Kuongororwa Kunotenderera Zvikuru Mukuedza Kweropa
Kana iwe kana munhu waunoda ane zviratidzo kana zviratidzo zvehutachiona husingagadziriswi (inonzi hypothyroidism), zvakakosha kuona chiremba wako kuti aongorore zvakakwana. Kuti uongorore dambudziko rehutachiona, chiremba wako achakubvunza mibvunzo pamusoro pehupenyu hwako hwemhuri uye hwemhuri, kuita chiitiko chekuongorora, uye kuronga kuongororwa kweropa (zvikurukuru, horoid-stimulating hormone, kana TSH muedzo).
Kana chiremba wako achikuongorora iwe ne hypothyroidism, iye achadawo kuziva chikonzero chinokonzerwa nehutachiona hwehutachiona hwako, sezvo izvi zvichatora chirongwa chako chekurapa. Kuti ufukidze "nei" mushure me hypothyroid diagnosis, iwe unogona kudiwa kuti uwedzere kuedzwa, kufanana nehutachiona hwekutsvaga ropa.
Tsvaga Chiremba
Vanhu vazhinji vanoonekwa kuti vane hypothyroidism nechiremba wemhuri kana kuti mudzidzisi. Kunyange zvakadaro, vanachiremba vokutanga vanove nehutano hwakasiyana mukurapa chirwere chetachiona.
Basa renyu rokutanga rinofanira kunge ririkudzidza kana kana kwete iwe chiremba mukuru wekuchiremba anonzwa akasununguka kukubata iwe, kana kana uchifanira kubvunzurudza an endocrinologist (chiremba anonyanya kugadzirisa zvirwere zvehomoni).
Pakuguma, iwe unogona kuona nyanzvi yekugumira kare, uye zvino ita kuti chiremba wako wekunyanya kutarisira agadzirise chirwere chako chetachiona chinofambira mberi. Zvichida, wako endocrinologist angaita zvose zvehutano hwako gore negore kana zvakadaro.
Undergo an Examination
Paunoona chiremba kwenguva yekutanga nezviratidzo kana zviratidzo zvinoshungurudza hypothyroidism, unogona kutarisira kuve nenyaya yakakwana yezvokurapa uye kuongorora kwepanyama.
Mushure mokunge maongorora zviratidzo zvitsva izvo zvinoratidza kuti muviri wako unonzi metabolism unogona kuderera (somuenzaniso, ganda rinoputika, rinotonhora nyore nyore, kusagadzikana kwechando, kana kuvimbiswa), chiremba wako achabvunza mibvunzo yakananga pamusoro penhau yako yezvechirwere, yakadai se:
- Iwe une imwe chirwere chekuzvimirira (somuenzaniso, rheumatoid arthritis kana kuti chirwere cheshuga chechipiri here?)
- Iwe une nhengo dzemhuri dzine hypothyroidism here?
- Wakambotanga chirwere cheroyo here?
- Uri kutora chero mishonga inokonzera hypothyroidism sey amiodarone kana lithiamu?
- Uri kutora chero iodine-ine zvinowedzera here?
- Wati wambove nemirasidzo mumutsipa wako, kurapa lymphoma kana musoro nemukati wemutsipa here?
Mukuwedzera kune nhoroondo yezvokurapa, chiremba wako achaongorora utachiona hwako hwekuwedzera (inonzi goiter) uye mavhinga (majekwe). Chiremba wako achaongorora zvakare zviratidzo zve hypothyroidism sekuderera kweropa, kusuruvara kweputi, ganda rakaoma, kuzvimba, uye kusvibisa mafungiro.
Labs uye Miedzo
Kuongororwa kwe hypothyroidism kunotsigira zvikuru kuongororwa kweropa.
Thyroid-stimulating Hormone (TSH)
Chiyero cheTSH ndicho chiyamu chekutanga chinoshandiswa pakuongororwa nekugadziriswa kwe hypothyroidism . Asi mabhizimusi akasiyana-siyana anowanzove nemafungiro akasiyana pane izvo zvinozivikanwa se "TSH reference range."
Pakati pemakwenzi akawanda, tsanangudzo yeTSH inotangira kubva ku 0.5 kusvika ku4,5. A TSH kukosha kweasingapfuuri 0.5 inonzi hyperthyroid, nepo TSH inokosha ye4,5 inonzi inogona kunge inonzi hypothyroid.
Kusiyanisa mabhizimusi kungashandisa muganhu wakadzika wepakati kubva kune 0,35 kusvika ku6, uye kune chikumbaridzo chepamusoro chero kupi zvako kubva pa 4.0 kusvika ku6.0.
Chero zvazviri, zvakakosha kuti iwe uve kuziva ruzivo rwokutarira pabazi iro ropa rako rinotumirwa, saka iwe unoziva mitemo yauri kuongororwa nayo
Kana kutanga kweTSH kuongororwa ropa kwakawedzerwa, inowanzodzokidzwa, uye test yourroxine T4 yakasununguka inotorwawo.
Free Thyroxine (T4)
Kana TSH yakakwirira uye iyo T4 isingasununguki, kuongororwa kwepakutanga hypothyroidism inogadzirwa.
Kana TSH yakakwirira, asi T4 yakasununguka inowanzoitika, kuongororwa kwe subclinical hypothyroidism inogadzirwa. Kurapa kwe subclinical hypothyroidism kunobva pane zvimwe zvinhu.
Somuenzaniso, chiremba wako angabata mushonga wako subclinical hypothyroidism kana iwe une zviratidzo zvakadai sokuneta, kuvhiringidzika, kana kuora mwoyo, kana iwe une chimwe chirwere chinogadziriswa, somuenzaniso, chirwere chechiliac.
Age, pamwe chete, ichaita basa mukuita chiremba wako. Kazhinji, pane chikumbaridzo chepamusoro chekutanga utachiona hwemaprojoni mushanduro yemishonga kuvanhu vakuru; izvi ndezvokuti mutsara wavo wokutanga TSH uri pamucheto wepamusoro wezvakagadzirwa.
Kuvapo kwe TPO antibodies (ona pasi apa) kunobatsirawo mukuita kwechiremba wako. Kana iwe uine subclinical hypothyroidism uye yakanaka TPO antibodies, chiremba wako angangotanga utachiona hwehutrooni, kuitira kuti kudzivisa kufambira mberi kwe subclinical hypothyroidism mu overt hypothyroidism.
Izvo zvisingawaniki kuongororwa kwepakati kana yechipiri hypothyroidism zvishoma nezvishoma. Central hypothyroidism inoratidzira chirwere chinonzi pituitary kana hypothalamus. Aya maitiro europi anotarisa chirwere chetachiona uye inogona kukuvara kubva mumakumbo, zvirwere, mahara, uye zvirwere zvinopinda sarcoidosis, pakati pezvimwe zvinokonzera.
Muchikati che hypothyroidism, TSH yakadzika kana yakasununguka uye iyo T4 isingabhadharwi inowanzova yakashata kana yakaderera.
TPO Antibodies
Positive thyroid peroxidase (TPO) inorwisa zvirwere zvinoratidza kufungidzirwa kweHashimoto's thyroiditis, iyo ndiyo inonyanya kukonzera hypothyroidism muUnited States. Aya ma antibodies anorwisa zvishoma nezvishoma chirwere chetrojeni, saka kufambiswa kwe hypothyroidism kunowedzera kuva zvishoma nezvishoma, sezvo utachiona husingakwanisi kubudisa hormone yekemikari.
Izvi zvinoreva kuti munhu anogona kuva "akanaka" TPO antibodies, asi chirwere chinowanzoitika chetachiona kwenguva yakati; Zvechokwadi, zvinogona kutora makore kuti utano hwemunhu hurambe huchienda kusvika pakuva hypothyroid. Vamwe vanhu vanotova nehutano hwakanaka hwe TPO uye havatombofambira mberi kuva hypothyroid.
Kunyange zvazvo chiremba wako asingazogoni kukubata nehutachiona mushonga mushonga wemishonga kana TPO yako inorwisa zvirwere asi TSH yako iri mukati mekuratidza ruvara rwenzira, iye angangotarisa TSH yako munguva.
Imaging
Nepo kuongororwa kweropa ndiko kuedza kukuru kwekuongorora hypothyroidism, chiremba wako anogona kuraira utachiona ultrasound kana akacherechedza (kana achingoti adire kutarisa) a goiter kana kuti mishonga yepamusoro pane kuongorora kwepanyama. An ultrasound inogona kubatsira chiremba kuti aone ukuru hwehutundu uye kana ine zvinhu zvinoshungurudza kenza. Dzimwe nguva, nenyuchi inonzi biopsy (inonzi yakanaka yakanaka inoshuva, kana FNA) inoitwa kuti iwane shanduro yemasero mukati memumvuri. Aya masero anokwanisa kuongororwa zvakanyanya pasi pe microscope.
Mumamiriro ekumusoro hypothyroidism, kufungidzira kunoitwa kuti uongorore uropi uye plandishi gland. Semuenzaniso, MRI yepituitary gland inogona kuratidza chiremara, sepituitary adenoma.
Kusiyanisa Kuziva
Zviratidzo zve hypothyroidism zvinowanzosiyana uye zvinogona kuraswa nyore nyore kana kukanganisa zvimwe zvechiremba.
Kuongororwa Kwemamwe Mamwe Kubva Mazviratidzo
Zvichienderana nezviratidzo zvako zvakasiyana, chiremba wako achakuongororai kune mamwe maitiro emishonga (kunyanya kana TSH yako yakajairika). Izvi zvinogona kusanganisira:
- Anemia
- Utachiona hwehutachiona (somuenzaniso, mononucleosis kana chirwere cheLyme)
- Vitamin D kukwana
- Fibromyalgia
- Kushungurudzika kana kufunganya
- Kurara kuputika
- Chiropa kana chirwere chetsvo
- Chimwe chirwere chekudzivirira muviri (somuenzaniso chirwere chechiliac kana rheumatoid arthritis)
Kuongororwa Kunogona Kuwanikwa Kubva muZviviso Zvekutsvaga Ropa
Kunyange zvazvo kunyanya hypothyroidism ndiyo inonyanya kukonzerwa neTSH yakakwirira, pane zvimwe zvinosarudzwa chiremba wako acharamba achifunga. Semuenzaniso, zvirwere zvehutachiona zvehutachiona zvinotsigira kuongororwa kwepakati pe hypothyroidism zvingangove zvichibva kune zvisiri izvo zvisiri izvo.
Nonthyroidal lllness
Vanhu vari muzvipatara vane chirwere chakakomba kana vakawana mapfupa emapfupa, kuvhiyiwa kukuru, kana chirwere chemwoyo kunogona kuva nehutachiona hunoshandiswa ropa kuongororwa zvinoenderana nekati central hypothyroidism (yakaderera TSH uye yakadzika T4) -kudaro, "chirwere chisina kuchena" hachiiti kwete kazhinji kubvumirwa kushandiswa.
Muchiitiko ichi, kuenzanisa kuongorora ropa kunonzi reverse T3, metabolite yeT4, inogona kubatsira pakusiyanisa pakati pechokwadi pakati pee hypothyroidism uye chirwere chene nonthyroidal. Chimwe chetatu T3 chakasimudzwa mune chirwere che-nonthyroidal.
Mune zvirwere zve-nonthyroidal, utachiona hwehutachiona hwehutachiona hunofanira kumira kana munhu achidzoka kubva kurwere hwavo. Kunyange zvazvo, vamwe vanhu vanogadzira TSH yakakwirira mushure mokunge vadzikinura. Mune vanhu ava, kudzokorora TSH mumavhiki mana kusvika matanhatu kunowanzobudisa TSH yakawanda.
Kusarudzwa kweAdrenal Insufficiency
Hypothyroidism uye adrenal insufficiency inogona kugara pamwe chete, sezvavari kuita munharaunda isingawanzozivikanwa inonzi autoimmune polyglandular syndrome. Iyi chirwere chinokonzerwa nemagadzirirwo emagetsi anosanganisira zvipembenene zvakawanda, kunyanya chirwere chetroroid (zvichikonzera hypothyroidism) uye adrenal glands (zvichikonzera adrenal insufficiency).
Imwe yenjodzi huru inobatanidza neiyo syndrome inobata hypothyroidism (inopa utachiona hwemishonga inoshandiswa kune imwe nzvimbo) isati yatora unyengeri (izvo zvinoda kurapwa korticosteroid), sezvo izvi zvingaguma nehupenyu hunotyisa dambudziko. Zvinosuruvarisa nehurwere iyi, hunyengeri hungave husisipo nekuda kweTSH yakakwirira uye zviratidzo zvisinganzwisisiki zvinowanikwa neavo vanoonekwa mu hypothyroidism.
TSH-inobudisa Pituitary Adenoma
Kana TSH yakakwirira, zvakakosha kuti T4 isingabhadharwi inotariswa zvakare. Mukutanga hypothyroidism, iyo T4 yakasununguka inofanira kuva yakaderera, asi kana munhu ane TOR-secreting pituitary tumor, iyo T4 isina kubhadhara ichakwiridzirwa.
> Sources:
> American Thyroid Association. (2013). Bhuku Revarwere Nemhuri Yadzo .
> Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL / Wolters Kluwer; 2012.
> Garber J et al. Clinical Practice Guidelines for Hypothyroidism muVakuru: Cosponsored neAmerican Association of Clinical Endocrinologists uye American Thyroid Association. Endocrine Dzidzira . 2012 Nov-Dec; 18 (6): 988-1028.
> Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Ndiye Chiremba weNzara. 2012 Aug 1; 86 (3): 244-51.
> Upala S, Yong WC, Sanguanke A. Primary adrenal insufficiency isingazivikanwi se hypothyroidism mune murwere ane polyglandular syndrome. N Am J Med Sci . 2016 May; 8 (5): 226-28.