Hypothyroidism (maganin thyroid) ba shi da lafiya wanda zai iya tasiri lafiyarka sosai. Bugu da ƙari, sau da yawa yakan haifar da cututtuka masu yawa (ciki har da karfin gwaninta, gashi da fata, canji ko kuma ciwon hauka), hypothyroidism na iya haifar da matsalolin lafiya na zuciya da huhu, tsarin ilimin gastrointestinal, tsarin tausayi, idanu, da tsokoki.
Bugu da ƙari, zai iya haifar da canje-canje daban-daban da suka haɗa da hyponatremia (ƙananan magani na sodium), matakan cholesterol da aka hawanta, da kuma ƙarawa cikin kwayar halittar creatinine (ma'auni na aikin koda). Harkokin hypothyroidism mai tsanani zai iya haifar da canje-canjen da aka yi, haɓaka, da mutuwa.
Idan kana da hypothyroidism, yana da muhimmanci a gare ka da likitanka don magance yanayin don taimakawa bayyanar cututtuka, da kuma magance matsalolin matsalolin.
Mene ne Manufar Jiyya?
Makasudin yin maganin hypothyroidism abu ne mai sauki. Su ne:
- to normalize thyroid hormone matakan (musamman, T4, T3 da TSH matakan)
- don kawar da bayyanar cututtuka na hypothyroidism
- don dakatarwa da kuma sake duk wani sakamako na hypothyroidism zai iya kasancewa a kan daban-daban tsarin tsarin
- idan mai goiter yana kasancewa (kamar yadda lokuta akwai lokuta tare da cutar Hashimoto , alal misali), don rage yawanta
Ta Yaya An Yi Jiyya?
A takarda, lura da hypothyroidism abu ne mai sauƙi.
Ana bi da shi ta hanyar yin amfani da shiri na hormone maganin (yawanci levothyroxine, wanda aka sayar a matsayin Synthroid , shiri na T4), na sashi wanda ya isa ya mayar da matakan hormone na al'ada, ba tare da samar da guba daga nauyin hormone mai yawa ba.
Duk da haka, a cikin aikin mafi kyau maganin hypothyroidism ya haifar da mummunar gardama.
Babban batutuwa sune biyu:
- Yaya ya kamata ya kamata ka tura matakan TSH kafin kayi la'akari da hypothyroidism da za a bi da su da kyau?
- Shin shan T4 ne kawai ya isa, ko kuma ya kamata T3 ya sanya wajabta?
(Don taimakawa ci gaba da maganin horin ganyayyaki madaidaiciya, karanta mai sauri nazari na thyroid gland shine yake, T4, T3, da TSH .)
Za mu bincika waɗannan batutuwan bayan mun fara kallo "farfadowa" maganin hypothyroidism.
Tsarin 'Standard' na Hypothyroidism
Masu binciken endocrinologists (kwararru a cikin cututtukan hormonal) kusan dukkanin duniya suna bada shawara akan maganin hypothyroidism tare da T4 kadai. A yarinya, likitoci masu lafiya za su fara da abin da aka kiyasta su zama "nauyin maye gurbin" na T4 (wato, wani kashi wanda ya kamata ya sake mayar da aikin thyroid zuwa al'ada). An kiyasta yawan maye gurbin bisa ga nauyin jiki, kimanin 1.6 mcg kowace kg. Ga yawancin mutane wannan zai kasance tsakanin 50 zuwa 200 mcg kowace rana.
A cikin tsofaffi ko mutanen da ke fama da cututtukan jini , an fara yin gyaran maganin maganin maganin thyroid a hankali sosai; fara da 25-50 mcg yau da kullum, da kuma kara sashi a tsawon lokaci.
Ya kamata mutane su ɗauki T4 a cikin komai a ciki, in ba haka ba maye gurbin magani ba zai zama daidai ba.
Yawancin lokaci, likitoci sun bada shawarar yin amfani da magani a farkon safiya, sai su jira a kalla awa daya don cin karin kumallo (ko ma su sha kofi). Samun magani a lokacin kwanta barci, da yawa daga bayan ƙayyadaddun abinci na ƙarshe, ya kuma bayyana yana aiki, kuma yana iya kasancewa mafi dacewa ga mutane da yawa. Karanta game da lokaci na shan thyroid magani .
Ana kula da matakan TSH don taimakawa wajen bunkasa kashi na T4. TSH-thyroid stimulating hormone-ana haifar a cikin glandin pituitary a mayar da martani ga thyroid hormone matakan. Saboda haka, lokacin da matakan karamar karoid din suna da rauni (kamar yadda a hypothyroidism), matakan TSH sun karɓa ta hanyar karawa, a cikin ƙoƙari na "bulala" more hormone thyroid daga glandon thyroid.
Lokacin da ake kula da hypothyroidism da kyau, matakan TSH sukan saukewa zuwa cikin al'ada. Saboda haka, babban mahimmanci akan ƙayyade mafi kyau na T4 shine auna ma'aunan TSH .
Duk da yake bayyanar cututtuka na hypothyroidism yakan fara magance cikin makonni biyu na farawa magani, yana daukan kimanin makonni shida na matakan TSH don daidaitawa. Saboda haka, matakan TSH ana auna su ne makonni shida bayan an fara fara magani. Idan matakan TSH sun kasance sama da kewayon manufa, ana ƙara yawan nau'in T4 ta 12-25 mcg kowace rana, kuma an sake maimaita matakan TSH bayan makonni shida. Ana cigaba da wannan tsari har sai matakin TSH ya kai iyakar da ake so, kuma an tabbatar da bayyanar cututtuka. Da zarar an dauki nauyin mafi kyau na T4 a kan, ana auna matakan TSH a kowace shekara ko don haka bayan haka, don tabbatar da maganin da aka gyara.
Akwai nau'o'i daban-daban na T4 da masana'antun daban daban suka yi. Yayinda dukkanin takardun FDA sun amince su dace, mafi yawan masana sun bada shawarar yin jituwa zuwa wannan tsari, kuma ba su sauyawa, tun da ma'aunin samfurori na iya bambanta da yawa tsakanin shirye-shirye daban-daban.
Wannan, to, shi ne tsarin kulawa na musamman don magance hypothyroidism, kuma a sake, yana da kyau sosai. Ya bayyana yana aiki ga mafi yawan mutane; Wato, wannan hanyar magani yana haifar da ƙudurin maganin bayyanar cututtuka da kuma gyara tsarin al'ada na thyroid hormone a mafi yawan mutane da hypothyroidism.
Amma ba a cikin duka ba. Kuma wannan ita ce inda jayayya ta shiga.
Tambaya: Mene ne Mahimman Target na TSH?
Kamar yadda muka gani, yin la'akari da matakan TSH shine babban mahimmanci a tantance ƙimar maganin maganin thyroid sauyawa.
Amma ba kowa da kowa ya yarda da abin da "daidaitaccen yanayi" yake ga matakan TSH . Yawancin al'ummomin endocrine masu yawa suna la'akari da yanayin da ke tsakanin 0.5-4.5 (ko ma 5.0) mIU / L. Duk da haka, babbar ƙungiya mai kunyatarwa (Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Amirka) ta bayyana cewa mafi girman yanayin al'ada ya kamata a rage zuwa 3.0 mIU / L. Mutanen da ƙimar TSH sun fi girma fiye da wannan iyakar, sun ce, na iya zama hypothyroid.
Wannan tambaya yana da mahimmanci ga dalilan da dama, amma (kamar yadda muka gani) daya daga cikinsu shi ne cewa, lokacin da ake magance hypothyroidism, yana da muhimmanci a san ko matakin TSH yayin da yake farfadowa a cikin al'ada, ko a'a. Idan matakan TSH da aka bi da ku na 4.2 mIU / L, bisa ga yawancin masu aikin likita na al'ada da aka kula da ku da kyau; amma bisa ga babban mahimmancin kalamai kana buƙatar wani kashi mafi girma na hormone thyroid.
Sabili da haka, wannan rikicewar rikicewa na iya sauƙaƙa yawan maganin hypothyroidism.
Tattaunawa: Shin T4 kadai ne ya dace ko ya kamata a ba T3?
T4 shi ne babban yaduwa da hormone thyroid, amma ba hormone mai aiki ba ne. T4 an canza zuwa T3 a cikin kyallen takarda, kamar yadda ake bukata. Kuma T3 shine hormone thyroid wanda yake aikata duk aikin. (T4 ne "kawai" wani tsari-mai tantancewa na T3 mai yiwuwa, hanyar da za ta tabbata cewa T3 za a iya ƙirƙirar a minti daya zuwa minti daya kamar yadda ake bukata.)
Idan muka ba T4 kuma ba T3 ba, muna "dogara" da kyallen takalmin mutum da hypothyroidism don canzawa kawai adadin T4 zuwa T3, a daidai wuri, kuma a daidai lokaci. (A gaskiya, wannan mahimmancin mahimmancin endocrinologists yayi amfani da bada T4 kadai-jiki "ya san" mafi kyawun lokacin da kuma inda yake buƙatar T3, kuma idan dai kuna samar da shi da isasshen T4 zai yi aiki daidai. Baya ga T4, su ne "zancewa na biyu" jikin jiki na jiki.)
Duk da haka, an gabatar da hujjojin shaida mai yawa cewa, a kalla a wasu mutane da hypothyroidism, cewa fasalin na T4 zuwa T3 ya rasa. A wasu kalmomi, duk da gaskiyar cewa matakan T4 zasu iya zama al'ada, matakan T3 zasu iya ƙananan-musamman a cikin kyallen takalma, inda T3 ke aiki.
Me ya sa T4 zuwa tuba T3 zai iya zama mahaukaci a wasu mutane shine, a wannan lokaci, yawan hasashe-ko da yake akalla ƙungiyar marasa lafiya an gano su da bambancin kwayoyin (a cikin tsarin diodinase 2) wanda ya rage fasalin T4 zuwa T3. A kowane hali, yana nuna cewa likitoci ya kamata a magance akalla wasu mutanen da suke da hypothyroidism tare da duka T4 da T3.
Yin amfani da T3 mai dacewa ya fi kyau fiye da T3. T4 yana aiki; idan ka ba da yawa babu wani abu na gaggawa, sakamakon sakamako na yau da kullum (tun da ya kamata a canza shi zuwa T3 kafin a fara shafa takalma). T3 shine labarin daban; shi ne hormone thyroid, don haka idan ka ba da yawa, za ka iya haifar da haɓakar hyperthyroid kai tsaye-wata hadarin, alal misali, ga mutanen da ke fama da cututtukan zuciya.
A lokacin da kake ƙara T3 zuwa T4 a lokacin sauyawa na gyaran maganin karoid, mafi yawan masana sun bayar da shawarar yin alhakin T4: T3 daga tsakanin 13: 1 zuwa 16: 1, wanda shine rabo wanda yake cikin mutane ba tare da cututtukan thyroid ba. Wannan halayen T4 ne mafi girma: T3 fiye da yadda aka yi amfani dashi a cikin gwajin gwaji na asibiti.
Gwaran gwajin da aka kwatanta da T4 kadai zuwa T4 + T3 ba su nuna amfanci mai yawa a cikin amfani da hadewa a cikin yawan marasa lafiya da hypothyroidism. Duk da haka, waɗannan gwaje-gwaje ba a tsara su ba don ƙididdigar yiwuwa yiwuwar amfani da farfadowa na iya haɗaka ga wasu takaddama na mutane da hypothyroidism. Kuma duk da rashin asalin shaidun gwaji, kusan dukkanin masana sun yarda cewa akwai wasu mutanen da ke da hypothyroidism wanda ya kamata su karbi T4 da T3.
Yin maganin Hypothyroidism: Hanyar Hikima
Ganin abin da muka sani game da hypothyroidism, matakan TSH, da dangantaka tsakanin T4 da T3, saboda mafi yawan masana mahimmin hanyar kulawa da wannan yanayin yana kama da haka:
Fara da tsarin "daidaitattun", ta yin amfani da T4 kawai kawai, yin la'akari da kyau duka matakan TSH da matakin jinƙai na alama, da kuma daidaita sashi na T4 daidai. Ga mafi yawan mutane, wannan tsarin zaiyi aiki sosai.
Idan bayyanar cututtuka na hypothyroidism tace duk da cimma matakan TSH a cikin matsakaicin al'ada (wato, a sama da 3 mIU / L amma a kasa 5.0 mIU / L), to, ko dai ko duka biyu hanyoyi biyu ya kamata a yi la'akari:
1) Ƙara kashi na T4 ya dace don tura matakin TSH zuwa kasa 3 mIU / L.
2) Ƙara T3 zuwa tsarin kulawa, tare da kiyayewa mai dacewa.
Kafin zabar madadin 2, masana da yawa sun bada shawarar daidaita ma'aunin matakan T3, da kuma rubutawa cewa sun kasance kusa da ƙarshen iyakar al'ada, ko a ƙasa. Idan matakan T3 suna cikin matsakaicin matsakaicin matsakaici, yana da shakka cewa ƙara T3 zuwa tsarin kulawa zai inganta abubuwa. ( Kara karantawa game da auna aikin aikin hormone thyroid .)
Saboda haka: Idan ana bi da ku don hypothyroidism ta yin amfani da tsarin "daidaitattun" kuma ba a rage magungunan ku ba, dole ne ku yi magana da likitanku game da la'akari da ɗaya ko duka waɗannan hanyoyi.
Kalma Daga
Yin maganin hypothyroidism shi ne ainihin abu mai kyau, a kalla a ka'idar. Kuma a cikin mafi yawan mutane da wannan yanayin, mai sauƙi, "daidaitacce" tsarin kula da farfadowa aiki da kyau sosai.
Amma idan tsarin kulawa mara kyau bai yantar da alamar warkarwa na hypothyroidism ba, lokaci ne da za a yi la'akari da "maras daidaituwa," hanya madaidaiciya-ko dai yana tura matakan TSH zuwa ƙasa a cikin al'ada, ko ƙara T3, ko duka biyu.
> Sources:
> Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, et al. GABATARWA: Jiyya na Hypothyroidism Tare da Haɗuwa da Levothyroxine Plus Liothyronine. J Clin Endocrinol Metab 2005; 90: 4946.
> Jonklaas J, Bianco AC, Bauer AJ, et al. Sharuɗɗa don Kula da Hypothyroidism: Kungiyar Amfani da Ƙungiyar Ƙungiyar Ƙungiyar Karoid ta Thyroid wadda ta shirya daga Thyroid Hormone Replacement. Thyroid 2014; 24: 1670.
> Panicker V, Saravanan P, Vaidya B, et al. Bambanci na Kayan Kasa a cikin DIO2 Gene Rikicin Kasa da Lafiya na Zamantakewa da Amsawa don Haɗin Thyroxine Plus Sauran Tutar Halitta na Halitta na Cyiodothyronine a Hypothyroid. J Clin Endocrinol Metab 2009; 94: 1623.