Meel Fudud oo Fiirfiirsan Xeerarka Caafimaadka
Marka hyperthyroidism aan lagu xakameynin uurka, waxay la socotaa dhibaatooyin kala duwan, oo ay ku jiraan dhicin, uur-qabid uur-ku-dhalasho, dhalmo-bilo, miisaan yar oo hooseeya, xaddidaadda korriinka ilmo-galeenka, dhalashada, duufaanka qanjirka, iyo qalitaanka wadnaha ee wadnaha. Sidaa daraadeed, baaritaan ku habboon iyo daaweynta cudurka Graves 'iyo hyperthyroidism inta lagu jiro uurka waa muhiim.
Sida lagu sheegay 2011 "Tilmaamaha Qanjirta Maraykanka ee Qaabilaadda iyo Maareynta Cudurka Qanjirka 'Thyroid Disease' inta lagu jiro Uurka iyo Dhalmada Kadib," haweenka qabta cudurka Graves 'waa inay uur qaadaan kaliya markay noqdaan euthyroid - oo lagu qeexay inay leeyihiin heerarka tirtirka caadiga ah . Tilmaamayaashu waxay si adag ugu talinayaan ka-hortagga uur-qaadidda ilaa tan la gaaro, waxayna ku talinayaan in dhakhaatiirtu ay ku taliyaan haweenka la xiriira saameynta daaweynta ee qorshayaasha ra'yiga.
Gaar ahaan, Tilmaamayaashu waxay ku talinayaan in dadka bukaanka qabaa ay helaan daaweynta ablative-ka ee qalliinka ama iodine (RAI), ama daawooyinka antithyroid .
Tilmaamayaashu waxay soo jeediyaan qalliin loogu talagalay haweeney ay leedahay heerarka sare ee dawada uur-qaadka (TRAb) iyo kuwa qorsheynaya in ay uuraystaan laba sano gudahood. Fikirka ayaa ah in heerarka TRAb ay u muuqdaan inay kor u kacayaan ka dib RAI oo wali sarreeyaan.
Haddii RAI la sameeyo, baaritaanka uurka waa in la sameeyaa 48 saacadood ka hor maamulka RAI.
Qalliinka ka dib ama RAI, Tilmaamayaashu waxay ku talinayaan inay sugaan muddo lix bilood ah inay uuraystaan, si loogu oggolaado haweeney in ay qaadato qiyaasta xasaasiyadeed ee hormoonka tayroodhka , oo ay la socdaan heerarka TSH ee u dhaxeeya .3 iyo 2.5.
Daawooyinka antidiotide, dumarka waa in lagu wargeliyaa halista la xariirta propylthiouracil (PTU) iyo methimazole, haddii daawooyinkaas la isticmaalo, PTU waa in loo isticmaalo bilowga koowaad ee uurka.
Methimazole (magaca calaamada: Tapazole) waxay halis u tahay uurjiifka haddii loo isticmaalo saddexda bilood ee ugu horeeya. Tilmaamayaashu waxay sidoo kale ku talinayaan inay tixgeliyaan joojinta PTU ka dib markii saddexda bilood ee hore iyo u beddelashada methimazole, si loo yareeyo khatarta beerka ee la xidhiidha PTU .
Daaweynta Graves 'Hyperthyroidism inta lagu jiro Uurka
Daaweynta asaasiga ah ee hyperthyroidism inta lagu guda jiro uurka waa daawooyinka antithyroid , si kastaba ha ahaatee, laga bilaabo 3% ilaa 5% bukaannada ayaa leh saameynaha daroogada la xidhiidha sida falceliska xasaasiyadda iyo finanka.
Sababtoo ah daawada antithyroid ka soo gudubta mandheerta, baahida daryeelka ayaa loo baahan yahay in la qaato isticmaalka daawooyinka antithyroid inta lagu jiro uurka. Gaar ahaan, welwelka ugu weyni waa awoodda methimazole si ay u keento cilad naadir ah - dhibaatooyinkaas aan la xiriirin isticmaalka PTU. Hase yeeshe, PTU waxay halis u tahay sunta sunta , iyo tilmaamaha waxay ku talinayaan in PTU loo isticmaalo saddexda bilood ee ugu horeeya, iyo in bukaanku ay u wareegaan methimazole ka dib saddexda bilood ee ugu horeeya.
Beta-blockers ayaan sida caadiga ah lagula talin inta lagu guda jiro uurka, maadaama ay la xiriiraan xaddidaadda kororka koritaanka, wadnaha garaaca wadnaha ee hooseeya, iyo hypoglycemia ee dhaladka cusub.
Dawooyinka Antithyroid inta Uurka ah
Tilmaamayaashu waxay ku talinayaan in haweenku qaataan daawooyinka antithyroid inta lagu guda jiro uurka iyagoo maraya kormeer joogta ah ee T4 iyo TSH, sidaa daraadeed qiimaha T4 ee lacag la'aanta ah ayaa joogaya, ama ka sarreeya xadka sare ee caadiga ah, adoo qaadanaya qiyaasta ugu yar ee daawada antithyroid.
T4 iyo TSH lacag la'aan ah waa in la qiyaasaa labadii illaa afar asbuuc marka bilowga daaweynta, iyo afartii ilaa lix toddobaad kadib, si loo gaaro heerarka dhiigga lagu beegsanayo. Caadi ahaan, maxaa yeelay hyperthyroidism inta badan caadada uurka inta lagu guda jiro uurka, dawooyinka antithyroidku waxay ku dhammaan karaan joojinta saddexda bilood ee saddexaad ilaa inta ka badan 20% illaa 30% bukaanada.
Tilmaamayaashu waxay ku talinayaan in haweenka qaada antibiyootikada sare (TRAb) ay sii wadaan daweynta dawooyinka antithyroid illaa dhalashada.
Qanjirka 'Thyroidectomy' ee Cudurada Graves 'inta lagu jiro uurka
Haddii haweenku ay xasaasiyad u leeyihiin daawooyinka antidiotiga, waxay u baahan yihiin qiyaaso badan oo lagu xakameynayo hyperthyroidism, ama aysan raacin daaweynteeda daweynta, Tilmaamaha ayaa tilmaamaya in loo baahan yahay in loo tixgeliyo thyroidectomy.
Haddii qaliinka tayroodka - loo yaqaano thyroidectomy - loo baahan yahay, wakhtiga ugu fiicani waa xilliga uurka labaad ee uurka.
Waqtiga qaliinka, heerarka TRAb waa in la qiyaasaa si loo qiimeeyo khatarta ka iman karta hyperthyroidism ee uurjiifka. Tilmaamayaashu waxay kugula talinayaan in la diyaariyo beta beta , iyo koorso gaaban oo kiniin ah iodine potentium ka hor qaliinka thyroidectomy .
Halisaha uurjiifka ee Haweenka Uurka leh Hawlaha Hawlgabka 'Hyperthyroidism
Waxaa jira khataro badan oo ku saabsan uur-jiifka dumarka leh firiiricda "hyperthyroid" firfircoon , oo ay ka mid yihiin:
- fetal hyperthyroidism
- neonatal hyperthyroidism
- uurjiifka
- neonatal hypothyroidism
- hypothyroidism
Waxyaabaha saameyn kara khatarta uur-ku-jirta waxaa ka mid ah:
- Xakameyn xun oo ka yimaada hyperthyroidism inta uurku socdo, taas oo keeni karta hypothyroidism-ka dhexdhexaad ah ee ilmaha caloosha ku jira.
- qadar sare oo daawooyinka antidiotiko ah, taas oo keeni karta in uurjiifka iyo neefaha uu ku dhaco hypothyroidism.
- heerarka sare ee serum TRAb inta u dhexeysa 22 iyo 26 toddobaad ee uur-ku-jirta, taas oo keeni karta uur-ku-jirka ama u-dhalashada hyperthyroidism .
Sida ku xusan Xeerka, in ka badan 95% haweenka qaba cudurka Graves 'waxay leeyihiin caddeyn ah TRAb, xitaa kadib daaweynta ablative-ka, TRAb waa in lagu ilaaliyaa haweenka uurka leh :
- oo leh firfircoonida hyperthyroidism;
- kaasoo hore u helay daaweynta RAI ;
- oo leh taariikh soo gudbinta ilmo yar oo qaba hyperthyroidism; iyo
- oo qabay thyroidectomy inta lagu guda jiro uurka, si loo daaweeyo hyperthyroidism.
Fetal iyo neonatal hyperthyroidism wuxuu u dhexeeyaa inta u dhexeysa 1% ilaa 5% dhammaan haweenka uurka leh ee leh hawl firfircoon ama taariikhda hore ee Graves ' hyperthyroidism, waxaana lala xiriiriyaa dhowr dhibaatooyin.
Haweeneyda uurka leh ee leh taariikh ama firfircoon taariikhda cudurka Graves ', TRAb waa in lagu qiyaasaa 20 illaa 24 usbuuc oo gestational ah. Sida ku xusan Xeerka, qiimaha in ka badan saddex jeer xaddiga sare ee caadiga ah waxaa loo tixgeliyaa calaamadaha ku-xigeenka uur-jiifka, taasoo ah mid ku lug leh dhakhtar ku takhasusay daawada hooyada-uurjiifka.
Haddii loo baahdo, ultrasounds waa in la sameeyaa si loo kormeero koritaanka uur-jiifka.
Xigasho:
Stagnaro-Green, Alex, et. al. "Tilmaamaha Ururka Astaamaha Ameerikaanka ee loogu talagalay Cilimaadka iyo Maareynta Cudurka Qaaxada inta Uurka iyo Dhalmada ka Dib." Tirada . Volume 21, Number 10, 2011