A kutarisa Natural Thyroid, Levothyroxine, uye Innovative New Treatment Options
Mutsvakurudzi akakurumbira Dr. Wilmar Wiersinga, munyaya yaJanuary 2014 yebhuku rezvechiremba Journal Reviews Endocrinology , ine chiitiko chinonakidza chezvimwe zvinokosha paradigm mashizha mune utachiona hormone replacement therapy ye hypothyroidism mumakore achangopfuura. Ndapfupikisa zvimwe zvezvinhu zvinonakidza zvakanyanya zvenyaya yacho.
Ichina Paradigm Shifts
Dr. Wiersinga anotsanangura mafirimu mana makuru echidimbu.
- Kutanga Paradigm Shift: Hypothyroidism yakanga isingatambudziki kusvikira muna 1891 muLondon, Dr. George Murray akadzoka zvikuru hypothyroidism mune murwere nokupa jekisi yematokari ehutachiona. Zvadaro, pasi kana zvakabikwa makumbo ehutachi kana mahwendefa emakumbo akaomeswa ehutachiya akatanga kushandiswa seyokutanga kurapa kwakasimba kwe hypothyroidism.
- Paradigm Yechipiri Yakasimuka: Kubva muna 1960 kusvikira muna 1988, kushandiswa kwemasikirwo emasikirwo emasikirwo akatsika zvishoma nezvishoma, sezvo kushandiswa kweLevothyroxine kwawedzera. Muna 1978, nhamba yezvinyorwa zve levothyroxine zvakapfuura zvinyorwa zvezvinyorwa zvakanyorwa. Pakazosvika 1988, 84% yevarwere vose vakanga vachitora levothyroxine.
- Chechitatu Paradigm Shift: Dr. Wiersinga anotsanangura kuti mhuka dzinoedza sei kubva kuma1990 dzakaratidza kuti euthyroidism - kubudirira pakuita T4 nemazinga matatu mumatumbi emumuviri - mushure mekuvhima kubviswa kwekemikari yakakosha haigoni kuwanikwa pa levothyroxine chete, asiwo yaida liothyronine (T3) . Varwere uye vashandi varondedzera varwere vachiita zviri nani nekuwedzera kweT3, kana nezvehutachiona hwakarongeka , asi vazhinji vezviedzo uye kutsvakurudza kwakaitwa munguva ino havana kuwana kuti mishonga iyi yakakosha yakanga iri nani. Dr. Wiersinga anoratidza kuti kune mazita ezve genetic predispositions anoita kuti vamwe varwere vashandise kune hutano huri pamwe chete - uye vanoti "kana zvidzidzo zvinogona kujekesa ichi chikamu chiduku chevanhu vane hypothyroid, chirwere chechitatu chinoshandiswa mukurapa hypothyroidism chinogona kuitika-zvichida kuchiradza kushandiswa kwemishonga chaiyo mumamiriro ezvinhu aya. "
- Nhamba yechina yeParadigm Shift : A 2012 kuongorora kutsvakurudza kwakarondedzerwa kwekutanga kokushanda kwetachiona mishonga inogona kuve yakabva mumamera emumiti masero. Dr. Wiersinga anotsanangura kuti "basa iri rinogona kupedzisira rinotungamirira kuchinje chechina cheparadigm, umo hypothyroid varwere vanogona kurapwa nehutachiona-inokonzera masero emasero."
Levothyroxine Only Treatment
Mukukurukurirana nezvemafirimu, Dr. Wiersinga akatarisa zvakanyanya kushandiswa kweLevothyroxine (T4) chete kurapwa . Akataura kuti kune zviverengero zvakawanda zvinoratidzira kuti levothyroxine kurapwa inobatanidza nehuwandu hwezvakaipa kune varwere, kusanganisira:
- kuwedzerwa mupfungwa mupfungwa
- kukanganisa hukama hwakanaka
- kupera kwehutano hwehutano hwehupenyu
- kukanganiswa kwepfungwa dzepfungwa, kukurumidza, kudzidza nekuyeuka
- kuwedzera kupararira kwekuzvidya mwoyo
- murombo mupfungwa mupfungwa, kushanda chiyeuchidzo uye motokari yekudzidza
Kunyanya, maererano naDkt. Wiersinga, "Kutambura kwepfungwa mupfungwa, kuora mwoyo kana kufunganya kunoonekwa mu5-10% yevanhu vane hypothyroid vanowana levothyroxine, pasinei nehutano hwemaTSH ."
Dr. Wiersinga anotaurawo nezvekuongorora kweScottish inofadza iyo yakaona kuti njodzi dzematambudziko emwoyo, arrhythmias, uye mapfupa ehutano zvakanyanya kuwedzera kune varwere vakadzingwa TSH mazinga (pasi pe003), uye kune varwere vane mazinga eTSH akareba (pamusoro apa 4.0) asi kwakanga kusina ngozi yakawedzerwa ne "pasi" TSH mazinga (.04 kusvika .4).
Dr. Wiersinga akaperekedza tsvakurudzo iyo inoratidza kuti "maitiro akafanana eTSH maitiro haafaniri kutendesa euthyroidism mune zvese zvinokonzera hormone yekemikari." Zvimwe chete: levothyroxine-chete kurapa ingasava yakakosha kurapa varwere vane hypothyroidism. Pane kudaro, kumwe kuwedzera kwe t3 kunogona kubatsira kuisa chimiro chetachiona mumashandi ose.
Levothyroxine Kuwedzera Liothyroinine (T4 + T3)
Zvidzidzo zvakasiyana-siyana zvichicherechedza levothyroxine-chete chirwere, zvichienderana nekuwedzerwa kweT3 zvakaratidza kuti, maererano naDkt. Wiersinga, "chikwata chikuru kwazvo chevarwere (pavanenge mavhareji 48%) chakasarudza mushonga wekubatanidza ... Kusiyana mukupedzisira serum TSH mazinga haana kukwanisa kutsanangura izvi zvinoda kurapa. "
Mhedziso
Dr. Wiersinga anogumisa kuti "nharo inogutsa inogona kuitwa kuti mushonga unobatanidza ungave wakabatsirika kana levothyroxine: liothyronine dose ratios iyo inoshandiswa iyo inokonzera kuti sarum yakakwana yezinga TSH uye isunungurwe T4: pasina T3 kuenzanirana kwezvinhu" kana iyo yakapiwa kuvarwere vane nhoroondo dzemazwi dzinobata kukwanisa kwavo kutendeuka T4 kusvika kuT3.
Anorayirawo kuti endocrinologists inofanira kunge iri kutarisa pane zvingasarudzwa, kusanganisira kuwedzera kweT3, kubatsira hypothyroid varwere vane zviratidzo zvinoramba zvichiri kunyangwe vachifungidzirwa zvakakwana levothyroxine doses.
Maererano naDkt. Wiersinga, imwe sarudzo ndeyekutevera mirairo yeEurope Thyroid Association (ETA) yezvinonzi "kuedza" kushandiswa kweT4 + T3 therapy , iyo inosanganisira chiyero che levothyroxine kusvika liothyronine inenge 17: 1 Maererano ne iyo nyaya, "somuenzaniso, TSH-normalizing levothyroxine mazana e100 μg, 150 μg uye 200 μg munguva yei monotherapy inoshandura muchibatanirano chetachiona masero e 85 μg levothyroxine uye 5 μg liothyronine, 125 μg levothyroxine uye 7.5 μg liothyronine uye 175 μg levothyroxine uye 10 μg liothyronine, zvichienderana).
Vanokurudzirawo kuparadzanisa zuva rega rega T3 muviri (duku shoma inopiwa mangwanani uye muto wakakura unopiwa panguva yokurara, zvakanyatsoenderana zvichienderana nezvenzvimbo iripo inowanika liothyronine yakagadzirirwa) kushandisa kutevedzera rwiyo rwechikati vakasununguka T3 mazinga, anosvika pakakwirira pa3 am "
IETA inokurudzirawo kugadzirira kusununguka T3 kugadzirira.
Zvimwe Zvimwe Zvinofadza
Heano mamwe mazita mashomanana emamiriro ekutanga anofarira kubva munyaya yacho.
Mitemo yekurapa ye hypothyroidism iyo yakabudiswa muma1980 ne1990 "zvisina kufanira" inokurudzira levothyroxine (synthetic T4) uye haitauri chero nzira ipi zvayo yekurapa kwevarwere. Inofadza, iyo yose hypothyroidism mishonga yekurapa yakabudiswa muma2000 inoramba ichikurudzira levothyroxine seyekurapa kwakakwana, asi inewo zvikamu zvinotaura kuti nei kuunganidza levothyroxine uye liothyronine (T4 + T3) kurapwa isingafaniri kushandiswa.
Iko kuwedzera kwe hypothyroidism kurapwa. MuEngland, mitsara yehomoni yakakura yakapetwa kanopfuura kaviri kubva muna 1998 kusvika muna 2007. MuNetherlands, nhamba yevanhu vanoshandisa utachiona hwemishonga inodhaka yakawedzera ne 53% pakati pe 2005-2011 - chiDutch chiwandu chakawedzera 2.1% panguva iyoyo.
Chiyero chevarwere vari mu levothyroxine-chete kurapwa kwakaderera zvishoma kubva muna 2005 kusvika muna 2011 - uye kuwedzera kuwedzera kwechirwere chevarwere pavanogadzira T4 + T3 kurapwa.
Chinhu
Wiersinga, Wilmar. "Paradigm inoshandiswa mune utachiona hormone kushandiswa kwemishonga ye hypothyroidism." Nature Reviews Endocrinology (2014), Yakabudiswa paIndaneti 14 January 2014