Domin fiye da shekaru 40, hanyar da ta dace don magance hypothyroidism shine don samar da kwayar cutar maye gurbin maganin hormone mai levothyroxine (watau Synthroid, Levoxyl); tare da manufar tabbatar da cewa matakin TSH yana cikin layin kewayawa. An yi la'akari da wannan cikakken maganin yanayin.
Ka'idar bayan wannan magani na al'ada shi ne cewa maganin levothyroxine-wani nau'i na roba na thyroxine (T4) wanda aka haifar da glander thyroid - zai samar da isasshen T4, mayar da shi zuwa al'ada thyroid aiki-da aka sani da euthyroidism - da kuma warware duk thyroid- related cututtuka.
Yawancin masu aikin kirki, ciki har da masanin kimiyyar maganin Dr. Anthony Weetman , sun bayyana cewa marasa lafiyar da suke da "gwajin gwajin maganin thyroid" amma sun dage cewa ya kamata a bi da su saboda yawan cututtukan kawo ko wadanda ke ci gaba da bayyanar cututtuka suna da "disorders disorder". (Datomattun maganganu an bayyana a cikin dictionaries na likita kamar "cututtuka na zuciya wanda aka nuna ta hanyar gunaguni na jiki, wanda ba'a gano kwayoyin halitta ko ilimin lissafi ba, wanda kuma akwai yiwuwar cewa abubuwan da ke cikin kwakwalwa suna da hannu.")
Glandar thyroid gilashi ta haifar da amfanoni masu yawa, ciki har da horroone thyroxine (T4) da hormone triiodothyronine (T3). Mafi yawan hormone da glandon ya haifar shine T4, amma T4 dole ne a canza cikin jikin zuwa cikin T3 hormone mai aiki don ya sami tasiri akan jikinka. Mashahurin karfi da rinjaye shi ne cewa hypothyroidism ya kamata a kula da shi kawai tare da levothyroxine-wani lokacin ana kiransa LT4 monotherapy ko levothyroxine monotherapy-a kwayoyin da za su haifar da kasancewa mai tausayi, tare da matakan TSH da ke fadi a cikin maƙallin kewayawa.
Wannan ikirarin yana da'awar cewa lokacin da T4 ke da isasshen, jiki zai kasance mai isa T3.
Duk da yawancin wannan imani da magani na musamman, shekaru da yawa wasu marasa lafiya na kawo sun kara kara game da gaisuwar levothyroxine wajen magance alamun su. Masu bincike sunce kimanin kashi 15 cikin dari na marasa lafiya suna ci gaba da shawo kan cutar ta hypothyroidism duk da levothyroxine magani.
Sakamakon binciken masu maganin karoid sun nuna cewa lamba yafi girma .
Sakamakon binciken
Don bincika ko sake mayar da matakin TSH zuwa layi na amfani da amfani da levothyroxine, masu bincike a Rush University Medical Center dake Birnin Chicago sunyi nazarin kwatanta ƙungiyar masu kula da marasa lafiyar, ba tare da shaidar alamun maganin karoid ba, tare da ƙungiyar mutanen da suka an magance su tare da levothyroxine don hypothyroidism. An ruwaito sakamakon a cikin watan Oktobar 2016 na Journal of Clinical Endocrinology da Metabolism .
Sakamakon ya kasance mamaki. Binciken ya gano cewa:
- Kungiyar levothyroxine ta samu kashi 20 cikin dari bisa girman matakan TSH, kashi 10 cikin dari na matakan T3 marasa kyauta, da matakan T3 kashi 15% idan aka kwatanta da ƙungiyar kulawa.
- Ƙungiyar levothyroxine da aka kula da ita sun kasance mafi girma da yawa, duk da cewa sun bayar da rahoton yawancin calories a kowace rana. Sun auna kimanin fam guda 10, duk da ƙin calories kadan kadan a kowace rana.
- Ƙungiyar levothyroxine ta biyo baya shine sau 1.6 ke iya ɗaukar beta-blockers, wanda aka saba amfani dasu don magance cutar hawan jini.
- Ƙungiyar levothyroxine ta biyo baya sau 1.5 ne mai yiwuwa ya dauki magungunan statin, wanda ake amfani da shi don magance ƙananan cholesterol.
- Ƙungiyar levothyroxine da aka kula da ita shine sau 1,46 da zai iya daukar magungunan antidepressants.
- Ƙungiyar levothyroxine ta yi rahoton ba ta da karfi sosai a jiki fiye da rukuni.
- Ƙungiyar levothyroxine ta biyo bayanta sun ruwaito kwanakin da suka gabata a watan da ta gabata inda suka ji lafiyar jiki da tunanin mutum "ba kyau ba."
Theories
Masu binciken sun ce suna da ra'ayoyi guda biyu game da dalilin da ya sa - duk da cewa suna fama da matakan TSH a cikin ragamar tunani - ƙungiyar levothyroxine da aka kula da ita ba ta da lafiya kamar yadda aka auna ta hanyar da dama sigogi, kuma me yasa levothyroxine kansu sun ruwaito cewa basu " Ina jin dadi sosai fiye da ƙungiyar kulawa.
- Wata ka'ida ita ce, duk da matakin TSH na yau da kullum, matakan T3-hormone mai aiki-bazai zama cikakke ba, saboda T4 bai isa ya canza cikin T3 ba.
- Wata ka'ida ta biyu ta nuna cewa matakan T3 da za su kai ga kwayoyin halitta bazai iya nuna su ba ta hanyar gwajin TSH ko T4, saboda ayyukan deiodinases, wanda ke taka rawar a cikin tsari na T4-to-T3.
Masu binciken sun kammala rubutun labarin mujallo tare da wannan sharuddan:
Maganar cewa kafa wata al'ada ta al'ada TSH ta sa mutane a kan (levothyroxine) monotherapy na ƙwayar ƙwaƙwalwar ƙwayar cuta ya kamata a sake dawowa kuma ingancin matakan rai ya kamata a fi mayar da hankali a cikin bincike na hypothyroidism da jagororin sana'a.
Ƙarin Karin Ilimin Daga Nazarin Nazarin Antonio Bianco, MD
Ɗaya daga cikin marubucin binciken, Antonio Bianco, MD, tsohon shugaban kasar Amurka na Thyroid Association, kuma Farfesa a Jami'ar Rush, ya ba da wata hira ga MedicalResearch.com. A cikin wannan hira, ya bayyana wannan binciken:
A fuskar darajar binciken yanzu yana nuna cewa daidaitawar matakan TSH a hypothyroid marasa lafiya bazai kasance da amfani ba kamar yadda aka yi la'akari don saka idanu. Duk da matakan TSH na yau da kullum, marasa lafiya suna da mummunar haɗari na ciwon ciki da rashin ciwon daji na halin da ake ciki da kara yawan nauyin jiki da ƙananan ƙwayoyin cholesterol ... Munce cewa ta hanyar daidaita tsarin jini na TSH dukkanin bayyanar cututtuka da suka shafi hypothyroidism ya kamata su tafi . Wannan mai yiwuwa yana bukatar canzawa.
A cikin wata sanarwa game da binciken, da Cibiyar Harkokin Kimiyya ta Jami'ar Rush ta bayar, inda aka gudanar da bincike, Dr. Bianco ya ce:
Duk da yake manufar maganin kiwon lafiyar shi ne tabbatar da lafiyar marasa lafiya, ba a yi amfani da bayyanar cututtuka ba don yin la'akari da rashin lafiya. Tsarin TSH na jini. A wasu kalmomi, an gyara kashi na levothyroxine dangane da matakan TSH kuma ba ko ko mai lafiya ya ji daɗi ba ... Abu mai mahimmanci ya fahimci cewa T4 ba hormone ne ba. T4 dole ne a canza zuwa T3 ta jikinmu tare da enzyme da ake kira deiodinase.
Magunguna suna koka da kasancewar raunana, jinkirin kuma suna da hankali. Suna da wahalar rasa nauyi. Suna koka da jin dadi kuma suna da ƙasa da makamashi. Duk da haka muna likita sun ci gaba da gaya musu, "Ina ba ku magani mai kyau kuma TSH din na al'ada ne.
Wadannan binciken sunyi daidai da abin da marasa lafiya suka gaya mana. Wannan binciken na farko, a cikin hanyar da ba a yarda ba, wadanda marasa lafiya a kan levothyroxine sunyi mummunan rauni kuma suna da matukar aiki fiye da masu sarrafawa, suna nuna halayen ƙwayoyin cardiometabolic duk da ciwon matakan TSH na yau da kullum.
Dr. Bianco yana daya daga cikin shugabannin a cikin motsi don bincike ko cutar kwayoyin cutar a wasu marasa lafiya zai iya ɓarna aikin deiodinase kuma ya ɓata T4-to-T3 musanya, da kuma ko tarin T3 zuwa levothyroxine monotherapy na iya haifar da kyakkyawan tsari na bayyanar cututtuka, halayyar rai mai kyau, da kuma inganta sigogin lafiya don wasu mutane da ake bi da su don hypothyroidism.
Dokta Bianco ya bayyana a fili cewa ya yi imanin cewa mafi mahimmancin magunguna ne ake bukata don magance hypothyroidism. A halin yanzu, ya ba da shawarar cewa likitoci sun fita daga gargajiya, "sauƙin magancewa, dauki wannan kwaya kuma za ku kasance lafiya" kusa da magani, kuma a maimakon haka, yi wani daban-daban hanya a lokacin da shawara marasa lafiya game da hypothyroidism magani. A cewar Dr. Bianco:
Doctors ya kamata su gaya wa marasa lafiya, "Zan ci gaba da daidaita ka'idar TSH, amma za ku kasance cikin haɗari mafi girma don samun nauyin nauyi, fama da damuwa da kuma gajiya." Kuma ya fi dacewa cewa cholesterol zai tafi. " Wannan shine abin da ya kamata mu gaya wa marasa lafiya, bisa ga bincikenmu.
Abin da Wannan Bincike Na Neman Ka
Shekaru biyu da suka gabata, masu bada shawara na haƙuri da wasu masu aiki suna cewa levothyroxine monotherapy ya kamata ba wai kawai zaɓi ba. Duk da yake yana aiki ga wasu mutane da hypothyroidism, wani ɓangare mai mahimmanci na marasa lafiya har yanzu ba sa jin dadi, koda yake an kula da su tare da levothyroxine, kuma ana ganin su da tsauraran matakan TSH "na al'ada," bisa ga gwajin jini.
Dokta Bianco na ƙaddamar da bincike da kuma samar da shaida game da yiwuwar bukatun T4 / T3 a cikin wani ɓangare na marasa lafiya na hypothyroid duka suna da alhaki kuma sananne. Kuma a, kamar yadda Dokta Bianco ya ce, ana buƙatar magunguna mafi kyau don magance hypothyroidism.
A halin yanzu, duk da haka, akwai wani zaɓi ga marasa lafiya cewa Dokta Bianco ba a ba da shawara ba. Zaka iya gwada gwajin T3 ɗinku kyauta, kuma idan yana da ƙananan ko ba mafi kyau ba, za ku iya yin aiki tare da wani mai aiki wanda zai iya ƙara magungunan T3 - irin su Cytomel (liothyronine), ko ƙaddarar rigakafi, maganin sa, - don maganinku, ko kuma wanda zai rubuta wani abu na ainihi wanda ke da ƙwayar maganin thyroid kamar Nature-throid ko Armor Thyroid a gare ku.
> Sources:
> Hira da Antonio Bianco, MD. MedicalResearch.com. Oktoba, 14, 2016.
> Cibiyar Magunguna ta Rush. Sanarwa: Tsarin hypothyroidism alamun yaduwa duk da amfani da magani, gwajin jini na al'ada. Oktoba 12, 2016. Kimiyya Daily.
> Sarah J. Peterson, Elizabeth A. McAninch, Antonio C. Bianco. Shin al'ada ta TSH ne da "Euthyroidism" a Levothyroxine Monotherapy? Jaridar Clinical Endocrinology & Metabolism, 2016; jc.2016-2660