Hypothyroidism (dheef-shiid kiimikaad hooseeya) waa xaalad caafimaad oo culus oo si weyn u saameeya caafimaadkaaga. Marka lagu daro in badanaa keena calaamadaha dhibaatada badan (oo ay ku jiraan miisaan culus, timo iyo isbeddelo maqaarka, caloosha ama shubanka, dhalmo la'aanta, daal, iyo daal iyo jirro), hypothyroidism waxay sidoo kale keeni kartaa dhibaatooyin caafimaad oo daran oo ku lug leh wadnaha iyo sanbabada, nidaamka caloosha, habdhiska dareenka, indhaha, iyo muruqyada.
Waxaa intaa dheer, waxay keeni kartaa isbedelo dheef-shiid kiimikaad ah oo ay ka mid yihiin hyponatremia (xajmiga soodhiyamka ee hooseeya), heerarka kolesteroolka sareeya , iyo kordhinta serine creatinine (qiyaasta shaqada kelyaha). Xiiqdheerka daran wuxuu xitaa sababi karaa isbeddellada garashada, jilitaanka, iyo dhimashada.
Haddii aad qabto hypothyroidism, adiga iyo dhakhtarkaaga ayaa muhiim u ah inaad daaweyso xaalada si loo yareeyo calaamadahaaga, iyo inaad yareyso oo aad ka hortagto dhibaatooyinka caafimaad ee kala duwan.
Waa Maxay Yoolalka Daaweynta?
Hadafyada daaweynta cudurka hypothyroidism waa kuwo sahlan. Waxay yihiin:
- inay caadi u yeelato heerarka hoormoonka qanjirka (gaar ahaan, heerarka T4, T3 iyo TSH)
- si loo baabi'iyo astaamaha hypothyroidism
- in la joojiyo loona soo celiyo waxyeellooyin kasta oo loo yaqaan 'hypothyroidism' ayaa laga yaabaa inuu ku dhaco nidaamyada hababka kala duwan
- haddii goosiga uu joogo (sida mararka qaarkood xaalada cudurka Hashimoto , tusaale ahaan), si loo yareeyo cabbirka
Sidee Daaweeye loo Qabtaa?
Waraaqda, daaweynta hypothyroidism waa mid toos ah.
Waxaa lagu daaweeyaa iyada oo la qorayo tallaalka hoormoonka hoormoonka ee afkiisa (badanaa levothyroxine, oo loo iibiyo sidii Synthroid , diyaarinta T4), oo ah qiyaas daawo ku filan oo lagu soo celiyo heerarka hoormoonka tayroodh caadiga ah, iyada oo aan la saarin sunta ka timaadda hoormoonka tayroodh aad u badan.
Si kastaba ha noqotee, ficil ahaan daaweynta ugu wanaagsan ee hypothyroidism waxay abuurtay qadar xaqiiqo ah oo muran ah.
Muranka ugu weyni waa labo:
- Intee in le'eg ayaad ku riixi kartaa heerarka TSH ka hor inta aanad tixgelineynin hypothyroidism in si habboon loola dhaqmo?
- Miyuu T4 kaliya ku filan yahay, ama waa in T3 la qoraa?
(Si aad u ilaaliso hoormoonka tayroodhka tooska ah, akhriso dib u eegis dhakhso ah qanjirka thyroid, T4, T3, iyo TSH .)
Waxaan tixgelin doonaa labadaba muranadaas ka dib markii aan marka hore fiirino "teraabiyada" daaweynta hypothyroidism.
Daaweynta 'Standard' ee Hypothyroidism
Dhakhaatiirta 'endocrinologists' (takhasusayaasha xanuunka hormoonnada) waxay ku dhow yihiin guud ahaan inay kugula taliyaan daaweynta hypothyroidism oo leh T4 oo keliya. Dhallinyarada, dhakhaatiirta caafimaadku waxay guud ahaan bilaabi doonaan waxa lagu qiyaaso "qadar buuxa" T4 (taas oo ah, qiyaasta loo malaynayo in ay gabi ahaanba dib u soo celiso shaqadii caadiga ahayd). Qiyaasta bedelka buuxa waxaa lagu qiyaasay miisaanka jirka, qiyaastii 1.6 mcg halkii kg. Dadka intooda badani waxay noqon doonaan inta u dhaxeysa 50 iyo 200 mcg maalintii.
Dadka waayeelka ah ama dadka qaba cudurka halbowlaha wadnaha , bilaabidda daaweynta beddelidda tayroodhka waxaa badanaa la sameeyaa si tartiib tartiib ah; oo ka bilaabma 25-50 mcg maalin kasta, iyo kordhinta qiyaasta mudada dheer.
Dadku waa inay qaataan T4 calool madhan, haddii kale nuugista daawada waxay noqon doontaa mid qaldan.
Caadi ahaan, dhakhaatiirtu waxay ku talinayaan inay qaataan daawada ugu horreysa subaxdii, ka dibna sug in ugu yaraan saacad ay cunaan quraac (ama xittaa cabitaanka kafeega). Qaadashada daawada wakhtiga hurdada, dhowr saacadood ka dib cuntada ugu dambeysa, waxay u muuqataa inay shaqeyneyso, waxaana laga yaabaa inay noqoto mid haboon oo loogu talagalay dad badan. Akhriso wax dheeraad ah oo ku saabsan wakhtiga qaadashada daawada tayroodh .
Qiimaha TSH ayaa la ilaaliyaa si loo yareeyo heerka qiyaasta T4. Qanjirka 'th-thyroid stimulating hormone' - waxa lagu soo saaraa qanjirka 'pituitary' ka jawaab celinta qanjirka 'thyroid'. Marka, marka heerarka hoormoonka tayroodhku uu hooseeyo (sida hypothyroidism), heerarka TSH ayaa ka jawaabaya sii kordhaya, isagoo isku dayaya inuu "xakameeyo" hormoonka qanjidhada ka soo baxa qanjirka thyroid.
Marka hypothyroidism si haboon loo daaweeyo, heerarka TSH ayaa caadi ahaan hoos u dhacaya inta caadiga ah. Sidaa daraadeed, habka ugu muhiimsan ee lagu ogaanayo qiyaasta ugu fiican ee T4 waa in la cabbiro heerarka TSH .
Inkasta oo astaamaha hypothyroidism ay caadi ahaan bilaabaan in ay xaliyaan laba toddobaad gudahood ee daaweynta bilowga ah, waxay qaadataa qiyaastii lix todobaad oo ah heerarka uur-jiifka si loo xasiliyo. Sidaa daraadeed, heerarka TSH ayaa guud ahaan la qiyaasaa lix todobaad ka dib marka daaweyntu bilaabanto. Haddii heerarka TSH-ta ay ka sarreyso heerarka bartilmaameedka, qiyaasta T4 ayaa kordhay 12-25 mcg maalintii, heerarka TSH ayaa lagu soo celiyaa ka dib lix toddobaad oo dheeraad ah. Nidaamkan waa la sii wadi doonaa ilaa heerka Qaabu uu gaaro heerarka la rabo, calaamadaha la xalliyo. Marka qiyaasta ugu wanaagsan ee T4 lagu xakameeyo, heerarka TSH waa la qiyaasi karaa sanad walba ama ka dib, si loo hubiyo in daaweynta lagu wanaajiyo.
Waxaa jira habab kala duwan oo T4 ah oo ay sameeyeen shirkadaha kala duwan. Inkasta oo dhammaan shuruudaha FDA ee la ansixiyey ay yihiin kuwo lagu habboon yahay, khubarada intooda badani waxay ku talinayaan in ay sameeyaan hal isku mid ah, oo aysan badalin, maadaama maadooyinka isbarbardhiga ah ay ku kala duwanaan karaan waxqabadyo kala duwan.
Tani, markaa, waa habka caadiga ah ee lagu daaweyn karo hypothyroidism, mar labaadna waa mid toos ah. Waxay u muuqataa in ay u shaqeyso badi dadka; taas oo ah, habkaan daaweyntu waxay ku dambeyneysaa xallinta calaamadaha iyo dib u soo celinta heerarka hoormoonka tayroodhka caadi ahaan dadka qaba hypothyroidism.
Laakiin ma aha in dhan. Tani waa meesha ay muranadu ka yimaadaan.
Khilaafaad: Waa maxay Ujeeddada Haboon ee Cus
Sida aan aragno, heerka qiyaasta TSH ayaa ah midka ugu muhiimsan ee lagu qiimeeyo ku filnaanshaha daaweynta beddelidda tayroodh.
Laakiin qof kastaa ma aqbalo waxa "caadiga ah" ee loogu talagalay heerarka TSH . Inta badan jaaliyadaha ugu wayn ee jimicsiga waxay tixgeliyaan heerka caadiga ah ee u dhaxeeya 0.5-4.5 (ama xitaa 5.0) mIU / L. Si kastaba ha noqotee, koox wayn oo diidan (Ururka Xirfadaha Caafimaadka ee Endocrinologists) ayaa sheegay in heerka ugu sarreeya ee caadiga ah in la yareeyo 3.0 MIU / L. Dadka ay heerkoodu sarre ay ka sarreeyaan xadka sare, waxay yiraahdeen, waxay noqon karaan hypothyroid.
Su'aashan ayaa muhiim u ah dhowr sababood, laakiin (sidaanu aragnay) mid ka mid ah ayaa ah, marka la daaweynayo hypothyroidism, waxaa muhiim ah in la ogaado heerka heerarka TSH marka daweynta ay tahay mid caadi ah, ama aan. Haddii heerka qaaxada ee daaweynta ay tahay 4.2 mIU / L, sida badan inta badan dhakhtarka indhaha ayaa laguula dhaqmayaa si habboon; laakiin sida laga soo xigtay tiro yar oo muhiim ah waxaad ubaahantahay qadar sare oo hoormoon tayroodh.
Sidaa darteed, murankan sii socda ayaa badanaa adkeyn kara daaweynta cudurka hypothyroidism.
Khilaafaad: T4 Kalidaa Loogu Tahay ama Ma T3 Lahaa?
T4 waa hormoonka thieroid ee weyn, laakiin ma aha hormoonka firfircoon. T4 waxaa loo beddelaa T3 ee unugyada, sida loo baahdo. T3 waa hoormoonka tayroodh ee sameeya shaqada oo dhan. (T4 waa "kaliya" "Prohormone" -kaabis ah T3, taasoo ah hab lagu hubiyo in T3 lagu abuuri karo daqiiqad-daqiiqo sidii loo baahdo.)
Marka aan siin karno T4 oo aan ahayn T3, waxaanu "ku kalsoonahay" unugyada qofka qaba hypothyroidism si loogu badalo qadarka saxda ah ee T4 ilaa T3, meesha kaliya ee saxda ah, iyo waqtiga kaliya ee saxda ah. (Dhab ahaantii, tani waa xirfadlaha ugu wayn ee loo yaqaan 'endocrinologists' ee isticmaala T4 oo keliya - jidhku "wuu ogyahay" ugu fiican marka iyo meesha uu u baahan yahay T3, iyo intaad ku siinayso T4 ku filan, waxay u qaban doontaa shaqada. Marka lagu daro T4, waxay yihiin "labaad" malaha jirka.
Si kastaba ha noqotee, cadad cad oo caddayn ah ayaa la soo saaray oo soo jeedinaya, ugu yaraan dadka qaarkiis ee qaba hypothyroidism, in qaabka ugu wanaagsan ee T4 illaa T3 uu ka maqan yahay. Si kastaba ha ahaatee, inkastoo xaqiiqda ah in heerka T4 ay caadi noqon karaan, heerarkooda T3 waxay noqon karaan kuwo hooseeya-gaar ahaan kuwa unugyada, halkaas oo T3 dhab ahaantii shaqadeeda ay qabato.
Sababtoo ah T4 ilaa T3 isbedel ayaa dhici karta in dadka qaarkood ay yihiin, waqtigaan, inta badan is-sheegashada-inkastoo ugu yaraan hal koox oo bukaan ah lagu aqoonsaday astaamo hidde ah (oo ah diodinase 2 gene) taasoo hoos u dhigaysa beddelidda T4 illaa T3. Si kastaba ha ahaatee, waxay u muuqataa in dhakhtarradu ay tahay inay daweeyaan ugu yaraan dadka qaba hypothyroidism ee leh T4 iyo T3 labadaba.
Siinta daawooyinka ku habboon ee T3 way ka adag tahay marka loo eego qiyaasta T4. T4 waa mid aan firfircooneyn; haddii aad siiso wax badan ma jiraan wax saameyn ah oo toos ah, oo toos ah saamiga unugyada (maxaa yeelay waa in loo beddelo T3 ka hor inta unugyada ay saameynayaan). T3 waa sheeko ka duwan; waa hoormoonka tayroodh firfircoon, sidaas darteed haddii aad si aad u badan u bixiso, waxaad si toos ah u saameeyn kartaa saameynta hyperthyroid -tusaale ahaan, dadka qaba cudurrada wadnaha.
Marka lagu daro T3 ilaa T4 inta lagu jiro daweynta beddelidda thyroid, khabiirada intooda badan waxay ku taliyaan inay maamulaan saamiga T4: T3 ee u dhexeeya 13: 1 illaa 16: 1, taas oo ah saamiga ka jira dadka aan lahayn cudurka thyroid. Tani waa saamiga ugu sareeya ee T4: T3 intii loo isticmaalay tijaabooyinka kiliinikada ee la kala doortay.
Tijaabo aan caadi aheyn oo la barbardhigay natiijooyinka T4 oo keliya oo ah T4 + T3 guud ahaan guud ahaan muu helin faa'iido muhiim ah isticmaalka daaweynta isku dhafan ee dadka bukaanka qaba hypothyroidism. Si kastaba ha ahaatee, tijaabooyinkan looma qorsheynin inay xisaabiyaan suurtagalnimada in faa'iidooyinka daaweynta isku dhafan ay u badan tahay in ay ku kooban tahay qayb ka mid ah dadka qaba hypothyroidism. Inkasta oo aanay jirin caddayn tijaabo ah oo xooggan, haddana dhammaan khubarada ayaa hadda isku raacay in ay jiraan runtii dadka qaarkii qaba hypothyroidism oo u baahan in la helo T4 iyo T3 labadaba.
Daweynta Hypothyroidism: Ujeedo macquul ah
Marka la eego waxa aan ka ogaanno qanjirka 'hypothyroidism', heerarka TSH, iyo xiriirka ka dhexeeya T4 iyo T3, khabiirada intooda ugu badan ee habka macquulka ah ee daaweynta xaaladdan waxay u egtahay sidan:
Ka bilow habka "habka", adigoo isticmaalaya daawada T4 oo keliya, si taxadar leh u qiimeynaya heerarka TSH-ga iyo heerkulka gargaarka ciladaha, iyo hagaajinta qiyaasta T4 si waafaqsan. Dadka badankood, habkani si fiican ayuu u shaqeynayaa.
Haddii astaamaha hypothyroidism ay sii socdaan inkastoo ay gaareen heerka heerarka caadiga ah ee heerka caadiga ah (taas oo ah 3 mIU / L oo ka hooseeya 5 mIU / L), hadaba midkood ama labadaba waa in la tixgeliyaa:
1) Kordhinta qiyaasta T4 si ku filan si aad ugu riixdid heerka TSH hoose ee 3 mIU / L.
2) Ku dar T3 habka daweynta, iyadoo taxadar ku haboon.
Ka hor inta aan la dooran 2 kale, khubaro badani waxay kugula talinayaan in ay cabbiraan heerarka T3-da, iyo diiwaangelinta in ay ku dhawdahay dhamaadka hoose ee qiyaasta caadiga ah, ama hoos. Haddii heerarka T3 ay ku jiraan dhexdhexaad ilaa heer dhexdhexaad ah, waa arrin shaki badan in T3 lagu daro habka daaweynta uu hagaajin doono waxyaabaha. ( Akhri wax dheeraad ah oo ku saabsan qiyaasta hawlaha hoormoonka hoormoonka .)
Sidaas awgeed: Haddii lagugu daaweeyo cudurka hypothyroidism iyadoo la adeegsanayo habka "caadiga" iyo calaamadahaaga aan si aad ah loo yareynin, waxaad u baahan tahay inaad kala hadasho dhakhtarkaaga si aad u tixgeliso hal ama labadaba hababkan kale.
Ereyga
Daaweynta hypothyroidism dhab ahaantii waa mid toos ah, ugu yaraan aragti. Iyo badi dadka qaba xaaladdan, tooska ah, habka 'habka' habka daaweynta ayaa si fiican u shaqeysa.
Hase yeeshee, haddii habka caadiga ah ee aan la isku haleynin calaamadaha cudurka hypothyroidism, waxaa la joogaa waqtigii loo tixgelin lahaa "aan caadi ahayn," habab kale - ama riixidda heerarka TSH ee hoos udhaca qiyaasta caadiga ah, ama lagu daro T3, ama labadaba.
> Ilo:
> Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, iyo al. DIB U EEGID: Daaweynta Hypothyroidism Iyadoo Isku Diyaarin Lootothyroxine Plus Liotyronine. J Clin Endocrinol Metab 2005; 90: 4946.
> Jonklaas J, Bianco AC, Bauer AJ, et al. Tilmaamaha loogu talagalay Daaweynta Hypothyroidism: Waxaa diyaariya Wakaaladda American Thyroid Association oo ku saabsan Beddelaadda Qanjidhka Qanjirka 'Thyroid'. Tirada 2014; 24: 1670.
> Panicker V, Saravanan P, Vaidya B, iyo al. Isbeddelka Guud ee DIO2 Gene Predicts Fududeynta Cilmi-nafsiyeedka iyo jawaab-celinta ee isku-dhafka Thyroxine Plus Triiodotyronine Therapy ee bukaannada Hypothyroid. J Clin Endocrinol Metab 2009; 94: 1623.