Edita daga Maryamu
Daya daga cikin batutuwan da suka shafi matsalolin da ke fuskantar thyroid marasa lafiya a Amurka kuma a duniya duka shine ko marasa lafiya ya kamata su yi tunani da kansu don magance matsalolin thyroid, kuma musamman, unroid da hypothyroidism. Lokacin da na ce "mai tunani," ina nufin sayen sayen maganin maganin hormone wanda ba tare da takardar likita ba, sannan kuma shan shan magani ba tare da kula da likita ba.
(Ba na Magana game da marasa lafiyar wadanda likitoci suka rubuta maganin maganin kawanci ba amma sai ka bari marasa lafiya su tashi ko ƙasa a cikin sashi tsakanin ziyara.)
Samun kai don hypothyroidism a fili yana da wasu bayyane-bayyane ga marasa lafiya.
Na farko, idan ba a gano mutum ba a matsayin hypothyroid, amma a maimakon haka, likitoci, to wani lokaci kuma za'a iya rasa wani yanayin - kuma tafi ba tare da izini ba. Kwayoyin cututtuka kamar gajiya, wadataccen abu, da kuma bakin ciki suna da mahimmanci a hypothyroidism, amma su ma sun kasance alamun bayyanar cututtuka da dama na wasu yanayi - wasu tsanani. Rashin samun samfurin ganewa daidai da magani zai iya, sabili da haka, ya zama haɗari ga mai haƙuri wanda yayi kuskuren gwajin kansa da magungunan kansa don zaton hypothyroidism.
Na biyu, thyroid aiki ba kullum barga. Mutane na iya samun kwanakin lokaci na hypothyroidism saboda magunguna, thyroiditis, ko postpartum thyroid al'amurran da suka shafi bayan da ya haifi jariri, bi da komawa al'ada thyroid aiki.
Tsarin magani na dace zai iya zamawa da sauri lokacin da thyroid ke gudanawa.
Abu na uku, akwai haɗarin rashin jin daɗi. Yin amfani da kwayar cutar yana kara haɗari ga wasu yanayi da suka hada da cututtukan zuciya, kiba, da ciki. (Tabbas, karbar magani ba don hypothyroidism kuma yana dauke da hatsari mafi girma na wadannan matsalolin kiwon lafiya).
Amma na hudu da mafi girma damuwa ga mutane da yawa shi ne hadarin cewa waɗanda suka yi tunani a kansa za a overmedicated . Samun da yawa na maye gurbin maganin hormone zai iya haifar da cututtuka da dama, ciki har da tashin hankali, tashin hankali, tashin hankali, ciwo mai tsanani, cutar hawan jini, tachycardia (azumi mai saurin zuciya), zuciya mai laushi, zuciya arrhythmia, da mummunan zuciya kamar yadda fibrillation ke yi . Aikin filastillation - wani lokaci ake kira "fi-fib," zai iya haifar da bugun jini, wanda wani lokaci zai haifar da nakasar rashin lafiya har ma da mutuwa.
Wasu marasa lafiya sun nuna cewa magani na lafiya yana da lafiya idan dai marasa lafiya suna da ilimi. Na san ƙwararrun marasa lafiya da suka sami karbar kansu. A lokaci guda, Na kuma ji daga magungunan thyroid waɗanda suka ƙare a cikin ɗakunan gaggawa waɗanda ke shan wahala daga fibrillation bayan da lokuta na shan magani. Da yawa daga cikin wadannan marasa lafiya sun kasance masu ƙwarewa sosai kuma suna karantawa game da maganin cutar thyroid, kuma sun dauki kansu sosai game da yadda suke kula da hypothyroidism. Duk da haka, sun gama magance cutar kuma sun fuskanci rikicin kiwon lafiya mai tsanani.
Duk da yake mafi yawan marasa lafiya - ko da wadanda suke da tabbaci a saninsu - sun san akwai yiwuwar magani, aikin yana faruwa saboda marasa lafiya suna fuskantar manyan matsaloli da ke hana su daga samun cikakkiyar tasiri da kuma magani .
Mene ne wadannan matsaloli?
Na farko, akwai mutanen da aka gano da hypothyroidism a baya, amma wanda ba zai iya biyan kudin likita ba. A Amurka kadai, muna da miliyoyin miliyoyin marasa lafiya, miliyoyin tsofaffi a kan samun kudin shiga, kuma miliyoyin mutanen Amirkawa waɗanda suka rasa aikinsu a lokacin ragowar tattalin arziki. Mutane da yawa ba za su iya biya su daga aljihu don likitoci ba. A duk faɗin duniya, samun dama ga likitoci da kulawa na likita suna da kyawawan zane, kuma ya dogara da ilimin geography, tattalin arziki, tsarin kula da kiwon lafiya, da halin kuɗi na mutum.
Na biyu, da dama likitoci sun kasance masu rikice game da yadda za su gwada gwajin maganin horroid (TSH) na gwajin maganin karoid - gwajin da kansu suke kira "ma'auni na zinari" don bincikar hypothyroidism.
Idan mai haƙuri yana da alamun cututtuka na hypothyroidism, kuma yana da sakamakon gwajin da ya faɗo a yankin "limbo" ta TSH - sama da 2.5 kuma a kasa 4.0 zuwa 5-5.5 - sakamakon TSH na mai haƙuri yana sanya shi a matsayin lakabi "na al'ada" a Amurka. rahoton raho. A TSH a wannan bangare an yi la'akari da wasu hypothyroid subclinically hypothyroid. Masu binciken endocrinologists sunyi yayatawa da yin muhawarar wannan batu har kusan shekaru goma, tun lokacin da kungiyar Aminiya na Endocrinologists (AACE) ta bada shawara a farkon shekara ta 2003 cewa hanyar kulawa ta al'ada ta gwajin TSH za ta karɓa zuwa 0.3 zuwa 3.0 . Yawancin likitoci, duk da haka, har yanzu suna bin tsohon cutoff, kuma za su bincikar su kawai kuma su bi da hypothyroidism idan mai haƙuri yana da TSH wanda ya fi sama da 4.5 zuwa 6.0.
Na uku, akwai marasa lafiya wadanda ke da alamun cututtukan hypothyroidism, kuma waɗanda suke da alamun "al'ada" akan gwajin TSH - fadowa a ko'ina a cikin kewayon tsakanin .3 zuwa 6.0 - amma wadanda suka tayar da kwayar cutar ta maganin cutar Hashimoto. Yawancin likitoci ba su sani ba - ko kuma ba su yin aiki bisa ga - binciken da ya nuna cewa a wasu marasa lafiya marasa lafiya, maganin maganin jijiyar jiki zai iya taimakawa hypothyroid bayyanar cututtuka kuma hana ci gaba zuwa rinjaye hypothyroidism.
Hudu, akwai marasa lafiya da suke da "TSH" na al'ada, amma ainihin matakan da ke kewayewa na hormone thyroid - Free T4 da Free T3 - nuna nuna rashin tausayi a cikin wadannan kwayoyin. Yawancin likitoci sun ƙi yarda da cewa matsalar ta da ƙananan al'amuran Free T4 da / ko Free T3 - da maɗaukaki na matakan Tverse T3 ko kuskuren rashin daidaituwa na Reverse T3 / Free T3 - alamun hypothyroidism ne. T4 an canza zuwa T3 - nau'in hormone thyroid a matakin salula. Yawancin likitoci sun ce, kowa zai iya canza T4 zuwa T3 da kuma daidai. A halin yanzu, likitoci masu haɗin kai, da wasu masu binciken cututtuka, sun yarda cewa wasu marasa lafiya na iya samun ciwon magungunan cuta, rashin ciwon enzyme, rashin cin abinci mai gina jiki, ko cututtuka na kwayoyin cutar da ke ɗauke da T4 zuwa tuba T3, kuma wannan rashin lafiya zai iya zama magani.
Na biyar, ana kula da marasa lafiya da yawa tare da miyagun ƙwayar levothyroxine - watau Synthroid, Levoxyl, Levothroid, Eltroxin, ko kuma generic levothyroxine / l-thyroxine, amma har yanzu suna da alamun cututtuka na hypothyroidism, ko da bayan jiyya ya dawo wadannan sakamakon gwajin cutar jinin ka " al'ada. " Wasu daga cikin wadannan marasa lafiya suna buƙatar adadin magani na T3 - wato, Cytomel (liothyronine), ko T3 - lokaci-da-wane-ko kuma nemi takardar izinin maganin kwayoyin halitta wanda aka ba da launi - watau Armor, Nature-Throid, ko Erfa. Yin amfani da T3 yana da rikici, duk da haka , da yawa likitoci ba su yarda da yin amfani da magungunan T3 ba ko magungunan maganin ka. Wadannan likitoci suna da'awar cewa ba a buƙatar ƙarin maganin maganin maganin kawo saboda alamar cututtuka ba su da alaka da ka, ko kuma cewa bayyanar cututtuka sune shaida na matsalar kiwon lafiya ta jiki da kuma tabbatar da maganin maganin antidepressant. Sau da yawa, muna jin "babu wanda yake buƙatar T3 ko thyroid" saboda "kowa ya juya tubar T4 zuwa T3 daidai yadda dai." Wannan "ba ku buƙatar shi / kowa da kowa ya tuba T4 zuwa T3" mantra mai sanannen sa da kuma jurewa
h a magani na hypothyroidism. Wasu likitoci sun ki sun rubuta T3 da / ko magungunan maganin karoid don suna jin cewa waɗannan magunguna suna haifar da hadarin cututtukan zuciya na kowa ga kowa. Amma hadarin yana da ƙananan lokacin da aka yi amfani da magunguna sosai. Domin in ba haka ba marasa lafiya ba, hadarin T3 da magungunan maganin karoid ne idan mai tsanani ya shafe. Kwararrun likitoci suna da hankali amma duk da marasa lafiya da marasa lafiya da marasa lafiya da ke da halin zuciya / cututtukan zuciya, kamar yadda waɗannan rukuni zasu iya zama masu kulawa da T3 ko magungunan kuɗin da ke dauke da T3. (Abin sha'awa, akwai kuma bincike wanda ya nuna cewa hypothyroidism ba tare da hana ba ya kara hadarin cututtukan zuciya .)
Na shida, akwai wasu marasa lafiya da ke kula da kungiyoyin kiwon lafiya na kiwon lafiya (HMOs) ko asibiti na likita, wadanda likitoci basu yarda da gwagwarmayar hypothyroidism ba, sun ƙi yin amfani da hypothyroidism, ba su kula da cutar Hashimoto ba. / Free T3 ƙetare / rashin daidaituwa, da kuma / ko ki ya rubuta T3 magunguna da / ko magungunan thyroid. Wasu daga cikin marasa lafiya suna ganin wadannan likitoci suna da kudi ba zasu iya biya daga aljihu ba don ziyarar zuwa likitan likitancin thyroid-savvy.
A ƙarshe, a waje da Amurka, magani na kai ya zama wajibi ga wasu marasa lafiya. A cikin Ƙasar Ingila, alal misali, yawancin yankunan suna amfani da Neman Kula da Lafiya ta Duniya (NHS) don kula da su. Ana buƙatar likitoci na NHS, amma, su bi sosai sosai - wanda zai iya cewa, dadewa kuma a yawancin lokuta ba daidai ba - ma'auni a cikin bincikar cutar da kuma magance hypothyroidism. Bugu da kari, akwai likitoci masu zaman kansu don ganewa da kuma magance hypothyroidism, kuma waɗannan likitoci suna da tsada sosai.
Wata ƙalubale ga marasa lafiya
Don haka, a ƙarshe, ya kamata marasa lafiya suyi tunani, ko a'a? Na kwanan nan ya jawo damuwa tsakanin marasa lafiya wadanda ke da kwarewa saboda na ce ba na da shawarar yin magani, da kuma Ajiyar Halittar Thyroid - kungiyar da na kafa a lokacin rani na 2009 don taimakawa marasa lafiya su jimre da karancin, rashin lafiya da kuma FDA ta ƙaddamar da lalacewar kwayoyin cututtukan karoid - kuma ba ya bada shawarar yin magani.
Babu shakka cewa marasa lafiya suna cikin halin da ake ciki. Kuma yana sa hankalina a gare ni cewa wasu marasa lafiya suna jin cewa basu da wani zaɓi sai dai don yin tunani. Ba na sukar da yanke shawarar mutum game da tunani - wannan abu ne da kowane mutum zai yanke masa ba. Yana da damuwa da cewa wasu mutane suna tilasta ta hanyar yanayi don yin wannan zabi, kuma ina fushi da yadda wasu likitoci suka ji maganin cutar thyroid, halin da ke sa wasu marasa lafiya suyi wannan zabi. Har ila yau, ina fata fatan cewa wa] anda ke yin tunani, suna yin haka, tare da tsattsauran ra'ayi, kuma za su iya kauce wa wata matsala.
Wani lamari mai rikitarwa ga wasu marasa lafiya shine imaninta cewa na rayayye ingantaccen magani - kuma musamman, inganta kai magani tare da yanayin desiccated thyroid - kyakkyawan iya aiki da thyroid haƙuri bukatun.
Mun riga mun fuskanci lokutta masu tsanani na kwayoyin maganin karoid a cikin wadataccen kayan aiki ko kaucewa kasuwa , ƙananan kayan aiki maras kyau, da kuma abubuwan da suka faru da ban mamaki da suka faru a baya-bayanan ayyukan FDA. Kwayoyin maganin maganin karoid ne kuma a kan jerin jerin kwayoyin "marasa kyauta" na FDA wanda za a tilasta su shiga ta hanyar yin amfani da lokaci da kuma farashi. FDA ta bayyana a fili cewa thyroid ne mai magani ba tare da amincewa ba, kuma ba mai girma ba, kuma yana da bukatar yin amfani da tsari don tabbatarwa a kasuwa. Lokacin kuma yadda hakan zai faru har yanzu an yanke shawarar. Shirin yanke shawara na FDA ga amincewar miyagun ƙwayoyi ba shi da gaskiya. Abin da muka sani shi ne cewa dakarun siyasa da tattalin arziki a bayan al'amuran - dakarun da basu damu ba game da jin dadin zaman lafiya - suna shawo kan tsarin yanke shawara.
Wasu likitoci, da kuma jami'ai daga FDA sun gaya mini, daga cikin rikodin, cewa suna jin cewa tallace-tallace ba da kyau - ciki har da takardun likita - game da maganin maganin karoid dinka ya motsa dabi'un da ke dauke da kwayoyi thyroid a cikin wani abin da ba a so. a cikin su suna yin karin haske game da FDA.
Wani abin damuwa ga magungunan maganin maganin kawo ne Dr. Sidney Wolfe na Citizen Citizen, wanda aka nada shi kwamiti na Kwamitin Tsaro da Gudanar da Harkokin Kiwon Lafiyar FDA. Don wani dalili wanda har yanzu ba'a iya bayyanawa ba, Dokta Wolfe - wanda a wasu lokutan ya bayyana cewa rashin jin dadin karoid shine kariyar kari (ba haka ba), kuma anyi shi ne daga shanu (shi ne porcine, daga aladu) - - shi ne abokin adawar na halitta wanda ya rage karoid (ko a kalla abin da yake a halin yanzu ya yi imani da yanayin da ake kira thyroid ya zama.) Ya wallafa misalai da ba daidai ba a kan Armor Thyroid a cikin "Cikakken Kwayoyin Kwayoyin Wutar Kwayoyi," mafi kyawun 'yan kasuwa. yi aiki a kwamiti na FDA. Ya yanzu yana cikin matsayi na yanke shawarar abin da kwayoyi ya ƙare a cikin crosshairs ga FDA ta Unapproved Drugs yaƙin neman zaɓe.
Kuma babban cikas ya ci gaba da "kafa" thyroid - kuma a nan zan hada da masu aikin likita, likitoci, likitocin likita, FDA, sauran majalisa, da manyan kamfanonin ƙwayoyi suna yin levothyroxine - wadanda suke da farin cikin kama da kuma yin hay daga BABI DA dukkancin lalacewar, da mummunan sakamako, ko kuma matsalolin da aka gano tare da maganin karoid da / ko T3, yana fatan yin amfani da labarai mara kyau a matsayin hanya don cire wadannan kwayoyi daga kasuwa. Abin baƙin ciki, amma ba abin mamaki bane, "damuwa" mafi sau da yawa ba shi da wani abin da za a yi tare da jin dadin zaman lafiya da duk abin da ya yi da son kai, samun kudi, thyroid groupthink, ko misinformation.
Ofishin Jakadancinka na Thyroid: Yin aiki don Karɓar Thyroid Groupthink
A matsayin mai ba da shawara mai haƙuri, ina son in mayar da hankali ga kokarin da na taimakawa wajen ilmantar da wayar da kan jama'a, da kuma neman shawara ga canje-canje ga tsarin kanta. Daga qarshe, Ina so mu zauna a duniyar da ba a rage yawan marasa lafiyar ku a cikin mawuyacin hali don yin zabi mai wuya a tsakanin magungunan kai - da haɗari da wadatar da ke tattare da shi - da kuma tafiya ba tare da magani ba.
Kada ku kuskure, wannan haƙiƙa ne mai ƙalubale. Rashin gwagwarmaya da duniyar maganin endocrinology, da kuma "kasuwancin" maganin maganin karoid - kuma abin da likitocin da ake kira "maƙarƙashiyar TSH" - yana da wuya. Yana da yakin da yawa daga cikinmu sunyi fada har fiye da shekaru goma. Mun ga wasu ci gaba, da kuma wasu matsaloli a hanya.
Kamar yadda muka sani, daga likita / kimiyya, hangen nesa da yawa, masu binciken endocrinology da kungiyoyin endocrinology suna jinkirta karban canje-canje, kuma, da baqin ciki, sau da yawa suna da sha'awar lambobi a kan rahotanni fiye da wanda ke zaune a gaban su kuma ko wannan mai haƙuri yana jin dadin duk wani ingancin rayuwa. Doctors sun dogara da gwajin TSH - gwajin gwaji na wani hormonan pituitary - don tantancewa da kuma sarrafa hypothyroidism, yayin da yake jin dadin barazanar kauce wa matakan Free T3 - hormone mai aiki wanda ke shiga cikin sel don yada oxygen da makamashi. Mutane da yawa likitoci ba su damu ba don gwada kwayoyin maganin thyroid - wanda zai iya gaya mana lokacin da karoid yana cikin rashin cin nasara.
A halin yanzu, an sanar da yawancin malaman endocrinologists da likitoci cewa maganin thyroxine (T4) - da ake kira levothyroxine / l-thyroxine - ko fiye da sunan, Synthroid - shine bayani guda daya. An gaya musu cewa levothyroxine ne kadai ya fi dacewa da haɗin gwiwa tare da sarƙoƙi na triiodothyronine (T3) - da aka sani da suna liothyronine (Cytomel). An gaya musu cewa dabi'ar da ke cikin maganin thyroid - wanda shine, don rabin karni kawai magani na hypothyroidism - "tsohuwar al'ada," "m," kuma bai fi dacewa da maganin thyroxine ba. Gaskiyar ita ce duk inda yake, duk da haka, duk abin da magani ke biyan likita - ko yana da levothyroxine monotherapy, T4 / T3 haɗin hade, ko kuma yin amfani da launi na ƙwayar thyroid - akwai nazari wanda zai iya mayar da matsayin da aka zaɓa. Kuma idan likita ya fuskanci wani binciken da ya saba da ita ko ra'ayinta, zaku ji su ce, "Na'am, wannan bincike ne mara kyau."
Baya ga muhawarar kimiyya / kimiyya, masana'antun masana'antun sarrafa kayan magani suna da mummunar sakamako a kan tunanin masu aikin maganin thyroid.
Ba wani asiri ba ne cewa maƙallan magungunan likitanka - watau American Thyroid Association, da kuma Ƙungiyar Amirka na Magungunan Harkokin Clinical - sun samu daruruwan dubban dala a kowace shekara a cikin tallafi, kudade, tallafi, da kuma shirye-shirye na masu tallafawa Synthroid. Kuma yawancin likitocin da suke da matsayi na jagoranci a cikin wadannan kungiyoyi suna karɓar kuɗi daga kamfanin Synthroid.
Synthroid iri na levothyroxine ya kasance mafi sayar da miyagun ƙwayoyi a Amurka shekaru da yawa, kuma yana da matukar riba. A makarantu na likita, masu ofishin likitancin likita, da kuma ma'aikatan asibiti a kullun kasar, kwakwalwan abinci tare da kwandunan muffin sun zo a kai a kai, wanda kamfanin Synthroid ya biya, a matsayin hanyar da za ta taimaka wajen tabbatar da hangen nesa da maganin maganin karoid - wanda ba ya haɗa da T3 da thyroid thyroid - shi ne wanda likitoci, ma'aikatan jinya, ma'aikata ofishin, dalibai kiwon lafiya da matasa likitoci ji. Kuma kada ka manta da tallan tallace-tallace - kazalika da samfurori na miyagun ƙwayoyi da kuma swag kamar ƙwallafi, kwalliya, wallafe-wallafe, takardun magani, ƙwayar thyroids, da wasu abubuwa - cewa dubban magungunan miyagun ƙwayoyi suna kawowa dubbai a kowane mako zuwa likitoci. , da kuma gabatarwa a kowane taron likita na thyroid.
Sakamako na ƙarshe: muna da ƙwararrun likitocin da suke tafiya a kulle kullewa, gaskantawa - kuma ci gaba da sauraren sakon duk inda suka tafi - cewa Synthroid shine maganin da aka dakatar da kowa da kowa da hypothyroidism, cewa kowa ya tuba T4 to T3 daidai, cewa babu wanda ya buƙaci T3, kuma babu wani rawar da zai dace da yanayin jin dadin ka a cikin maganin hypothyroidism.
Ƙungiyar karoid da kuma yiwuwar wasu likitoci zuwa tasirin kudi suna da yawa da cewa akwai wasu masu binciken likita da likitoci waɗanda suka yanke hukunci a fili kuma suna nuna wa likitocinsu likitocin da suka rubuta magungunan T3 ko magungunan maganin karoid na marasa lafiya.
Yin duk abin da zan iya taimakawa wajen warware wannan irin tunani mai tsabta - tunanin cewa ya la'anci mutane da dama zuwa rayuwa ta rashin lafiya - abu ne mai mahimmanci na bada shawara.
Manufar tawa ita ce inganta wayar da kan jama'a game da dukkanin hanyoyin da za a iya ba da izinin magance su - ciki har da T3 da kwayoyin maganin thyroid. Manufarta ita ce yin aiki zuwa ga duniya inda cikakken jigilar hanyoyin maganin maganin kawanci zai zama mafi fahimta, mafi sani, mafi kyawun karɓa, mai araha, da kuma samammen doka ... duniya inda akwai fahimtar juna a tsakanin likitoci, masu sayarwa, magunguna, asibitoci, da kuma marasa lafiya na cikakken jigon hanyoyin maganin maganin thyroid. Kuma ta} arshe, aikin na shine don taimakawa wajen kare wa] annan za ~ en daga hare-haren da} ungiyoyi masu sha'awa da suke son ganin su daga kasuwar.