Daaweynta Qanjidhka Daacuunka ee Hypothyroidism
Warbixin wanaagsan oo loogu talagalay bukaannada tirakoobka: Daraasad lagu daabacay joornaal qadarin leh oo lagu qadariyo 'Journal of endocrinology' ayaa sheegay in isku-dhafka T4 / T3 uu ka sareeyo daaweynta T4 oo keliya / levothyroxin oo loogu talagalay hypothyroidism! Waa kuwan faahfaahinta.
Daraasaddan ayaa ka soo baxday wargeyska Yurub ee Endocrinology waxay eegtay arin murugo leh oo ku saabsan daaweynta T3 dabiiciga ah oo loo yaqaan 'T4-only (levothyroxine) oo loogu talagalay daaweynta hypothyroidism.
Daraasadaha qaarkood dib u noqosho ka badan toban sano waxay muujiyeen korodhka daaweynta isku dhafan. Daraasado kale, si kastaba ha ahaatee, ma helin isbeddel. Kala- duwanaanta natiijooyinka cilmi-baarista ee T3 ayaa horseeday khubaro qaar - gaar ahaan, kuwaas oo ka soo horjeeda daaweynta levothyroxine-kaliya oo keliya - si loo ogaado in wax faa'iido ah aysan u lahayn T3. (Qaar ka mid ah kuwa "khubaro" isku mid ah ayaa xitaa sameeyay xuddun macquul ah, oo si khalad ah u soo gabagabeeyay in daaweynta levothyroxine / T4 kaliya ay ka sarreyso daaweynta isku dhafan ee T4 / T3.)
Cilmibaadhistii cilmibaadhayaasha deenishka ayaa sameeyay baadhitaan indho-indhoole ah, oo lagu qiyaaso daraasadda, taas oo loo arko qaab-dhismeedka dahabiga ah ee cilmi-baarista - oo ah 59 bukaan. Kooxda bukaanka, 50 mikrogram oo qiyaasta caadiga ah ee T4 waxaa lagu bedelay 20 mcg oo ah T3 ama 50 mcg oo T4 ah 12 toddobaad. Bukaanka ayaa markaas sameeyay "iskutallaabta", oo ka soo horjeeda 12 toddobaad oo kale.
Qiyaasta tallaalka T4 ayaa lagu qoondeeyey haddii loo
Baaritaannada tayada nolosha (QOL) iyo niyad-jabka ayaa la bilaabay bilowga, iyo labadaba mudada daaweynta 12-usbuuc labadaba. Tayada nolosha iyo xaaladaha maskaxeed ee la qiimeeyey waxaa ka mid ah, arrimaha kale: caafimaadka guud, shaqada bulshada, caafimaadka dhimirka, maaraynta, dareenka, niyad-jabka iyo walwalka.
Waxa cilmi-baarayaashu ku ogaadeen in bukaanku - 55 ka mid ah ay ahaayeen dumar - waxaa jiray farqi weyn oo ku yimid 7 ka mid ah 11-ka QOL iyo dhibcaha niyad-jabka, oo muujinaya saameyn togan oo la xidhiidha daaweynta isku dhafka T4 / T3.
Wadarta 49% bukaanjiifka ayaa doorbiday daaweynta isku dhafan, keliya 15% daaweynta levothyroxine-ka keliya.
Cilmi-baarayaasha waxay soo gabagaboobey in daraasaddan oo ah in heerarka TSH-ga la joogteeyo, daaweynta T4 / T3 ee isku-dar ah oo ay ku jiraan 20 mcg oo ah T3 maalin kasta waxay ka sarreysay daaweynta levothyroxine-keliya, marka la qiimeeyo tiro tayadood oo ah cabirada nolosha, niyad-jabka iyo welwelka miisaanka, iyo mudnaanta bukaanka.
Dhakhaatiirtu inta badan waxay tilmaamayaan halista saameynaha daaweynta T3 inay sabab u tahay inaysan isticmaalin T3, laakiin daraasaddan ayaa muujisay in aysan jirin wax isbeddel ah oo ku saabsan saamaynta daawada. Sida laga soo xigtay qorayaasha, intii lagu jiray daaweynta isku dhafan ee T4 / T3, shan qof ayaa la kulmay waxyeelooyin kale oo ay ka mid yihiin isku-buuq, qulqulo xad-dhaaf ah, iyo xasillooni darro maskaxeed. Intii lagu jiray daaweynta T4 oo keliya, sagaal qof ayaa soo sheegey saameyno isku mid ah.
Teeda kale, cilmibaadhayaasha deenishka ayaa qaba, in dhibaatooyin la xidhiidha daraasadihii hore ee dawooyinka T4 / T3, oo aan wax faa'iido ah u lahayn dawaynta T3, oo lagu yidhi: "daraasadaha lagu daray miisaaniyadda ayaa ahaa isku darka kooxaha bukaanka ee kala duwan, oo ay ku jiraan bukaanka oo leh kansar horayba loo yaqaan 'thyroid cancer', 'autoimmune hypothyroidism', iyo subclinical iyo sidoo kale hypothyroidism.
Marka la eego cilmibaadhayaasha deenishka, mid ka mid ah daraasadaha muhiimka ah, "... qoraalladu ma awoodeen inay sii wadaan heerarka serum TSH ee heerka isku midka ah ee labada kooxood ee daweynta, macnaheedu waa serum TSH oo ah 3 kooxeed iyo 1.5 mU / l ee kooxda daaweynta monotherapy.
Cilmi-baadhayaasha ayaa sheegay in daraasaddooda ay soo jeedinayso in koox-hoosaad oo bukaannada ah ay u muuqdaan kuwo ka faa'iideysanaya daaweynta T4 / T3 ee isku-jirka ah. Gaar ahaan, waxay soo jeedinayaan in ay jiri karaan sababo nafsaani ah sababta sababa kooxdu uga jawaab celiso - ama baahida - T3, gaar ahaan, in:
... dhowaan la aqoonsan yahay ee hiddaha oo lagu magacaabo noocyadda deiodinase, enzyme mas'uul ka ah helitaanka helitaanka T3 ee unugyada, ayaa loo soo jeediyay si loo caawiyo aqoonsiga subgroups ka badan tahay inay ka faa'iideystaan daaweynta isku dhafan ee T4 / T3. Polymorphism kale, oo ku yaal OATP1C1, oo ah tareenka hoormoonka hoormoonka ee lagu caddeeyey barxadda dhiigga, ayaa lala xiriiriyay daal iyo niyadjab.
Wilmar Wiersinga oo ah Fannaan Cudurka Nederlandka ee Fool-xumada ah ayaa sheegay in sii-deynta sii wadidda T3 laga yaabo inay noqoto midka ugu wanaagsan, dadka qaarkiis ayaa laga yaabaa in ay ku habboonaadaan hiddaha hidaha si ay wax uga qabtaan T3
Wilmar Wiersinga oo ah cilmi-baaris ku takhasustay farsamada Holland ayaa qoray qoraal tifaftiran, oo cinwaankeedu yahay "Ma waxaan ubaahannahay tijaabooyin kale oo dheeraad ah oo ku saabsan daaweynta T4 iyo T3 ee isku-dhafan ee hypothyroidism?"
Sida laga soo xigtay Dr. Wiersinga, daraasado hore ayaa soo gabagabeeyay inaan wax faa'iido ah u lahayn kordhinta T3. Hase yeeshee, xaqiiqda ah, sida laga soo xigtay Wiersinga, boqolkiiba 10% dadka bukaanka qaba hypothyroid ayaan ku qanacsanayn sida ay u dareemayaan waxa ay takhaatiirtu u yeeri lahaayeen "dose ku filan" ee beddelka levothyroxine waxay keentay daabacaadda daraasadda deenishka.
Tifaftirka, oo lagu daabaco internetka oo dhan, ayaa tilmaamaya in uu khaldan yahay daraasadaha hore iyo falanqeynta daaweynta T4 / T3. Dr. Wiersinga ayaa soo gabagabeynaya in ay jiraan laba sababood oo xooggan oo ah in la sameeyo tijaabooyin dheeraad ah oo la xakameynayo oo la barbardhigo daaweynta daaweynta levothyroxine / T4 kaliya, daaweynta isku dhafan ee T4 / T3:
Marka hore, tijaabooyinka illaa iyo hadda waxa ay ku guuldareysteen in ay la qabsadaan sanbabada FT4-FT3 oo dhan 24 saacadood. Horumarinta diyaarinta sii-deynta sii-deynta ah ee T3 waxay noqon kartaa mid lagama maarmaan u ah helitaanka himilada 'beddelaadda hormoonka' thyroid hormone. Marka labaad, tirada sii kordhaysa ee polymorphisms ee deiodinases iyo gaadiidleyda tayroodhka thyroid waxay la xiriiraan fayoobaanta nafsaaniga ah, niyadjab, daal, iyo doorbididda daaweynta isku dhafan. Ma noqon kartaa maadooyinka aan ku qanacsaneyn daaweynta monotherapy waa kuwa soo noqnoqda ee ka yimaada polymorphisms, oo waxay ka jawaabi doonaan daaweynta isku dhafan?
Sida laga soo xigtay Dr. Wiersinga, horumarinta diyaarinta sii-deynta T3 ee joogtada ah, oo la siiyo hal mar oo qado ah (oo ay la socoto levothyroxin hal maalin maalin) ayaa ugu wacnaan karta saamiga nafsaaniga ah ee T4 iyo bilaashka T3 ee bukaannada qanjirada ah muddo 24 saacadood ah.
Ogsoonow: haddaba mar kale aynu dib u soo celinno mar kale. Kala badh bukaanku wuxuu doorbiday iskudhafka T4 / T3 - keliya 15% oo keliya levothyroxin-keliya, IYO, tayada nolosha iyo waxyaabo kale ayaa la hagaajiyay. IYO, daaweynta T4 / T3 ma lahan wax saameyn ah oo ka duwan tan T4-keli ah. (Dhab ahaantii, daraasaddan, daaweynta T4 kaliya waxay keentay saameyno badan oo ka yimaada.) Waxaan rajeynayaa in qaar ka mid ah kuwa loo yaqaan 'thyroid khabiir' - kuwaas oo had iyo jeer ay sidoo kale ku jiraan mushaar bixiyeyaasha levottyroxin - waxay u badan yihiin inay tagaan ku dhicii oo dhan iskuday inay isku sharraxaan natiijooyinka, iyo waxay noqon doontaa mid xiiso leh daawashada iyaga isku day!
Maqaalka saxda ah ee dhabta ah ee guud ahaan waa akhrin xiiso leh, lakiin nasiib daro, ma ahan in lagu dhajiyo internetka oo dhan. Si kastaba ha ahaatee, waxaad ku iibsan kartaa nuqul internetka ah $ 25 oo ku qoran bogga Yurub ee Endocrinology . Tani waa hubaal inaad tahay mid aad rabto in dhakhtarkaagu kuu akhriyo sidoo kale, hubso inaad u ogolaato inuu ogaado inuu nuqul ka heli karo. Si daacad ah, waxaa laga yaabaa inay u qalantid inay soo iibsato nuqul si loo dhiso dhaqtarkaaga, haddii uusan isagu / iyadu aysan rabin inay wax ka bartaan horumarinta tayroodh.
Macluumaad Dheeraad ah oo ku saabsan T4-Only Vs. T4 / T3 Isugeynta Daaweynta Hypothyroidism
- Fiiri T4 Kaliya T4 iyo T4 / T3 Khilaafaadka Daroogada
- T3 Triiodothyronine Daroogooyinka Hagaajinta Tayada Nololeed ee Hypothyroidism: Cilmi baadhista Inta badan bukaanku way fiicnaadeen iyadoo la raacinayo T3 / New Journal of Journal of Medicine ee 1999
- Daraasad ku socota Bukaanka Doonaya Isugeynta T4 / T3 Daaweyn: Cilmi-baaris ayaa muujinaya Daaweynta Daaweynta Combo Therapy
> Ilo:
> Birte Nygaard, Ebbe Winther Jensen, Jan Kvetny, Anne Jarløv iyo Jens Faber. "Saameynta Isugeynta Daaweynta Thyroxine (T4) iyo 3.5,3'-Triiodothyronine Versus T4 Daaweynta Monotherapy ee Bukaanka qaba Hypothyroidism, Labo-Indhoole, Daraasad Isku-dhajisan oo Xirfad ah," Journal Journal of Endocrinology , Vol 161, Issue 6, 895-902, Diseembar 2009 Abstract, (Dhammaystir buuxa ($ 25))
> Wiersinga, Wilmar "Ma u Baahan Tahay Sidii Hore Dhibaatooyin Dheeraad ah T4 iyo T3 Isku Daaweynta Hypothyroidism?" Journal Journal Endocrinology , Vol 161, Issue 6, 955-959. Qoraal buuxa (bilaash)