T4T3 ee Miisaanka Miisaanka? Cilmi baaris ayaa muujinaya daaweynta Combo Therapy
Waa aqoon guud oo ka mid ah bukaanada, iyo qaar ka mid ah xirfadlayaasha caafimaadka, in tiro badan oo bukaan ah oo qaba cudurka hypothyroidism ay sii wadi doonaan cabashooyinka iyo calaamadaha kala duwan, inkastoo daaweynta levothyroxine ee hagaaga loo yaqaan "caadi" heerarka hoormoonka kicinta ee "thyroid stimulating hormone" (TSH).
Mid ka mid ah daraasadda ayaa lagu ogaaday, marka la barbardhigo kantaroolka, in ka badan 13% kuma qanacsanayn xaaladda caafimaad, oo muujinaysa qanacsanaan la'aanta daaweyntooda.
Cabashooyinka asaasiga ah waxay ahaayeen daal, miisaan korodh , jir xanuun iyo xanaaq, iyo cirrid.
Sida laga soo xigtay Dr. Bente Appelhof, MD, oo ka socda Jaamacadda Amsterdam ee Netherlands iyo saaxiibada: "Muran ka taagan qiimaha daweynta isku dhafka ah ee LT4 iyo LT3, marka la barbar dhigo LT4 oo kaliya, ee ku jirta hypothyroidism, waa kiliinik aragtida ah in qaybta cadaadiska ah ee bukaanka qaba hypothyroidism ay la socdaan cabashooyinka caafimaadka, inkastoo ay beddelaan daaweynta beddelidda levothyroxine iyo caadada udubdhexaadka [hormoonka hormoonka kiciya].
Daraasado kale oo xayawaan ah ayaa muujiyay in daaweynta beddelidda ee levothyroxine (LT4) kaliya aysan hubin eitiroidism - heerarka tir tirka caadiga ah - dhammaan unugyada. Taa bedelkeeda, daawada 'eyryroidism' waxaa kaliya oo lagu gaadhi karaa daaweynta isku dhafan ee LT4 iyo liothyronine (LT3). Daraasado kala duwan ayaa diiradda saara arrintan, iyagoo eegaya haddii daaweynta LT4 aysan ku filneyn in ay ku soo celiso unugyada casriga ee unugyada aadanaha.
Inkastoo ay bukaanku si joogta ah u soo wargeliyaan dookha daraasadaha isku dhafan, cilmi baarayaashu ma aysan awoodin inay joojiyaan arimo horumarineed oo gaar ah kuwaas oo lagu cabbirayo kiliinikar ahaan.
Hadda, cilmi-baarayaashu waxay aqoonsadeen ugu yaraan hal arrin oo u muuqda in ay la xiriiraan daaweynta isku dhafan - miisaan lumis.
Cilmi-baadhis lagu daabacay Joornaalka Endocrinology iyo Metabolism-ka ee lagu soo bandhigay daraasaddan oo lagu ogaaday in bukaanjiifku uu doorbiday daaweynta qanjirka 'thyroid' oo ay ku jiraan isku-darka levothyroxine (T4) iyo T3, halkii laga daaweyn lahaa daaweynta levothyroxine (T4 kaliya) ee caadiga ah, iyo daaweynta isku dhafan oo leh miisaan lumis.
Baaritaankan weyn ee bukaan-socodka ayaa xaqiijiyay natiijooyinka ka soo baxa daraasaddan Bunevicius, oo lagu daabacay Wargeyska New England Journal of Medicine, taas oo saameyn ku leh daaweynta T4 / T3 ee daaweynta hypothyroidism.
Dacwada laba-indhoole ah ee la xakameynayo, ayaa la eegay 141 bukaan oo qaba cudurka asaasiga ah ee "autoimmune hypothyroidism", kuwaas oo lagu jajabiyay kooxo lagu daweeyay T4 / T3 marka loo eego 5: 1, 10: 1, iyo sidoo kale koox sii waday iyada oo daaweyntoodii hore ee T4. Ka dib 15 toddobaad ka dib, daraasaddan waxay muujisay doorbid cad oo ka mid ah bukaannada daaweynta isku dhafan, iyo gaar ahaan, 5: 1 daaweynta oo leh heer sare ah T3, oo ka soo horjeeda daaweynta T4-ka keliya.
Qaar ka mid ah natiijooyinka xiisaha leh:
- Hoos-u-dhac miisaanka jirka - laakiin aan hoos u dhicin serum TSH - waxay ku xiran tahay qanacsanaanta kordhinta daawada daraasadda.
- Labada kooxood ee isku dhafan, waxaa jiray hoos u dhac miisaankeedu yahay, ugu caansan kooxda 5: 1, oo hoos u dhacay 1.7 kg, ama 3.75 rodol. Kooxda 10: 1 waxay lahaayeen miisaanka celceliska 1 rodol. Kooxda T4-keli ma laha wax isbeddel ah miisaanka.
- Dadka bukaanka ah ee doorbiday daaweynta isku dhafan, 44% waxay qabeen serum TSH ka yar 0.11.
- Isbedelada la cabbiri karo ee niyadda, daalka, fayoobaanta, iyo hawlaha neurocognitka lama aqoonsan karo inay sharxayaan mudnaanta bukaanka ee daaweynta isku dhafan.
Mid ka mid ah cilladaha ugu muhiimsan ee daraasadda ayaa ahaa in bukaanjiifka qaar qaata daaweyn isku dhafan ay helayaan qiyaaso la isku halleyn karo, taas oo loo tixgelinayo in ay tahay feejignaan. Waxay qabeen heerar kala duwan oo ka hooseeya heerka caadiga ah, sidaas darteedna waxaa loo tixgelin doonaa hyperthyroid.
"Bukaanku waxay doorbideen daaweynta LT4 / LT3 ee daaweynta caadiga ah ee LT4, laakiin isbedelka niyadda, daal, fayoobaanta, iyo hawlaha neurokognikku kuma qancin karin sababta keentay natiijada asaasiga ah ee daaweynta isku dhafka ah ee LT4 / LT3," ayaa qoraagu qoraa. "Hoosudhaca miisaanka jidhka ayaa la xiriiray qanacsanaanta daawada wax lagu barto."
Inkasta oo qorayaasha cilmi-baadhayaashu aanay ka heli karin sabab loo qiyaaso oo lagu talinayo daaweynta isku dhafan, waxay ku dhameeyeen: "Si kastaba ha ahaatee, natiijada daraasaddan ma joojinayso suurtagalnimada in koox gaar ah oo bukaannada ah ay ka faa'iideysan karaan daaweynta isku dhafan ee LT4 / LT3."
Ilaha:
Appelhof BC, et. al. "Daaweynta isku dhafka ah ee levothyroxine iyo liotyronin laba lanbar, marka la barbar dhigo daaweynta levotyroxine monotherapy ee astaamaha hypothyroidism: waa laba indhoole ah oo indha la '
Saravanan et. al. Faa'idada maskaxeed ee bukaanka ku jira 'ku filan' qiyaasaha daawada l-tirokoojin: Clin Endocrinol (Oxf) 57: 577-585)