Duba kallon Thyroid, Levothyroxine, da kuma Sabbin Maganin Nishaji
Masanin bincike mai suna Dr. Wilmar Wiersinga, a cikin watan Janairu 2014 na mujallolin ilimin lissafin Labaran Bayani na Endocrinology , yana da fassarar ban sha'awa na wasu daga cikin mahimman tsari wanda ke canzawa a tsarin maye gurbin hormone wanda ke maye gurbin hypothyroidism a cikin 'yan shekarun nan. Na taƙaita wasu daga cikin abubuwan da suka fi ban sha'awa na labarin.
Shirye-Shirye Hudu na Bakwai guda huɗu
Dokta Wiersinga ya gano fassarar huɗun mahimmanci.
- Sanya na farko: Shirin Hypothyroidism bai kasance ba sai a 1891 a London, Dokta George Murray ya juya mai tsauraran jini a cikin mai haƙuri ta hanyar yin watsi da tumakin tumakin thyroid. Daga bisani, ƙasa ko gurasar tumakin tumakin ko allunan da aka fara da ƙwayar thyroid ya fara amfani dashi a matsayin farko na farfadowa na likita don hypothyroidism.
- Fasali na biyu: Daga shekarun 1960 zuwa 1988, amfani da kwayoyin cututtukan kwayoyin da ke cikin kwayar karoid sun ki yarda, saboda amfani da levothyroxine ya karu. A shekara ta 1978, adadin lambobin levothyroxine sun wuce ka'idoji marasa kyau. A shekara ta 1988, kashi 84 cikin dari na duk marasa lafiya suna shan levothyroxine.
- Shirye-shiryen na uku: Dokta Wiersinga ya bayyana yadda gwajin dabbobi daga shekarun 1990 sun nuna cewa euthyroidism - cimma matakai na T4 da T3 daidai a cikin kyallen jikin jiki - bayan an cire glandan thyroid gishiri a kan levothyroxine kadai, amma kuma ya buƙatar riko (T3) . Magunguna da masu aiki sun bayar da rahoton cewa marasa lafiya sun fi kyau tare da tarin T3, ko kuma a kan yanayin da ake ciki , amma yawancin gwaje-gwaje da bincike da aka gudanar a wannan lokacin ba su sami cikakkiyar tabbacin cewa hanyoyin haɗin gwiwa sun kasance m. Dokta Wiersinga yana nuna cewa akwai kwayoyin halitta wadanda ke sa wasu marasa lafiya suyi dacewa da maganin hade - kuma ya ce "idan ƙarin bincike zai iya gane wannan ƙungiyar ta musamman na masu cutar hypothyroid, sauya sauƙi na uku a maganin hypothyroidism na iya faruwa-watakila sanar da Amfani da magani na musamman a cikin wannan wuri. "
- Fasali na hudu : Shirin bincike na bincike na 2012 wanda aka bayyana a karo na farko da aikin aikin thyroid nama zai iya haifar da daga jikin kwayoyin halitta na embryonic. Dokta Wiersinga ya ce "wannan aikin zai iya haifar da motsawa na hudu, wanda za'a iya magance marasa lafiya na hypothyroid tare da kwayoyin ƙwayar maganin maganin kawo."
Lemothyroxine kawai jiyya
Lokacin da yake magana game da wannan yanayin, Dokta Wiersinga yayi la'akari da yin amfani da levothyroxine (T4) kawai magani . Ya nuna cewa akwai wasu karatun da suka nuna cewa maganin levothyroxine yana hade da wasu abubuwa marasa lafiya ga marasa lafiya, ciki har da:
- ƙara yawan ƙalubalen tunani
- rashin lafiya
- rage yawan lafiyar lafiyar rayuwa
- lalacewa a cikin gudunmawar hankali, hankali, ilmantarwa da ƙwaƙwalwa
- ƙara yawan yawan damuwa
- lalacewar aikin tunanin mutum, aikin ƙwaƙwalwar ajiya da kuma ilmantarwa
Musamman, a cewar Dokta Wiersinga, "Lalacewar rashin lafiyar jiki, damuwa ko damuwa a cikin 5-10% na hypothyroid marasa lafiya suna karbar levothyroxine, duk da yawan matakan TSH ."
Dokta Wiersinga kuma yayi rahotanni game da wani binciken da ya fi kyau a Scotland wanda ya gano cewa hadarin matsalolin zuciya, arrhythmias, da matsalolin kashi mai yawa sun karu da marasa lafiya tare da matakan TSH da suka rage (kasa da .03), kuma a cikin marasa lafiya da matakan TSH (sama da 4.0) amma babu wani haɗari mai haɗari da "ƙananan" matakan TSH (.04 zuwa .4).
Dokta Wiersinga ya gabatar da bincike wanda ya nuna cewa "al'amuran TSH na yanzu ba sa bada tabbacin euthyroidism a cikin dukkan kyallen da ke da nau'i na hormone thyroid." Kawai sanya: levothyroxine-kawai jiyya bazai zama mafi kyau magani ga marasa lafiya da hypothyroidism. Maimakon haka, ƙari na t3 zai iya taimakawa wajen maganin thyroid aiki a cikin dukan kyallen takarda.
Levothyroxine Plus Liothyroinine (T4 + T3)
Yawan karatun da ke kallon levothyroxine-onlyrapy, tare da Bugu da ƙari na T3 sun nuna cewa, a cewar Dokta Wiersinga, "yawancin masu karuwanci (a matsakaicin 48%) sun fi son maganin juna ... Differences a cikin magani na karshe Tsarin TSH ba zai iya bayyana wannan zaɓi na likitanci ba. "
Ƙarshe
Dokta Wiersinga ya ƙare cewa "za a iya tabbatar da hujjojin tabbatar da cewa haɗin haɗin zai iya samun amfani idan levothyroxine: ana amfani da kashi na hawan hawan hawan hamsin da sakamakon wannan a sakamakon maganganu na TSH da kuma T4 kyauta: t3 ƙaddarar ƙaddara" ko kuma lokacin da aka ba marasa lafiya wanda ke da takamaimai al'amurran kwayoyin da suka shafi ikon su na canza T4 zuwa T3.
Ya kuma bada shawarar cewa endocrinologists ya kamata a duba zažužžukan, ciki har da Bugu da kari na T3, don taimaka wa hypothyroid marasa lafiya da suke da ciwo bayyanar cututtuka duk da cewa isa isa levothyroxine allurai.
A cewar Dokta Wiersinga, wani zaɓi shine bi ka'idodi na Turai (ETA) da ake kira "gwaji" amfani da T4 + T3 farfadowa , wanda ya haɗa da rabo daga levothyroxine zuwa zumuntar zumuntar zumunta na kimanin 17: 1. labarin, "misali, TSH-normalizing dosin levothyroxine 100 μg, 150 μg da 200 μg a lokacin da monotherapy fassara a cikin maganin maganin na 85 μg levothyroxine da 5 μg liothyronine, 125 μg levothyroxine da 7.5 μg liothyronine da 175 μg levothyroxine da 10 μg liothyronine, bi da bi).
Suna kuma bayar da shawarar rabawa kowace rana T3 cikin kashi biyu (ƙaramin kashi da aka ba da safe da kuma karar da aka ba a kwanakin kwanta, ƙaddara daidai da abin da ake amfani da shi na kayan haɗin na horsethyronine na gida) don "taimakawa wajen yin amfani da ragowar circadian matakan T3 masu kyauta, wanda zai kai gabar su a karfe 3 na safe "
Har ila yau, ETA na bayar da shawarar jinkirin shirye-shirye T3.
Wasu Ƙarin Batu
Ga wasu wasu abubuwan ban sha'awa daga labarin.
Ka'idojin kula da hypothyroidism da aka buga a shekarun 1980 da 1990 sun "ba da shawara" ba da shawara ga levothyroxine (T4 na roba) kuma ba su ambaci wasu maganin maganin marasa lafiya ba. Abin sha'awa, duk sharuɗɗan kula da hypothyroidism da aka buga a shekara ta 2000 har yanzu suna bada shawarar levothyroxine a matsayin magani na kwarai, amma har ma sun ƙunshi sassan da ke nuna dalilin da ya sa ba a yi amfani da haɗin levothyroxine da na ruthyronine (T4 + T3) ba .
Akwai karuwa a magani na hypothyroidism. A Ingila, ka'idojin hormones na thyroid sun fi ninka sau biyu a tsakanin 1998 zuwa 2007. A cikin Netherlands, yawan mutanen da ke amfani da kwayoyin karamar karoid sun karu da kashi 53 cikin dari tsakanin 2005-2011 - yawan mutanen Holland sun karu da kashi 2.1% kawai a lokacin.
Yaduwar marasa lafiya da ke kan levothyroxine-only treatment ya kara dan kadan daga 2005 zuwa 2011 - kuma an sami karamin ƙãra yawan adadin marasa lafiya kan T4 + T3 magani.
Source
Wiersinga, Wilmar. "Daidaitawa na canzawa cikin maganin maganin rigakafi na thyroid hormone don maganin hypothyroidism." Yanayi Bayani Tsarin Endocrinology (2014), An wallafa shi a layi 14 Janairu 2014