neL-thyroxine zvine FDA inogamuchirwa.
Thyrolar uye yakakonzerwa nekugadzirisa utachiona zvichida ine yepamusoro yeT3 / T4 yehuwandu kupfuura yakakosha uye naizvozvo, ini ndinowanzopa zvikamu zviduku zvezvigadzirira izvi zvinowedzera T4.
Vakawanda vanogumira kare vanoshandisa L-thyroxine marongwa ekutanga kurapwa kwemarudzi ese e hypothyroidism. Kunyange zvazvo kushandiswa kweL-thyroxine (T4) yakaenzaniswa neL-triiodothyronine (T3) inogona kushamisa sezvo T3 ndiyo inowedzera bioactive hormone, T4 inowanzoshandiswa. Ichi ndechokuti matumbu anochinja T4 kusvika kuT3 kuti agadzire physiologic mazinga eT3. Nokudaro, kutungamirirwa kweT4 kunoguma muT3 uye T4. Sezvo T4 yakanyanyogadzikana kupfuura T3, T4 yehutano inopa kunyange mazinga eropa, apo utachiona hweT3 hunotungamirira kumazinga akareba mushure mokutora mishonga uye pasi shomanana musati waita chiitiko chinotevera. Hondo yehutachiona ndiyo yakagadzirirwa kugadzirira. Nokuti Hondo yehutano inouya yehugori yehutachiona, vamwe veEstocrinologists vanofunga kuti kune mapiritsi akawandisa pamapirisi akasiyana, asi izvi hazvigone kuva zvechokwadi.
Chimwe chidzidzo chakabudiswa muNew England Journal of Medicine muna 1999 chakaratidza kuti uropi T4 kusvika kuT3 kutendeuka kunogona kukanganisa mune vamwe varwere uye kuti boka rakasarudzwa revarwere rinofanira kurapwa pamwe neT4 neT3 . Zvimwe zvidzidzo zvakabudiswa mu Journal of Clinical Endocrinology uye Metabolism muna 2003 ( ona nyaya ino ) yakaratidza kuti kuwedzerwa kweT3 kusvika kuT4 kurapwa hakudikanwi kuvarwere vazhinji vane primary hypothyroidism. Ndinokurudzira kuti varwere vazhinji vatange kutangwa paT4 kugadzirira, izvo zvinovandudza zviratidzo muzhinji rwevarwere. Ndakaona kuti vazhinji varwere vanoda Levoxyl kana Unithroid kune Synthroid , asi izvi zvinosiyana nemurwere mumwe nomumwe. Mushure mekutanga kurapwa neT4, ndinoshandura maitiro avo T4 kusvika TSH yavo iri pakati pe 0.5 uye 2 mU / mL. Kana vakaramba vachiratidza zviratidzo pasinei neTSH yakagadziriswa, ipapo kutsika kweT3 kwakapiwa maviri kana katatu pazuva kunogona kuwedzerwa nekuchenjerera kusvika T4. Kana varwere vachitanga neropa rakaderera pasina T3 yepamusoro, zvino ini ndinowedzera kutarisira navo neT4 pamwe neT3. PaT4 pamwe neT3 therapy , ndinoshandisa kuongorora ropa kuti ndive nechokwadi chokuti T4 yakasununguka uye isina T3 iri munzvimbo yakakwirira-yakakwana. Ikoshi yeTSH inowanzodzingwa pakusanganiswa kwehutano .
Chikamu chevarwere vachave nekuvandudzwa kwechiratidzo paT4 pamwe neT3 therapy. Kune avo vasingagadziri, ini dzimwe nguva ndinorayira kurapwa nemaitiro ekugadzirwa kwetroji, zvinowanzoshandiswa, Zvombo zvekugadzira, pamwe nekugadzira T4. Iko kusanganiswa kunodiwa sekugadzirwa kwetroji yakagadziriswa ine yepamusoro yeT3 / T4 yehuwandu kupfuura yakakosha uye inoda kubhadharwa nemagetsi eT4 kuti zvibudirire zviyero zvakakwana zvehomoni mbiri. Zvakare, ini ndinotarisira kuti T4 isunungurwe uye ndinosunungura T3 mupamusoro-yakakwana. Varwere vane pakati pe hypothyroidism vanogona kurapwa nemumwe wezvigadziriro zviripo kune varwere vane primary hypothyroidism. Misiyano ndeyokuti kurapwa kunoda kuongororwa nechinangwa chekusununguka T4 uye kusununguka T3 mupamusoro-yakakwana, sezvo TSH inodzingwa nekurapa kwakakodzera. Varwere vane zvose zviri pakati nepamusoro hypothyroidism vaidawo kurapwa nechinangwa chekusununguka T4 uye kusununguka T3 munzvimbo yakakwirira-yakatarisa. Ndakaparidzirwa ndine primary hypothyroidism munaFebruary 2003. Mumwe magistrologist akaita chiongorudzo chetachiona chetachiona uye ndakawanikwa ndine goiter. Ropa rangu rakataridzika TSH ye 8 mU / mL uye rakasimba anti anti-TPO antibodies. Ndine mhuri yakasimba yeHashimotos Thyroiditis asi ndaiva nerusununguko kuti ndive nemafungiro asina kunaka asati apora. Iye zvino ndave pari 150 mg pazuva reLevoxyl, ndine TSH ye 1.9 mU / mL uye ndinonzwa zvakanaka. Ndarasikirwa nemakirogiramu mashoma paT4 yehutano uye huwandu hwangu hwecholesterol hwakavandudzwa.
Yakatanga kubudiswa paIndaneti, 2003