Fiiri Xayawaanka Dabiiciga ah, Levothyroxine, iyo Fursadaha Cusub ee Cusbooneysiinta Daaweynta
Wilmar Wiersinga, oo ah cilmi-baaris caan ah, Warmar Wiersinga, oo ah joornaalka Janaayo 2014-ka ee daabacaadda qoraallada caafimaadka Dabeecadaha "Endocrinology" , waxay leedahay aragti xiiso leh oo ku saabsan qaar ka mid ah isbeddellada muhiimka ah ee isbedelka hormoonka tayroodhka ee daaweynta hypothyroidism sannadihii la soo dhaafay. Waxaan soo koobay qaar ka mid ah qaybaha ugu xiisaha badan maqaalkan.
Afarta Meelood ee Dhexdhexaadinta
Dr. Wiersinga wuxuu qeexayaa afar isbedel oo muhiim ah.
- Isbedelka ugu Horeeya: Hypothyroidism wuxuu ahaa mid aan la daweyn karin illaa 1891-kii London, Dr. George Murray wuxuu ku celiyay bukaanku in uu bukaanku aad u daran yahay isaga oo bixiyay caleemo qoyneed. Dabadeed xayawaanka dhulka hoostiisa ah ama la shiilay ee loo yaqaan 'thyroid' ama 'kiniiniyada' ee loo yaqaan 'thyroid nuddheer' ayaa bilaabay in loo isticmaalo daawaynta ugu horreysa ee loogu talagalay hypothyroidism.
- Isbedelada labaad ee Paradigm: laga bilaabo 1960 ilaa 1988, isticmaalka daroogada dabiiciga ah ee dabiiciga ah ee loo yaqaan 'thyroid' ayaa si tartiib ah hoos u dhacay, iyadoo isticmaalka levothyroxine uu kordhay. Sannadkii 1978, tirada daawooyinka levothyroxin waxay dhaafsiisnayd daawooyinka dabiiciga ah ee dabiiciga ah. Sannadkii 1988, 84% bukaannada oo dhan waxay qaateen daawada levothyroxine.
- Wiersinga wuxuu qeexayaa sida tijaabooyinka xayawaanka ah ee laga soo bilaabo 1990-yadii ay muujiyeen in daawada cirroolojiga ah - ay gaaraan heerarka caadiga ah ee T4 iyo T3 ee unugyada jidhka - ka dib markii qalliin looga saaro qanjidhada tayroodhka oo aan laga gaari karin keliya levothyroxine oo keliya, laakiin sidoo kale loo baahan yahay liotyronine (T3) . Bukaan-socodka iyo dhakhaatiirtu waxay sheegeen in bukaanlayda ay ku fiicnaanayaan kordhinta T3, ama dabiiciga ah ee dabiiciga ah , laakiin inta badan tijaabooyinka iyo cilmi-baarista la qabtay waqtigaan ma aysan helin in daaweyn isku dhafan ay ka sarreeyaan. Dr. Wiersinga waxa uu soo jeedinayaa in ay jiraan qiyaaso hidde ah oo bukaanjiifka ka dhigaya mid waxtar u leh daaweynta isku dhafan - waxayna yiraahdaan "haddii daraasado dheeraad ah ay tilmaami karaan kooxdan qaaska ah ee bukaanshoowga qaba, seddax qaybood oo isbeddel ah ayaa lagu daaweyn karaa cudurka hypothyroidism - laga yaabee isticmaalka daawada shakhsi ahaaneed ee goobtan. "
- Daraasad Afar Sinni ah : Daraasad cilmibaaris 2012 ah oo lagu faahfaahiyay markii ugu horeysay ee unugyada tayroodh shaqaynaya laga soo saaro unugyada asaasiga ee embriyaha. Dr. Wiersinga wuxuu ku nuuxnuuxsaday in "shaqadani ay ugu dambeyntii u horseedi karto wareegga afaraad ee isbedelka, taas oo dadka bukaansocodka ah lagu daaweyn karo unugyada unugyada qanjidhada kaadida."
Levothyroxine kaliya Daaweynta
Marka laga hadlayo isbeddelka isbeddelka, Dr. Wiersinga wuxuu eegay xaalad adag oo ah isticmaalka daaweynta levothyroxine (T4) oo keliya . Waxa uu tilmaamay in ay jiraan tiro daraasado ah oo muujinaya in daaweynta levothyroxin ay la xiriirto tiro ka mid ah waxyaabaha xun ee bukaanka, oo ay ka mid yihiin:
- sii kordhaya dhibta nafsaaniga ah
- naafanimada
- hoos u dhaca tayada caafimaad ee la xiriirta nolosha
- Dhibaatooyinka xagga garashada maskaxda, garashada, barashada iyo xusuusta
- korodhka baahsanaanta walaaca
- howlaha nafsiga ah ee saboolka ah, xusuusta shaqada iyo barashada mootada
Gaar ahaan, sida laga soo xigtay Dr. Wiersinga, "Faa'idada maskaxeed ee naafada ah, niyad-jabka ama walwalka ayaa lagu arkay 5-10% bukaanka hypothyroid ee hela levothyroxine, inkastoo heerka caadiga ah ee TSH ."
Dr. Wiersinga ayaa sidoo kale ka warbixiyay daraasaddan xiisaha leh ee Iskotishka ah ee lagu ogaaday in halista wadnaha, wadnaha iyo lafaha lafaha ah uu kor u kacay bukaanada qaba heerka cadaadiska TSH (oo ka yar 0,03), iyo bukaanada qaba heerarka sare ee TSH (ka sareeya 4.0) laakiin ma jirin khatar korodh ah oo la xidhiidha heerarka hooseeya ee "TSHOOB" TSHOOB (.04 ilaa 4.).
Dr. Wiersinga wuxuu soo bandhigay cilmi-baaris muujinaya in "heerarka caadiga ah ee TSH-ga ee kaabaha ah uusan u damaanad qaadin eutriroidism ee dhammaan unugyada oo bartilmaameedsanaya hoormoonka thyroid." Si fudud u dheji: daaweynta levothyroxine kaliya ma noqon karto daaweynta ugu wanaagsan ee bukaanka qaba hypothyroidism. Taa baddalkeeda, qaar ka mid ah dheeraadka ah ee t3 ayaa laga yaabaa in ay ka caawiso in ay caadi u noqoto hawlaha tayroodhka dhammaan unugyada.
Levothyroxine Plus Liotyroinine (T4 + T3)
Daraasado dhowr ah oo eegaya daaweynta levothyroxine-kaliya, marka loo eego iskudarka T3 ayaa muujiyey, sida laga soo xigtay Dr. Wiersinga, "Qiyaasta aadka u sareysa ee bukaanada (celcelis ahaan 48%) ayaa doorbiday daaweynta isku dhafka ah ... Kala duwanaanta serum final Qiimaha heerkoodu sarreeyo ma uusan sharxi karin doorashadan bukaanka. "
Gabagabo
Dr. Wiersinga ayaa ku soo gabagabeeyay in "dood sax ah loo samayn karo in daaweynta isku dhafan ay faa'iido u leedahay haddii levothyroxine: saamiga daaweynta liothyronin ayaa lagu dabaqayaa natiijada caadiga ah ee heerarka caadiga ah ee serum TSH iyo T4 ee lacag la'aanta T3 ee lacag la'aanta ah" ama marka la siiyo bukaanka leh qaas u gaar ah Arrimaha hidaha ee saameynaya awooda ay u leeyihiin inay beddelaan T4 ilaa T3.
Waxa kale oo uu ku talineyaa in dhakhtarka loo yaqaan 'endocrinologists' ay tahay inuu eego fursadaha, oo ay ku jiraan T3, si loo caawiyo bukaannada qaba hypothyroid oo leh calaamado joogto ah inkastoo la filayo in la qaato qiyaasaha levottyroxine oo ku filan.
Sida laga soo xigtay Dr. Wiersinga, hal ikhtiyaari waxay tahay in la raaco xeerarka 'Thyroid Association' (ETA) ee loogu talagalay isticmaalka "tijaabo" ee daaweynta T4 + T3 , taas oo ku lug leh saamiga levothyroxine ee liotyronin ee ku saabsan 17: 1 Sida laga soo xigtay Maqradda, "tusaale ahaan, qiyaasta daawada levothyroxin ee 100 μg, 150 μg iyo 200 μg inta lagu jiro daaweynta monotherapy inta lagu jiro daaweynta daaweynta isku dhafan 85 μg levothyroxine iyo 5 μg liotyronin, 125 μg levothyroxine iyo 7.5 μg liotyronin iyo 175 μg levothyroxine plus 10 μg liotyronin, siday u kala horreeyaan).
Waxay sidoo kale ku talinayaan in ay kala tagaan qiyaasta T3 maalinlaha ah (qadar yar oo la bixiyo subaxda iyo qadar weyn oo la bixiyo wakhtiga jiifka, qiyaasta saxda ah taas oo ku xiran sida loogu diyaar garoobo daawooyinka loo yaqaan liothyronine) heerarka T3 ee lacag la'aan ah, oo gaadhay heerkooda ugu sarreeya 3-da subaxnimo "
ETA ayaa sidoo kale ku talinaysa diyaarinta T3-da si tartiib ah loo sii daayo.
Meelaha kale ee xiisaha leh
Halkan waxaa ku yaal qodobo kale oo muhiim ah oo xiiso leh maqaalkan.
Tilmaamaha daaweynta ee loogu talagalay hypothyroidism ee lagu daabacay 1980-yada iyo 1990-yadii "si aan caadi ahayn" kugula talinaynaa levothyroxine (synthetic T4) iyo xaqiiqda sheegin wixii daaweyn kale oo daaweyn ah ee bukaannada. Xiiseyn, dhammaan tilmaamaha daaweynta hypothyroidism ee la daabacay 2000-kii ayaa wali kugula talineysa in levothyroxine ay noqoto daaweynta caadiga ah, laakiin waxaa sidoo kale ku jira qaybaha lagu sheegayo sababta daaweynta levothyroxine iyo liotyronin (T4 + T3) oo ka kooban mid aan la isticmaali karin.
Waxaa jira kororka daaweynta hypothyroidism. Dalka Ingiriiska, daawooyinka loo yaqaan 'thyroid thyroxes' ayaa labanlaabmeen intii u dhexaysay 1998 iyo 2007. Tirada guud ee dadka isticmaala daroogooyinka hormoonada hormoonada ah ayaa kordhay 53% intii u dhaxaysay 2005-2011 - tirada dadka reer Holland waxay kordhay 2.1% xilligaas.
Qaybta bukaanka ee daaweynta levothyroxine-ka keliya ayaa yaraaday intii u dhexaysay 2005 illaa 2011 - waxaana jiray tiro yar oo ka mid ah tirada bukaanada ee daaweynta T4 + T3 daaweynta synthetic.
Xigasho
Wiersinga, Wilmar. "Paradigm wuxuu isbeddelaa daaweynta hoormoonka tayroodhka ee loo yaqaan 'hypothyroidism.' Natiijada Dabeecadda Natiijada Endocrinology (2014), ayaa lagu daabacay 14 January 2014