Cilad-sheegisku wuxuu ku tiirsan yahay baaritaanka dhiigga
Haddii adiga ama qof aad jeceshahay uu leeyahay calaamado ama astaamo qanjirka thyroid oo aan firfircooneyn (oo la yiraahdo hypothyroidism), waa muhiim inaad u aragto dhakhtarkaaga qiimeyn buuxda. Si aad u hubiso dhibaatada dheef-shiid kiimikaad, dhakhtarkaagu wuxuu ku weydiin doonaa su'aalo ku saabsan taariikhda caafimaadkaaga shakhsiyeed iyo qoyseedka, sameynta baaritaan jireed, iyo baaritaanka dhiigga (sida ugu wanaagsan, hormoonka hormoonaya, ama baaritaanka TSH).
Haddii dhakhtarkaagu kuu ogaado cudurka hypothyroidism, wuxuu sidoo kale doonayaa inuu ogaado sababta keentay qalliinkaaga thyroid-ka, maadaama ay tani soo xulan doonto qorshahaaga daaweynta. Si aad u muujiso "sababta" udheerta cudurkaaga 'hypothyroid', waxaa laga yaabaa inaad u baahato inaad qaadato baaritaan dheeraad ah, sida baaritaanka dhiigga ee antibiyootikada.
Raadi dhakhtar
Dadka badankood waxaa laga helaa dhakhtarka qoyska ama internist. Si kastaba ha ahaatee, takhaatiirta daryeelka aasaasiga ah waxay leeyihiin khibrado kala duwan oo lagu maareeyo cudurka thyroid.
Hawsha ugu horraysa waa inaad ogaataa in takhtarkaaga daryeelka caafimaadku uu dareemo inuu kugu kalifayo inuu ku daweeyo, ama haddii aad la tashanayso dhakhtarka indhaha (dhakhtarka ku takhasusay daaweynta xanuunka hormoonka).
Dhamaadka, waxaad arki kartaa dhakhtarka indhaha, mar markaa dhakhtarkaaga daryeelka aasaasiga ah ayaa maamula cudurkaaga tayroodh ee horay u soconaya. Haddii kale, dhakhtarkaaga ku takhasusay qalliinka ayaa laga yaabaa inuu sameeyo dhammaan sanadkaaga daryeelka qashinka ee sanadka ka dib haddii taasi kani tahay.
Imtixaanka Imtixaanka
Markaad dhakhtar aragto marka ugu horeysa ee calaamadaha ama calaamadaha shaki laga qabo hypothyroidism, waxaad filan kartaa inaad qaadato taariikh caafimaad oo dhameystiran iyo baaritaan jireed.
Ka dib markaad dib u eegto calaamado cusub oo muujinaya in dheef-shiid kiimikaadku uu hoos u dhigi karo (tusaale ahaan, maqaarka, xoqida si fudud, qabow-qabad daro, ama caloosha), dhakhtarkaagu wuxuu weydiin doonaa su'aalo gaar ah oo ku saabsan taariikhda caafimaadkaaga, sida:
- Miyaad qabtaa cudur kale oo infalawanso ah (tusaale ahaan, rheumatoid arthritis ama nooca 1aad ee sonkorowga?)
- Miyaad leedahay xubin qoys oo leh hivotiroow?
- Weligaa qaliinka qanjirka 'qaliinka' ma ku jirtay?
- Miyaad qaadataa wax daawooyin ah oo sababa hypothyroidism sida amiodarone ama lithium?
- Miyaad qaadataa wax daaweyn ah oo dheeri ah?
- Weligaa miyuu jiraa qoortaaga qoorta, si loo daaweeyo lymphoma ama kansarka madax iyo qoorta?
Marka laga soo tago taariikhda caafimaadka, dhakhtarkaagu wuxuu baari doonaa qanjirkaaga xajmigaaga (oo la yiraahdo goiter) iyo buruq (nodules). Dhakhtarkaaga ayaa sidoo kale eegaya calaamadaha cudurka hypothyroidism sida cadaadiska dhiigga oo hoos u dhaca, garaaca wadnaha, maqaarka qalalan, barar, iyo falcelinta jilicsan.
Labo iyo Tijaabo
Cudurka qanjirka 'hypothyroidism' ayaa si weyn ugu tiirsan tijaabooyinka dhiigga.
Qanjirka 'Thyroid-stimulating hormone' (TSH)
Tijaabada TSH waa baaritaanka koowaad ee loo isticmaalo ogaanshaha iyo maaraynta hypothyroidism . Hase yeeshee, shaybaarro kala duwan ayaa badanaaba leh qiimo kala duwan oo loogu talagalay waxa loo yaqaana "Qeybta tixraaca ee MA."
Shaybaarro badan, kala duwanaanshaha tixraaca ayaa ka socda 0.5 ilaa 4.5. Qiimaha QT ee ka yar 0.5 ayaa loo tixgeliyaa hyperthyroid, halka qiimaha QT ee ka badan 4.5 uu yahay mid aad u liidata hypothyroid.
Shaybaarro kala duwan ayaa laga yaabaa inay isticmaalaan xadka hoose ee meel kasta oo ka soo jeeda 0.35 illaa 0.6, iyo heer sare ah meel kasta oo laga bilaabo 4.0 ilaa 6.0.
Si kastaba ha ahaatee, waxaa muhiim ah in aad ka warqabto qiyaasta tixraaca ee shaybaarka dhiiggaaga la soo diro, markaa waad ogtahay heerarka lagaa helayo
Haddii baaritaanka dhiigga ee hore ee dhiigga sareeya uu sarreeyo, waxaa badanaa la soo celiyaa, waxaana lagaa qaadayaa tijaabo T4 oo bilaash ah.
Thyroxine free (T4)
Haddii TSH-ga uu sarreeyo oo T4-ga oo bilaash ah, baaritaanka asaasiga ah ee hypothyroidism ayaa la sameeyaa.
Haddii uu TSHku sarreeyo, laakiin T4-ga bilaashka ah waa mid caadi ah, ogaanshaha cudurka hypotyroidism subclinical . Daaweynta qanjirka 'hypothyroidism' waxay ku xiran tahay dhowr arrimood.
Tusaale ahaan, dhakhtarkaaga ayaa daaweyn kara hypothyroidism-ka hoostaada haddii aad leedahay calaamado sida daal, calool-gal, ama niyad-jabka, ama aad qabtid cudur kale oo infalawanso ah, tusaale ahaan, cudurka baruurta.
Da 'da, sidoo kale, ayaa door ka qaadan doona go'aanka dhakhtarkaaga. Caadi ahaan, waxaa jira xaddi sare oo loogu talagalay in lagu bilaabo daaweynta beddelidda hoormoonka tayroodhka ee dadka waawayn; Tani waa sababta oo ah xaruntooda TSH waxay ku jirtaa xadka ugu sarreeya ee caadiga ah.
Jiritaanka unugyada difaaca TPO (hoos fiiri) ayaa sidoo kale door ka qaadanaya go'aanka dhakhtarkaaga. Haddii aad qabtid cudurka hypothyroidism iyo jimicsiga jirka ee TPO, dhakhtarkaagu wuxuu u muuqanayaa inuu bilaabayo daaweynta hoormoonka tayroodhka, si looga hortago in horumarka hypotyroidism-ka ee qotodheerta loo yaqaan hypothyroidism.
Cudurka qanjirka 'central hypothyroidism' ama 'hypothyroidism' waa mid aad u yar. Xinjirowga Central wuxuu soo jeedinayaa qanjirka 'pituitary gland' ama 'hypothalamus'. Nidaamyadan maskaxda ah waxay xakameynayaan qanjirka thyroid waxaana laga yaabaa inay waxyeelo ka soo baxaan burooyin, caabuq, shucaac, iyo cudurrada infiltrative sida sarcoidosis, iyo sababaha kale.
Xinjirta dhexe ee hypothyroidism, TSH ayaa ah mid hooseeya ama caadi ah oo T4 oo bilaash ah caadi ahaan ama hooseeyo.
TPO Antibodies
Dhiig-celinta "thyroid peroxidase" (TPO) ayaa tilmaamaya ciladda Hashimoto's thyroiditis, taas oo ah sababta ugu badan ee keenta hypothyroidism ee Maraykanka. Noocyada difaaca jirka waxay si tartiib tartiib ah u qaadaan qanjidhada tayroodh, sidaas darteed horumarinta hypothyroidism waxay u egtahay in ay noqoto nidaam tartiib tartiib ah, maxaa yeelay qanjidhka ayaa ka yaraada oo soo saaraa hoormoonka tayroodhka.
Tani waxay ka dhigan tahay in qofku yeelan karo "positive positive" TPO, laakiin hawlaha qanjidhada caadiga ah ee muddo yar; Xaqiiqdii, waxay qaadan kartaa sanado badan oo loogu talagalay shaqsiga tayroodhka ee qofka inuu hoos u dhigo heerka hypothyroid. Dadka qaarkood waxay xitaa yeeshaan difaacyo fiican oo TPO ah oo waligoodna horumar uma keenin inay noqdaan hypothyroid.
Inkasta oo dhakhtarkaagu aanu kuula dhaqmin daaweynta hormoonka tayroodhka hoormoonka haddii bedelka difaaca jirka ee TPO uu yahay mid wanaagsan laakiin Qiimahaagu wuxuu ku jiraa qiyaasta caadiga ah, wuxuu u egyahay inuu kormeero Qaadkaaga waqti ka dib.
Sawirka
Inkastoo baaritaanada dhiigga ay yihiin baaritaanka asaasiga ah ee lagu ogaanayo cudurka hypothyroidism, dhakhtarkaagu wuxuu dalban karaa ultrasound thyroid haddii uu qoro (ama wuxuu rabaa inuu hubiyo) goiter ama nodules baaritaanka jirka. Ultrasound ayaa kaa caawin karta dhakhtarku inuu go'aamiyo xajmiga nodule iyo haddii uu ka shakisan yahay kansar. Marmarka qaarkood, cirbadda laga soo jaray (oo la yiraahdo aspirin cirbad ah, ama FNA) ayaa loo sameeyaa si loo helo mantarro unugyada ku jira nodule. Unugyadaas ayaa markaa la baari karaa si ka badan maadada mikroskoobka.
Marka laga hadlayo cudurka hypothyroidism, sawir ayaa loo sameeyaa si loo baaro maskaxda iyo qanjirka 'pituitary gland'. Tusaale ahaan, MRI ee qanjirka 'pituitary gland' ayaa laga yaabaa inuu caddeeyo buro, sida adenoma pituitary.
Tijaabooyin kala duwan
Calaamadaha cudurka hypothyroidism waa kuwo aad u kala duwan waxaana laga yaabaa inay si fudud u seegaan ama u qalmaan xaalad caafimaad oo kale.
Baaritaano kale oo ku saleysan calaamadaha
Iyadoo ku xiran calaamadahaaga gaarka ah, dhakhtarkaagu wuxuu kuu qiimeyn doonaa xaaladaha caafimaad ee kale (gaar ahaan haddii ay TSH) caadi tahay. Kuwaas waxaa ka mid ah:
- Anemia
- Cudurka fayraska (tusaale ahaan, mononucleosis ama cudurka Lyme)
- Faytamiin D yaraanta
- Fibromyalgia
- Niyadjab ama walaac
- Hurdada jiifka
- Cudurka beerka ama kelyaha
- Cudurrada kale ee cudur-sidaha (tusaale cudur-wadareedka bararka ama rheumatoid arthritis)
Baaritaano kale oo ku saleysan natiijooyinka Baaritaanka Dhiiga
Inkasta oo asaasiga ah hypothyroidism uu yahay culeyska ugu sareeya ee ka dambeeya Qiimaha sare, waxaa jira baaritaano kale oo uu dhakhtarkaagu maskaxda ku hayo. Tusaale ahaan, tijaabooyinka dhiigga ee tirtira ee taageeraya ogaanshaha cudurka hypothyroidism ayaa dhab ahaantii laga yaabaa inay ka soo baxaan maqaar aan dawo lahayn.
Xadgudubka aan waxba ahayn
Dadka lagu jiifiyey cudur halis ah ama ku dhacay lafo-beelka lafaha, qalliinka weyn, ama wadne-qabadka wadnaha waxay yeelan karaan baaritaano dhiig ah oo shaqaynaya oo isku dhafan oo kudhaca maadada 'hypothyroidism' (hooseeyaT iyo hoose T4) -fiirin, "cudurada aan infekshanka" inta badan ma dalbanayaan daaweyn.
Xaaladdan oo kale, qiyaasidda baaritaanka dhiigga oo la yiraahdo T3, Tijaabada T4, waxay noqon kartaa mid wax ku ool ah oo kala duwanaanshaha u dhexeeya dhabta dhexe ee hypothyroidism iyo cudurada aan waxba galabsan. T3 waxay ku sarreysa xannuun aan waxba ahayn.
Xanuunka aan waxba galabsan, baaritaanka dhiigga ee hawlaha dhiigga waa in uu caadi noqdaa marka qofku ka bogsado cudurkiisa. Inkasta oo, dadka qaarkood waxay yeeshaan dib-u-bogsiin sare oo ah dib u soo kabashada. Dadkaas, dib u soo noqoshada Qoqanka afar illaa lix toddobaad ah ayaa sida caadiga ah muujiya habka caadiga ah ee TSH.
Awoodda Adrenal ee aan la daaweyn
Hypothyroidism iyo adrenal insufficiency waxay isku xirnaan karaan, sida ay ku sameeyaan xaalad naadir ah oo loo yaqaano "autoimmune polyglandular syndrome". Xanuunkani wuxuu ka yimaadaa geedi socodka gawaarida ee ku lug leh qanjidhada kala duwan, gaar ahaan qanjirka thyroid (keena hypothyroidism) iyo qanjidhada adrenal (oo keena adrenal la'aanta).
Mid ka mid ah khatarta ugu weyn ee la xiriirta cudurkaan waa daaweynta hypothyroidism (oo la siinayo beddelidda hormoonka tayroodh) ka hor inta aan la daaweynin hypolyrenalism (taas oo u baahan daaweyn corticosteroid), tani waxay sababi kartaa dhibaatada adrenal ee nolosha. Nasiib darro calaamaddan, waxaa dhici karta in uu gooyo hypolirenalism sababtoo ah qadar kacsan iyo calaamado aan caddayn oo ka soo horjeeda kuwa lagu arko hypothyroidism.
TSH-soo-saarka Cudurka Qanjidhka 'Pituitary Adenoma'
Haddii Qadku sarreeyo, waxaa lagama maarmaan ah in T4 lacag la'aan ah la hubiyo. Hase-yeeshe, waa in T4-ga bilaashka ah uu hoos u dhaco, laakiin haddii qofku leeyahay buro xabadka qanjirada "TSH-secreting tumor", T4 lacag la'aan ayaa la kordhin doonaa.
> Ilo:
> Ururka Astaamaha Maraykanka. (2013). Buug-yare Bukaanka iyo Qoysaska .
> Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10-aad. WLL / Wolters Kluwer; 2012.
> Garber J et al. Tilmaamaha Tababarka Caafimaadka ee loogu talagalay Hypothyroidism ee Dadka Qaangaarka: Cosponsored by American Association of Endocrinologists Clinical Association iyo Ururka Tiriinka American. Tababarka Indhaha . 2012 Nov-Dec; 18 (6): 988-1028.
> Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: Warbixin cusub. Am Dr. Dhakhtarka. 2012 Aug 1; 86 (3): 244-51.
> Upala S, Yong WC, Sanguanke A. Awooda ugu weyn ee adrenal-ka ee lagu baraarugay sida loo yaqaan 'hypothyroidism' ee bukaanka qaba cudurrada "polyglandular syndrome". N Am J Med Sci . 2016 May; 8 (5): 226-28.