Kwenguva yemakore anopfuura makumi mana, nzira inowanzogadziriswa yekubata hypothyroidism yave iri kupa hutachiona mushonga wemishonga levothyroxine (kureva, Synthroid, Levoxyl); nechinangwa chekuvimbisa kuti TSH yezinga inowanikwa mukati mekutarisa. Izvi zvave zvichionekwa sokurapa kwakakwana kwechiitiko.
Nheyo yeiyi inoenderana nekugadziriswa kwekutenda ndeyokuti kurapa nevothyroxine-iyo yakagadzirwa maitiro e thyroxine (T4) hormone yakakonzerwa nehutachiona-inopa T4 yakakwana, kudzorera imwe kune utachiona hunoshanda-inozivikanwa se euthyroidism-uye kugadzirisa utachiona hwose- zvakabatana zviratidzo.
Nyanzvi dzakawanda dzinotungamirira, kusanganisira mukurumbira wekupedzisira wemagokororiko Dr. Anthony Weetman , vakatotaurawo kuti varwere vane "maitiro ehutachiona ehutachiona" asi vanomiririra kuti vanofanira kurapwa nokuda kwezviratidzo zvakawanda zvehutano kana avo vanoenderera mberi zviratidzo vane "somatoform disorders." (Zvinetso zveSomatoform zvinotsanangurwa muzvinyorwa zvinotsanangurwa nezvechiremba se "zvinetso zvepfungwa zvinoratidzirwa nekunyunyuta kwepanyama, uko pasina tsanangudzo yehupenyu kana yepanyama inowanikwa uye iyo ine simba rakasimba kuti pfungwa dzepfungwa dzinobatanidzwa.")
Chirwere chetachiona chinowanzoitika chinokonzera mahomoni anokosha akawanda, kusanganisira yekuchengetedza hormone thyroxine (T4) uye inoshanda hormone triiodothyronine (T3). Ruzhinji rwehomoni runoberekwa nehuteni ndiT4, asi T4 inofanira kushandurwa mumuviri muT3 hormone inoshingaira kuitira kuti ive nemigumisiro mumuviri wako. Dzidziso yakasimba uye inokunda ndeyekuti hypothyroidism inofanira kurapwa chete ne levothyroxine-dzimwe nguva inonzi LT4 monotherapy kana levothyroxine monotherapy-pamatambudziko anokonzera kuti iwe uve euthyroid, uye maTSH ako mazinga ari pasi pezera rekutarisa.
Iyi dzidziso inoti kana pane T4 yakakwana, muviri unogara uchiita zvakakwana T3.
Pasinei nekutenda uku mune mushonga unoratidzira, kwemakumi emakore akawanda vamwe vane chirwere chetachiona vanowedzera kutaura pamusoro pekukanganisa kwa levothyroxine mukugadzirisa zviratidzo zvavo. Vatsvakurudzi vanongororesa kuti 15% yevarwere vanoramba vachiwana zvirwere zvinotambudza zvirwere zvechirwere pasinei ne levothyroxine kurapwa.
Kuongororwa kwevatachiona hwehutano kunoratidza kuti nhamba yacho yakakwirira kwazvo .
Zvitsvakurudzo Zvitsva
Kuti uongorore kana kudzorera hutachiona hweTSH kune referensi yekushandisa uchishandisa levothyroxine yakashanda, vatsvakurudzi veRush University Medical Center muChicago vakaongorora kuenzanisa boka rinodzora revanhu vakange vakagwinya, vasina uchapupu hwechirwere chetachiona, vachitarisana neboka revanhu vakanga vachirapa nevothyroxine ye hypothyroidism. Zvigumisiro zvakataurwa mumagazini yaOctober 2016 ye Journal of Clinical Endocrinology uye Metabolism .
Zvigumisiro zvaive zvakashamisa zvikuru. Tsvakurudzo yakawana kuti:
- Irovothyroxine-yakarapwa boka raiva ne20 muzana yakakwirira mazinga TSH, 10 muzana yakasununguka T3 mazinga, uye 15% muzasi mazinga T3 kana achienzaniswa neboka rinodzora.
- Bhuku reravothyroxine-rakarapwa raiva nehupamhi hwemuviri mashizha, kunyange zvazvo vaitaura kudya kudya zvishoma pamakori pazuva. Vaiyera zviyero zvinenge gumi pamapiro, pasinei nekudya zvishoma zvishoma maoriri pazuva.
- Irovothyroxine-yakarapwa boka raive nezviitiko zvinopfuura 1.6 zvekuwedzera kutora beta-blockers, iyo inowanzoshandiswa kurapa kukwira kweropa yakanyanya.
- Irovothyroxine-yakarapwa boka raiva 1.5 nguva yakawanda inowedzera kutora mishonga yemishonga, yakashandiswa kurapa cholesterol yakakwirira.
- Irovothyroxine-yakarapwa boka raiva 1.46 mara inowanzove yakanyanya kutora zvinodhaka.
- Irovothyroxine-yakarapwa boka yakashuma kunge isina kunyanya kushanda mumuviri kupfuura boka rinodzora.
- Irovothyroxine-yakarapwa boka pachayo-yakataura mamwe mazuva mumwedzi wapfuura umo vakafunga kuti hutano hwavo hwepanyama uye hwepfungwa hwakanga "husina kunaka."
The Theories
Vatsvakurudzi vakati vane zvinyorwa zviviri zvekuti sei-pasinei nokuti euthyroid neTSH mazinga mumutsetse wekutarisa-boka reravothyroxine rakarapwa rakanga risina hutano sezvakaenzana nemitengo yakawanda, uye nei levothyroxine ivo pachavo vakashuma kuti havana ' Tinonzwa zvakanaka kwazvo kakawanda kupfuura boka rinodzora.
- Imwe nyanzvi ndeyekuti pasinei nehutano hwemaTSH, mazinga eT3-iyo hormone inoshanda-ingasave yakanyatsogadziriswa, nokuti T4 haina kukwana zvakakwana kuT3.
- Chimwe chidzidzo chechipiri chinoratidza kuti mazinga eT3 anowanzosvika kumasero haafaniri kuratidzirwa neTSH kana kuti T4 kuongororwa kweropa, nekuda kwezviito zve deiodinases, iyo inobatanidzwa mubato reT4-to-T3 kutendeuka.
Vatsvakurudzi vakapedzisa magazini ino nehurukuro inotevera:
Iko pfungwa yokuti kuisa sarum inoratidzira TSH inopa vanhu pa (levothyroxine) monotherapy clinically euthyroid inofanira kuongororwa uye hutano hwehupenyu hunofanirwa kunyanya kukoshesa muongororo ye hypothyroidism uye mazano emitambo.
Kuwedzera Kunzwisisa Kubva Padzidza Munyori Antonio Bianco, MD
Mumwe wevanyori vekudzidza, Antonio Bianco, MD, mutungamiri wekare weAmerican Thyroid Association, uye purofesa paRush University, akapa hurukuro kuna MedicalResearch.com. Muhurukuro iyoyo, akatsanangura chidzidzo ichi zvakare:
Pachinyatsobvunzurudzwa chidzidzo chezvino chiri kuratidza kuti kushandiswa kwemaTSH mazinga mu hypothyroid varwere vangave vasina kukosha sezvakambofunga kutarisa kurapwa. Pasinei nehutano hwemaTSH huripo, varwere vari pangozi yakakwirira yekuwedzera kuora mwoyo uye kusagadzikana kwemagetsi kunoratidzwa nekuwedzera kwehutano hwemuviri uye kukwidziridzwa kwehushutera yepamusoro ... Tanga tiri kutaura kuti kuburikidza nekuchengetedza ropa mazinga eTSH zviratidzo zvose zvine chokuita ne hypothyroidism zvinofanira kubva . Izvi zvinotofanira kuchinja.
Mukudhinda kusunungurwa pamusoro pekudzidza, kwakabudiswa neRush University Medical Center uko kutsvakurudzwa kwakaitwa, Dr. Bianco akati zvakare:
Kunyange zvazvo chinangwa chokurapa ndechokuti varwere vachinzwe zviri nani, zviratidzo chete hazvibatsiri kutonga kukwanisa kurapwa. Ropa TSH mazinga ari. Mune mamwe mazwi, chirwere cheLevothyroxine chinogadziriswa zvichienderana nemazinga eTSH uye kwete kana kuti kwete here kana murwere anonzwa zviri nani ... Chinhu chinokosha kunzwisisa ndechekuti T4 haisi iyo hormone inoshanda. T4 inofanira kushandurwa kuT3 nemitumbi yedu ine enzyme inonzi deiodinase.
Varwere vanonyunyuta nezvekuora mwoyo, kunonoka uye kuva nepfungwa dzisina njere. Vane dambudziko rokurasikirwa uremu. Vanonyunyuta kuti vanonzwa vasina usimbe uye vane simba shoma. Asi isu vanachiremba tinoramba tichivaudza kuti, "Ndiri kukupai mishonga yakakwana yemishonga uye TSH yako inowanzofanira iwe kunzwa zvakanaka."
Izvi zvitsva zvinopindirana nezvakataurwa nevarwere. Izvi zvinyorwa zvekudzidza kwekutanga, nenzira isingafungi, kuti varwere pa levothyroxine vanonzwa vakaipisisa uye havasi kushanda kudarika kudzora, vachiratidza chinangwa chema cardiometabolic chisina kunaka pasinei nokuti vane maitiro anowanzo TSH.
Dr. Bianco mumwe wevatungamiri vari muchikwata chekutsvakurudza kana zvikanganiso zvemajini mune vamwe varwere zvinogona kukanganisa kushanda kwe deiodinase uye kunokanganisa T4-kusvika-T3 kutendeuka, uyewo kana kuwedzera kweT3 kune levothyroxine monotherapy kunogona kuita kuti kugadziriswe zviri nani zvezviratidzo, hutano hwehutano hwehupenyu, uye hutano huri nani hwehutano hwevamwe vanhu vari kurapwa kwe hypothyroidism.
Dr Bianco ave achitaura pachena kuti anotenda kuti mishonga inonzwisisika inodiwa kurapa hypothyroidism. Panguva ino, anorayira kuti vanachiremba vabve kubva kune tsika, "zviri nyore kurapa, tora piritsi iyi uye iwe unofadza" kuenda kumishonga, uye pane kudaro, tora nzira yakasiyana apo iwe uchipa varwere nezve hypothyroidism kurapwa. Maererano naDr. Bianco:
Vanachiremba vanofanira kunge vachiudza varwere vavo, "Ndiri kuzosimudzira TSH yako, asi iwe unenge uri pangozi yakakura yekuwana uremu, uchiona kuora mwoyo uye kuneta. Zvakare zvakare kuti cholesterol yako inokwira." Ndizvo zvatinofanira kuudza varwere, zvichibva pakudzidza kwedu.
Zvinotsvakurudzwa Nekutsvakurudza Kwako
Kwemakumi maviri emakore, varimi vanorwara uye vamwe vashandi vave vachireva kuti levothyroxine monotherapy haifaniri kunge iga yega sarudzo. Kunyange zvazvo inoshanda kune vamwe vanhu vane hypothyroidism, chikamu chikuru chevarwere vanoramba vasinganzwisisi zvakanaka, pasinei nekubatwa ne levothyroxine, uye kuonekwa se euthyroid ne "yekare" TSH mazinga, maererano neruzivo rweropa.
Kuzvipira kwaDkt. Bianco kutsvakurudza nekuvandudza uchapupu pamusoro pezvinodiwa zveT4 / T3 therapy in combination in subset of hypothyroid varwere zvose zvinopika uye zvinoshamisa. Uye hongu, sezvakataurwa naDr. Bianco, mishonga yakanaka inobatsira kurapa hypothyroidism.
Munguva iyi, zvakadaro, pane sarudzo kune varwere iyo Dr. Bianco haasi kuratidza pachena. Iwe unogona kuita kuti yako Free T3 iongorwe, uye kana yakaderera kana isiri yakakwana, unogona kushanda nemushandi uyo angangowedzera t3 mishonga - yakadai seCytomel (liothyronine), kana kuti yakawedzerwa, mishonga, nguva yakasunungurwa T3 drug -kukurapa kwako, kana ndiani achapa chimiro chechisikwa chemishonga yakadai seChina-throid kana Hondo yeTroroid kwauri.
> Sources:
> Kubvunzurudza naAntonio Bianco, MD. MedicalResearch.com. October, 14, 2016.
> Rush University Medical Center. Kushandura Kushandurwa: Hypothyroidism zviratidzo zvinoramba zvichiramba pasinei nekushandisa mishonga, kuenzaniswa kweropa. Gumiguru 12, 2016. Science Daily.
> Sarah J. Peterson, Elizabeth A. McAninch, Antonio C. Bianco. Ndeye TSH Isinganzwisisiki ne "Euthyroidism" muna Levothyroxine Monotherapy? Journal of Clinical Endocrinology & Metabolism, 2016; jc.2016-2660