Fiiri daawooyinka Antithyroid, Raadiyaha Iodine, iyo Qalliinka
Daaweynta ugu wanaagsan ee laguugu talagalay hyperthyroidism waxay ku xiran tahay dhowr arrimood, laga soo bilaabo sababahaaga da'daada, darnaanta kiiskaaga caafimaadka guud ahaan. Inkastoo daawooyinka antidiotide (Tapazole, tusaale ahaan) loo isticmaali karo si loogu caawiyo shaqada tayroodhka caadiga ah, daawooyinka kale-sida beta-blockers - waxaa loo qaadan karaa in la yareeyo calaamadaha hyperthyroid.
Fursadaha sida soodhadhka thyroid leh iodine raadiyaha ama qalitaanka si looga saaro qanjidhada (thyroidectomy) ayaa sidoo kale la tixgelin karaa.
Inkasta oo dhammaan saddexda doorashadu ay wax ku ool yihiin, waxay mid waliba leeyihiin kharashyo kala duwan iyo saameynaha saameyn kara. Tani waa sababta aad ula tashanayso dhakhtarkaaga oo kalsooni leh ka hor inta aadan qorsheyn daaweyn.
Rijeetooyinka
Daawooyinka dhakhtarku waa caadi ahaan daaweynta ugu weyn ee loogu talagalay hyperthyroidism. Waxa kale oo laguu qori karaa daawooyin kale si ay kaaga caawiso inaad maareyso calaamadaha la xiriira.
Daaweynta Dawooyinka Antithyroid
Ujeedada daawada antithyroid waa in lagu gaaro hawlaha caadiga ah ee tirtiridda bil gudaheed ama laba ka mid ah daaweynta bilawga ah. Kadibna qof ayaa laga yaabaa inuu sii wado doorashooyinka soo socda:
- Maqal qeexan oo lagu daweeyo iodine-ka ama qalitaanka
- Sii wad daawada antithyroid muddo sannad ama laba sano ah, iyada oo rajada laga qabo in lagu guuleysto xasaasiyad (taas oo u badanaaba dadka ay qabaan hyperthyroidism khafiif ah waxayna u badantahay dadka leh gebi iyo kuwa sigaarka cabba)
- Qaado mudada dheer ee daawada antithyroid
Inkasta oo daaweynta dawooyinka muddada dheer ee daawada antithyroid ay tahay rafcaan (waxaad fursad u leedahay in lagaa saaro, daaweyntu waa la beddeli karaa, waxaadna ka fogaan kartaa khatarta iyo kharashyada la xidhiidha qalliinka), hoos u dhacu waa in cilmi-baadhayaashu qiyaasaan ilaa boqolkiiba 70 dadka dib ugu noqda daaweynta daawada antithyroid ayaa la joojinayaa.
Labada dawooyinka antithyroid ee laga helo Maraykanka waa Tapazole (methimazole, ama MMI) iyo propylthiouracil (PTU). Sababtoo ah xaqiiqda ah in MMI uu leeyahay saameyno yaryar oo ka sii dillaacday hyperthyroidism si ka dhakhso badan PTU, MMI waa doorbidka la door bidayo.
Taasi waxay tidhi, PTU waxaa loo isticmaalaa in lagu daaweeyo hyperthyroidism inta lagu guda jiro saddexda bilood ee ugu horeeya ee uurka iyo dadka qaba duufaantii thyroid . Waxaa sidoo kale laga yaabaa in la siiyo dadka ka soo horjeeda methimazole oo aan rabin in ay qaataan Iodine raadin ama qalliin.
Qaar ka mid ah waxyeelooyinka yaryar ee suurtogalka ah ee la xidhiidha qaadashada MMI ama PTU waxaa ka mid ah:
- Cuncun
- Finan
- Xanuun wadajir iyo barar
- Lalabbo
- Qandho
- Isbedelada dhadhanka
Dhibaatooyin badan oo dheeraad ah, dhaawaca beerka ee leh labada MMI ama PTU (oo ka sii badan kuwa dambe). Calaamadaha dhaawaca beerka waxaa ka mid ah xanuunka caloosha, cagaarshow, kaadi mugdi ah, ama saxaro dhoobo ah. Inkasta oo aan caadi ahayn, xaalad halis ah oo halis ah oo loo yaqaanno 'agranulocytosis' (hoos u dhac ku yimaada unugyada caabuqa ee jirkaaga ku jira) ayaa laga yaabaa inuu ku dhaco midkood MMI ama PTU. Waa lagama maarmaan in dadku qaataan daawooyinkan si dhakhso ah u wargaliyaan dhakhtarkooda isla markiiba haddii ay ku dhacaan calaamadaha cudurka sida qandho ama cuno xanuun.
Beta Blocker Therapy
Inkastoo maahan daaweyn loogu talagalay hyperthyroidism, dad badan oo qaba hyperthyroidism ayaa loo qoraa antagoniste beta-adrenergic (oo loo yaqaan 'beta-blocker').
Beta-blocker wuxuu ka shaqeeyaa jirka si loo yareeyo saameynta hormoonka thyroid xad-dhaafka ah ee wadnaha iyo wareegga, gaar ahaan heerka garaaca wadnaha, cadaadiska dhiigga, cadaadiska, jimicsiga, iyo qaababka aan joogtada ahayn. Beta blockers sidoo kale waxay yareeyaan heerka neefsashada, yaraynta dhididka iyo kuleylka kuleylka, iyo guud ahaan yareynta dareenka walwalka iyo walwalka.
Daroogooyinka loogu talagalay Thyroiditis
Foomamka ku-meel-gaadhsiis ah ama "self-restraint" ee hyperthyroidism (tusaale ahaan, thyroiditis subaga ama tirakoobka dhalmada ka dib ), diiradda ayaa ugu horreynteeda daaweynta calaamadaha. Xanuunada xanuunka loo yaqaan 'thyroid pain' iyo 'inflammation', ama beta blockers ayaa loo qori karaa calaamadaha wadnaha la xiriira.
Marmarka qaarkood, daawada antithyroid waxaa loo qoraa waqti gaaban.
Ablation
Rooti-socodka iodine (RAI) waxaa loo isticmaalaa in lagu burburiyo unugyada qanjidhada thyroid, waxa loo yaqaan abort. Waxaa loo isticmaalaa in lagu daweeyo dadka intiisa badan ee lagu yaqaan cudurka Graves 'ee Maraykanka, laakiin looma isticmaali karo dumarka uurka leh ama naas nuujinaya, ama dadka qaba kansarka tayroodh marka laga reebo hyperthyroidism.
Inta lagu jiro daweynta RAI, iodine radioactive ayaa loo bixiyaa sida hal qadar ah, kaba ah ama xal afka ah. Ka dib marka qofku uu soo nuugo RAI, yoolalka yoolalka iyo galo qanjirada, halkaasoo uu ku faafo unugyada tayroodhka, waxyeelo u geysta iyo dilka. Taas waxaa sabab u ah, qanjidhada thyroid-ka ee hoos u dhacda iyo ficilka thyroid ayaa hoos u dhacaya, oo ka celinaya qofkisa hyperthyroidism .
Tani waxay caadi ahaan dhacdaa lix illaa 18 usbuuc ka dib markaad qaadato iodine radioactive, inkasta oo dadka qaarkiis u baahan yihiin daaweyn labaad RAI.
Dadka qaba da 'weyn, kuwa leh xaalado caafimaad oo hooseeya sida cudurada wadnaha, ama calaamadaha muhiimka ah ee hyperthyroidism, daawada antithyroid (methimazole, sida caadiga ah) ayaa loo isticmaalaa in lagu beddelo waxqabadka qanjidhka ka hor inta aan la gelin daaweynta RAI. Methimazole waxa kale oo la bixiyaa qiyaastii seddex ilaa todoba maalmood ka dib markii daaweynta RAI ee shakhsiyaadkaas, ka dibna si tartiib tartiib ah loo xoqo iyagoo shaqeynaya tayroodkooda caadiga ah.
Saameynada iyo Dhibaatooyinka
RAI waxay yeelan kartaa saameyno kale, oo ay ku jiraan lallabbo, dhuun xanuun, iyo bararka qanjidhada candhuufta, laakiin kuwani waa kuwo ku meel gaar ah. Boqolkiiba tiro yar oo bukaanjiif ah ayaa halis ugu jira inay duufaan ku dhacdo nolosha ka dib RAI.
Waxaa intaa dheer, waxaa jira caddayn cilmi ah oo muujinaysa in daaweynta RAI ay horseedi karto horumarka ama ka sii daridda cudurka indhaha (orbitopathy). Inkasta oo tani ay sii xumaanayso inta badan waa mid khafiif ah oo muddo gaaban ah, tilmaamaha American Thyroid Association ayaan kugula talineynin bixinta daaweynta RAI dadka qaba cudurka indhaha illaa illaa daran.
Haddii aad leedahay RAI, dhakhtarkaagu wuxuu kaala hadli doonaa heerka shucaaca iyo wixii tallaabooyin ah oo aad u baahan tahay inaad qaadato si aad u ilaaliso qoyskaaga ama dadweynaha. Taas ayaa sheegtay, in ay fududahay in shucaaca loo isticmaalo daaweynta RAI uu yar yahay mana keeno kansar, dhalmo la'aan, ama cilado dhalasho.
Guud ahaan, si kastaba ha ahaatee, 24ka saacadood ee ugu horreeya ka dib RAI, iska ilaali xidhiidhka iyo dhunkashada. Shanta maalmood ee ugu horreeya ama markaa ka dib RAI, xaddid u yeelashada carruurta yaryar iyo haweenka uurka leh, iyo gaar ahaan, iska ilaali carruurta sidooda inay u soo gaadho aaggaaga tirtirka.
Qalliin
Qalliinka qanjirka (oo loo yaqaan 'thyroidectomy') guud ahaan waa ikhtiyaarka ugu dambeeyay ee lagu daaweynayo qanjirka 'thyroid' ee firfircoon. Inkastoo laga jarayo qanjirka qanjirka 'thyroid' wuxuu waxtarka badan u leeyahay daweynta hyperthyroidism, qaliinku wuxuu soo jiidanayaa, qaali ah, iyo mid khatar ah.
Guud ahaan, qalliin ayaa lagula talinayaa xaaladaha soo socda:
- Haddii daawooyinka antithyroid iyo / ama RAI aanay awoodin inay xakameeyaan xaaladda
- Haddii qofku xasaasiyad ku leeyahay daawooyinka antidiotiyada iyo ma rabto daaweynta RAI
- Haddii qofku qabo shaki, laga yaabo in uu ku dhaco qanjirka 'nodule'
- Haddii qofku leeyahay badeeco aad u ballaaran (gaar ahaan haddii ay joojiso hawo-mareenka ama ay adagtahay in la liqo), calaamadaha daran, ama cudurka Graves 'indhaha oo firfircoon
Marka qaliinka qalliinka lagu sameeyo, dhakhtarkaagu wuxuu go'aan ka gaarayaa in laga saaro dhammaan qanjidhada qanjirka (oo lagu magacaabo total total thyroidectomy) ama qeyb ka mid ah qanjirka (oo lagu magacaabo qayb ka mid ah thyroidectomy). Go'aankaan mar walba ma aha mid sahlan waxayna u baahan tahay wadahadal feker ah iyo qiimeyn.
Guud ahaan, nooca qaliinka ee aad qaadato waxay ku xiran tahay sababta keenta hyperthyroidism. Tusaale ahaan, hal nodule oo xadidaya hoormoonka tayroodhka ee ku yaal dhinaca bidix ee qanjiradaada qanjirigaaga ayaa lagu daaweyn karaa qayb ka mid ah tayroodhka qayb ahaan (qaybta bidix ee qanjirka thyroid waa laga saaraa). Dhanka kale, goosaar weyn oo qaadaya labada dhinac ee tayroodhka waxaa lagu daaweyn karaa wadarta guud ee tirokoobka.
Maareynta Qaliinka Kadib iyo Khatarta
Haddii aad qaadatid wadarta thyroidectomy, waxaa loo baahan yahay bedelka hoormoonka hoormoonka ee dheeraadka ah. Dhinaca kale, oo leh qayb ka mid ah thyroidectomy, waxaa jira fursad wanaagsan oo aanad u baahnayn daawo tayrood ah oo joogto ah, ilaa inta uu jiro qanjir ku filan oo soo baxa si loo helo qadar ku filan oo ah hoormoon tayroodh.
Sida qalliin kasta, waxaa muhiim ah in dib loo eego halista iman karta dhakhtarkaaga. Qalliinka qanjirada, khatarta suurtagalka ah waxaa ka mid ah dhiigbax, iyo waxyeelo soo gaarta dareemaha cirridka ee soo noqnoqonaya (keena xabeeb) iyo / ama qanjirka 'parathyroid gland' (kaas oo xaddidaya dheelitirka calcium ee jirka). Iyadoo dhakhtar qalliin oo khibrad khibrad leh, inkastoo, khatarahaasi ay yar yihiin.
Inta Uurka ah
Caadi ahaan waxaa lagula talinayaa in haddii haweenku ay tahay hyperthyroid iyo rabitaanka uurka ee mustaqbalka dhow iyada oo tixgelinaysa daaweynta RAI ama qalliinka lix bilood ka hor intaadan uur qaadin.
Haweenka uurka leh ee leh calaamadaha iyo / ama hyperthyroidism-dhexdhexaad ah ayaa u baahan daaweyn. Daaweynta lagu taliyey waa daawada antithyroid, oo laga bilaabo PTU-da saddexda bilood ee ugu horeeya, ka dibna u beddesho daawada methimazole ee saddexda bilood iyo sadexaad (ama joogista PTU).
Inkasta oo daroogooyinkaasi ay halis u yihiin haweenka uurka leh, ujeedada dhakhtarkaagu waa inuu u isticmaalo sida ugu yar ee suurtogalka ah si uu u xakameeyo hyperthyroidism oo uu yareeyo khatarta uu u keeni karo adiga iyo ilmahaaga.
Caadi ahaan, dhakhaatiirta waxay ku talinayaan qiyaasta ugu yar ee suurtogalka ah ee xakameynaya xaaladda. Maadaama dhammaan daawooyinka antithyroid ay ka gudbaan mandheerta, si kastaba ha ahaatee, waxaa muhiim ah in la raaco tilmaamaha daawada laguu qoray oo la soco baaritaano la soo jeediyey (oo dhacaya laba ilaa afar asbuuc).
Booqashooyinka daryeelka caafimaadka, marka lagu daro baaritaanka thyroid, garaaca wadnahaaga, miisaankaaga korodhka , iyo qiyaasta tirakoobka ayaa la baari doonaa. Daqiiqadu waa inay ka hooseysaa 100 garaac daqiiqad kasta. Waa inaad ku dadaashaa inaad miisaankaaga ku hayso inta u dhaxaysa caadada caadiga ah ee uurka, sidaa daraadeed dhakhtarkaaga kala hadal nafaqada ku haboon iyo nooca dhaqdhaqaaqa jirka ee ku haboon xaaladdaada hadda. Koritaanka uurjiifka iyo garaaca wadnaha waa in sidoo kale la kormeeraa bil kasta.
Carruurta
Sida dadka qaangaarka ah, hyperthyroidism ee carruurta waxaa lagu daaweyn karaa daweynta dawooyinka antidiotiyada, daaweynta iodine radioactive, ama thyroidectomy.
Daaweynta xakameynta carruurta leh hyperthyroidism waa daawada antibioti-ga ee MMI, maadaama ay ku jirto khatarta ugu yar marka la barbar dhigo RAI ama qalliinka, waxeeyna leedahay waxyeellooyin yar marka loo eego PTU. Iyadoo RAI ama qalliin ama daaweyn kale oo la aqbali karo, RAI waxaa laga fogeynayaa carruurta ka yar 5 sano.
Daawada Dheeraadka ah (CAM)
Shiinaha iyo dalal kale, geedo Shiine ah ayaa mararka qaar loo isticmaalaa in lagu daaweeyo hyperthyroidism, mid kali ahaan ama wadata daawada antithyroid. Inkastoo habka saxda ah aan loo caddeyn, qaar ayaa aaminsan in geedo yaryar ay ka shaqeynayaan ka hortagga beddelidda tayriska (T4) ilaa triiodotyronine (T3) iyo hoos u dhigista saameynta T4 ee jirka.
Daraasad weyn oo dib u eegis ah, oo kormeeraysay 13kii tijaabo ee ka badan 1700 oo qof oo qaba hyperthyroidism, ku darida geedo Shiine ah si daawooyinka antidiotideadu ay wax ku ool u tahay hagaajinta calaamadaha iyo yaraynta saameynta daawooyinka antidiotiga iyo celinta (taasoo macnaheedu yahay soo noqoshada hyperthyroidism) dadka qaarkood. Qorayaashii daraasaddan, si kastaba ha ahaatee, waxay xuseen in dhammaan tijaabooyinkaas aan si fiican loo qorsheynin. Sababtoo ah tayadoodu hooseeyso, qorayaashu waxay sheegeen inaanay jirin caddayn ku filan oo lagu taageerayo hirgelinta dawooyinka dhirta shiineeyska ah ee daweynta hyperthyroidism.
Tan iyo maaddaama geedo yaryar (ama daweyno kale oo kale) ay saameeyaan dawooyinkaaga iyo tirooyinka qanjirka tho xun, waxaa muhiim ah in kaliya ay ku qaadato iyada oo la raacayo hogaaminta dhakhtarkaaga.
Ka sokow caleemaha Shiineeyska, fitamiin D waxa ay heleen feejignaan badan oo bulshada dhexdeeda ah. Inkastoo xiriirka laga helay fitamiin D-yarida iyo cudur-sidaha tayroodhka (cudurka Graves) iyo cudurka Hashimoto, haddana weli ma cadeeyo waxa uu ururku ka dhigan yahay, sida haddii fitamiin D-yarida uu yahay kicin ama natiijo ka timaadda qanjirada.
Waan ognahay in hyperthyroidism ay ka qayb qaadan karto lafo-darrada laf-dhabarka (osteoporosis), sidaas darteed hubinta in fitamiin D-ga iyo helitaanka kaalshiyamku waa muhiim. Machadka Daawada wuxuu kugula talinayaa 600 oo unugyo caalami ah (IUs) ee fitamiin D maalin loogu talagalay dadka qaangaarka ah ee da'doodu u dhaxayso 19 ilaa 70 iyo 800 IUs ee dadka qaangaarka ah ee ka weyn da'da 70. Taasi waxay tidhi, wali waa fikrad wanaagsan in la xaqiijiyo fitamiin D-gaaga dhakhtarkaaga. Waxa laga yaabaa inuu kugula taliyo in aad hubiso heerka fitamiin D-gaaga ee dhiiggaaga; haddii aad tahay qof aad u yar, waxaad u baahan kartaa qiyaas ka sareeya talooyinkaan tilmaamaya.
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