Hypothyroidism (utachiona hwehutachiona husina simba) chirwere chakakomba chirwere chinogona kukukanganisa hutano hwako. Mukuwedzera pane nguva dzose zvichikonzera zviratidzo zvakawanda zvinotambudza (kusanganisira kuwedzera kuwanda, bvudzi uye ganda rinoshanduka, kuvhiringidzika kana chirwere, kushaya simba, kuneta, uye aches nemarwadzo), hypothyroidism inogonawo kubudisa zvinetso zveutano zvakakomba zvinosanganisira mwoyo nemapapu, chirwere chepachiviri, nervous system, maziso, uye mishonga.
Mukuwedzera, zvinogona kukonzera kushanduka kwemashoko akasiyana-siyana kusanganisira hyponatremia (low serum sodium concentrations), yakakwirira yeklesterol , uye inowedzera mu serum creatinine (chiyero chepfungwa basa). Kunyanya hypothyroidism inogona kukonzera kuchinja kwekuziva, kufara, uye kufa.
Kana uine hypothyroidism, zvakakosha kwauri iwe nachiremba wako kuti uwane zvakakwana mamiriro acho ezvinhu kuitira kuti usununguke zviratidzo zvako, uye kuderedza uye kudzivirira izvi zvinetso zveutano zvakasiyana-siyana.
Ndeapi Zvinangwa Zvokurapwa?
Zvinangwa mukurapa hypothyroidism hazvisi nyore. Vari:
- kuti kuve nehutachiona hutachiona hwehutoni (kunyanya, T4, T3 uye TSH mazinga)
- kubvisa zviratidzo zve hypothyroidism
- kumira uye kuchinja chero mimwe miviri ye hypothyroidism inogona kunge iri pane dzimwe nhengo dzehutano
- kana hoita iripo (sezvinowanzoitika kune chirwere chaHashimoto , somuenzaniso), kuderedza huwandu hwayo
Kurapa Kwakaitwa Sei?
Papepa, kurapa kwe hypothyroidism kwakanaka chaizvo.
Iyo inorapwa nekurondedzera chirwere chetachiona chekugadzirira (kanowanzo levothyroxine, inotengeswa seSyroid , T4 kugadzirira), yehuwandu hunokwana kudzorera hutachiona hwehutachiona hwehutachiona, husina kubudisa tsvina kubva kune utachiona hwakawanda hwetachiona.
Zvisinei, mukuita zvakanakisisa kurapwa kwe hypothyroidism kwakaita kuti pave nekukakavara kwakakwana.
Nharo huru idzi mbiri:
- Iwe unofanira kudzikisa zvakadini mazinga TSH usati wafunga kuti hypothyroidism inofanirwa kurapwa zvakakwana?
- Kutora T4 ndoga kukwana here, kana kuti T3 inofanirawo kurongerwa?
(Kuti uchengetedze mahomoni ehutachiona zvakananga, verenga kuongorora kwakakurumidza kwetachiona gland, T4, T3, uye TSH .)
Tichakurukura zvose izvi zvepikisano mushure mokunge tatanga kutarisa "standard" therapy for hypothyroidism.
The 'Standard' Kuchirwa kweHypothyroidism
Endocrinologists (nyanzvi mune zvinetso zvehomoni) inenge yose inokurudzira kurapa hypothyroidism neT4 chete. Muvana vaduku, vane hutano vanachiremba vanowanzotanga neinofungidzirwa kuva "chizoro chechigadziriswa" cheT4 (kureva, chiitiko chinofanirwa kudzorera zvachose utachiona basa kurarama). Zvose zvinogadziriswa zvichienzaniswa nehutano hwemuviri, anenge 1.6 mcg nekg. Kune vanhu vakawanda izvi zvichava pakati pe50 ne200 mcg pazuva.
Muvanhu vakwegura kana vanhu vane chirwere cherononic , chirango chetachiona chinotsiviwa chinowanzoitwa zvishoma nezvishoma; kutanga na 25-50 mcg zuva rega rega, uye kuwedzerwa kuwedzerwa kwenguva.
Vanhu vanofanira kutora T4 musina chinhu chisina chinhu, kunze kwekuti kushandiswa kwemishonga kuchave kusina kujeka.
Kazhinji, vanachiremba vanokurudzira kutora mishonga yekutanga chinhu chamangwanani, saka kumirira kweawa imwe kuti vadye kudya kwemanheru (kana kuti kunyange kunwa kofi). Kutora mishonga panguva yekurara, maawa mashomanana mushure mekudya kwekupedzisira, inoonekwawo kushanda, uye inogona kuva nzira yakanakisisa yevanhu vazhinji. Verenga zvakawanda pamusoro penguva yekutora mishonga yehutano .
TSH mazinga anoongororwa kuti abatsire kugadzirisa chido cheT4. TSH-thyroid inokurudzira hormone-inobudiswa munharaunda yepituitary mukupindura maitiro ehomoni yekemikari. Saka, apo utachiona hweHormon huri pasi (sezvinonzi hypothyroidism), mazinga eTSH anopindura nekuwedzera, mukuedza "kurova" mamwe hosiyo yekemikari kubva muhutano hwetroroid.
Apo hypothyroidism inogadziriswa zvakakwana, mazinga eTSH anowanzodzokera kumashure kusvika muhutano hwakanaka. Saka, chinangwa chikuru mukugadzirisa chirongwa chakanaka cheT4 ndechekuyera mazinga eTSH .
Kunyange zvazvo zviratidzo zve hypothyroidism zvinowanzotanga kugadzirisa mukati memavhiki maviri ekutanga kurapwa, zvinotora anenge mavhiki matanhatu kuti mazinga eTSH agare. Saka, mazinga eTSH anowanzoverengwa mavhiki matanhatu mushure mekunge kurapwa kwatanga. Kana TSH ikasara pamusoro pezvinangwa, chirwere cheT4 chakawedzerwa ne12-25 mcg pazuva, uye mazinga eTSH anodzokororwa mushure memamwe matanhatu masvondo. Iyi nzira inoenderera mberi kusvikira tishini yeTSH yasvika pakatarisa, uye zviratidzo zvinogadziriswa. Kana imwe nguva yakakwana yeT4 yakagadziriswa, mazinga eTSH anoyerwa gore roga roga kana kuti shure kweizvozvo, kuti ave nechokwadi chokuti kurapa kunoramba kuri nani.
Kune maitiro akasiyana-siyana eT4 akaitwa nevashambadzi vakasiyana. Kunyange zvazvo maitiro ose eDAA anobvumidzwa kuti akakodzera, nyanzvi dzakawanda dzinokurudzira kuti dzirambe dzichigadzirisa kushandiswa kumwe chete, uye kwete kushanduka, sezvo kuenzaniswa kweiyo kunogona kusiyanisa zvimwe pakati pezvakagadzirirwa zvakasiyana.
Izvi, zvino, ndiyo nzira yakakwana yokurapa hypothyroidism, uye zvakare, yakajeka chaizvo. Zvinoratidzika kushanda kune vanhu vazhinji; ndiko kuti, iyi nzira yekurapa inoguma mukugadzirisa kwezviratidzo uye kudzorerwa kwemaitiro ehutachiona ehutachiona muvanhu vakawanda vane hypothyroidism.
Asi kwete mune zvose. Uye apa ndipo panopinda nharo.
Kakavhiringidza: Ndeipi Chinangwa Chakanaka cheTSH?
Sezvatakaona, kuyera mazinga eTSH ndeyekuita basa rekuongorora kuwanika kwehutano hwekuchinja hutachiona.
Asi havasi vose vanobvumirana kuti "zvakanakira" ndezvei TSH mazinga . Mazhinji evanhu makuru ekupedzisira ekupedzisira vanofunga kuti hutano hwakanaka huri pakati pe 0.5-4.5 (kana kunyange 5.0) mIU / L. Zvisinei, boka guru rinopesana (iAmerican Association of Clinical Endocrinologists) rakaratidza kuti huwandu hwepamusoro hwemazuva ose hunofanira kunge hwakaderedzwa kusvika ma 3.0 mIU / L. Vanhu vane mazinga eTSH ari akakwirira kudarika iyo yekumusoro-soro, ivo vakati, inogona kunge iine hypothyroid.
Mubvunzo uyu unokosha pane zvikonzero zvakawanda, asi (sezvatakaona) chimwe chazvo ndechekuti, pakuchengeta hypothyroidism, zvinokosha kuziva kana TSH iyo iri apo pane kurapa inowanzoenderana, kana kwete. Kana iwe wakabatwa neTSH muzinga we 4.2 mIU / L, maererano nehuwandu hwema endocrinologist iwe unobatwa zvakanaka; asi maererano nehuwandu hunokosha iwe unoda imwe yepamusoro yehomoni yehomoni.
Saka, kupopotedzana uku kunowanzogona kukonzera kurapa kwe hypothyroidism.
Kakavhiringidzika: Iko T4 Iga Ndega Yakakwana Here Kana Kuti T3 Inofanira Kupiwa?
T4 ndiyo yakakura inotenderera hutoni, asi haisi iyo hormone inoshanda. T4 inoshandurwa kusvika kuT3 mumatumbu, sezvinodiwa. Uye T3 ndiyo hormone yehutori inobata basa rose. (T4 "inongova" prohormone-imwe nzvimbo yeT3, nzira yekugadzirisa zvakakwana T3 inogona kusikwa paminiti-miniti zvichienderana nezvinodiwa.)
Apo patinopa T4 uye kwete T3, tiri "kuvimba" mishonga yemunhu ane hypothyroidism kushandura chikamu chakanaka che T4 kusvika kuT3, panzvimbo yakakodzera, uye panguva yakakodzera. (Izvozvi, iyi ndiyo inofanirwa kuti endocrinologists inoshandisa kupa T4 oga-muviri uno "unoziva" zvakanakisisa apo uye paunoda T3, uye chero bedzi iwe uchigovera nawo zvakakwana T4 ichaita basa rakakodzera.Vanenge vanopa vana T3 kunze kweT4, ivo "vechipiri vanofungidzira" muviri wemuviri wavo.)
Zvisinei, huwandu hunoratidza humwe humwe hwakagadzirwa hunoratidza kuti, zvichida mune vamwe vanhu vane hypothyroidism, iyo inoshandiswa kutendeuka kweT4 kusvika kuT3 inoshaikwa. Mune mamwe mazwi, pasinei nokuti mazinga avo ane T4 angave akaenzana, mazinga eT3 angave akaderera-kunyanya mumatutu, uko T3 chaizvoizvo inoshanda basa rayo.
Chikonzero nei T4 kusvika kuT3 kutendeuka kungave kusinganzwisisiki mune vamwe vanhu, panguva ino, kunyanya kufungidzira-kunyange boka rimwe revarwere rave richizivikanwa nerudzi rwemajini (mu diodinase 2 gene) iyo inoderedza kutendeuka kweT4 kusvika kuT3. Chero mamiriro ezvinhu, zvinoita sokuti vanachiremba vanofanira kunge vachirapa vamwe vanhu vane hypothyroidism pamwe chete neT4 neT3.
Kupa zviyero zvakakodzera zveT3 zvakakosha kudarika zvakakodzera kuisa T4. T4 haina kushanda; kana iwe uchipa zvakawanda hazvive pakarepo, zvakananga mutsara (sezvo inofanirwa kuchinjwa kusvika T3 tisati matanho achinetseka). T3 imwe nyaya yakasiyana; iyo inoshandisa utachiona hwehomoni, saka kana iwe ukapa zvakawanda, unogona kubudisa zvinokonzera hyperthyroid zvakananga-njodzi, somuenzaniso, kuvanhu vane chirwere chemwoyo.
Paunowedzera T3 kusvika kune T4 panguva yehutori inotsiva therapy, nyanzvi dzakawanda dzinokurudzira kutungamirira chiyero cheT4: T3 kubva pakati pe13: 1 kusvika ku16: 1, iyo inonzi iripo kune vanhu vasina chirwere chetachiona. Ichi ndicho chikamu chepamusoro che T4: T3 kupfuura yakashandiswa mumatareji akawanda emakiriniki.
Miedzo yeRandomized kuenzanisa migumisiro neT4 chete kusvika kuT4 + T3 kazhinji haina kuratidza kubatsirwa kwakanyanya mukushandiswa kwemaawa ekubatana muvanhu vanorwara ne hypothyroidism. Zvisinei, miedzo iyi yakanga isina kugadzirirwa kubhadharira mukana wekuti mikana yekurapa pamwe chete inogona kukwaniswa kune chimwe chikamu chevanhu vane hypothyroidism. Uye pasinei nekushayikwa kwechikwata chechipatori chakasimba uchapupu, zvese vese nyanzvi zvino vanobvumirana kuti pane zvechokwadi vamwe vanhu vane hypothyroidism vanofanirwa kugamuchira zvose T4 neT3.
Kurapa Hypothyroidism: Nzira Yakanaka
Tichipiwa zvatinoziva nezve hypothyroidism, TSH mazinga, uye ukama huripo pakati peT4 neT3, kune nyanzvi dzakawanda nzira yakakodzera yekurapa kwechiitiko ichi chinoratidzika seizvi:
Tanga ne "svondo" nzira, uchishandisa mishonga T4 chete, kunyatsotarisa mazinga maviri eTSH uye nehuwandu hwekusunungurwa kwechiratidzo, uye kugadzirisa muyero weT4 zvakakodzera. Kune vanhu vakawanda, nzira iyi inoshanda zvakanaka.
Kana zviratidzo zve hypothyroidism zvichiramba dzichiri pasinei nekuwana TSH mazinga mu-high-normal range (kureva, pamusoro pe 3 mIU / L asi pasi pe 5.0 mIU / L), kana zvimwe kana mbiri mbiri nzira dzakasiyana dzinofanira kuonekwa:
1) Kuwedzerwa chiyero cheT4 zvakakwana kuti shandise chikwata cheTSH kusvika pasi pemamiriyoni matatu / L.
2) Wedzera T3 kumagadziro ekurapa, nekutarisira kwakakodzera.
Asati asarudza mamwe maitiro maviri, nyanzvi dzakawanda dzinokurudzira kuenzanisa serum T3 mazinga, nekunyora kuti vanoramba vari pedyo nechokumucheto kwechirevo chenguva yakareba, kana pasi. Kana T3 mazinga ari pakati-kusvika-akakwirira zvakasiyana-siyana, hazvina mubvunzo kuti kuwedzera T3 kumagadziro ekurapa kuchavandudza zvinhu. ( Verenga zvakawanda pamusoro pekuyera utachiona hwehomoni .)
Saka: Kana iwe uri kurapwa nokuda kwe hypothyroidism uchishandisa nzira "yepamusoro" uye zviratidzo zvako hazvina kuderedzwa zvakanyanya, iwe unoda kutaura nachiremba wako pamusoro pekuona imwe kana kuti idzi mbiri idzi dzimwe nzira.
Shoko Rinobva
Mushonga we hypothyroidism zvirokwazvo chaizvo zvakananga, zvichida munyaya. Uye kune vanhu vazhinji vane chirwere ichi, nzira yakarurama, "yakakwana" nzira yekurapa inoshanda zvakanaka chaizvo.
Asi kana nzira yakasununguka isina kubvisa zviratidzo zvako zve hypothyroidism, inguva yekutarisa "isingaenzaniswi," kushandiswa kweimwe nzira-kana kukwidza mazinga eTSH achiwedzera pasi mukati memazuva ose, kana kuwedzera T3, kana maviri.
> Sources:
> Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, et al. KUCHOKURUKURWA: Kurapa kweHyspothyroidism Nekubatanidza kwaEevothyroxine Plus Liothyronine. J Clin Endocrinol Metab 2005; 90: 4946.
> Jonklaas J, Bianco AC, Bauer AJ, et al. Mirayiridzo yeUrapa weHypothyroidism: Yakagadzirirwa neAmerican Thyroid Association Task Force paTroroid Hormone Replacement. Thyroid 2014; 24: 1670.
> Panicker V, Saravanan P, Vaidya B, et al. Kusiyanisa Kufanana muDIO2 Gene Inofanotaura Baseline Psychological Well-Being uye Kupindura Kusanganiswa Thyroxine Plus Triiodothyronine Therapy muHypothyroid varwere. J Clin Endocrinol Metab 2009; 94: 1623.