Thyrotooticosis ndi matenda omwe amadziwika ndi kupanga kwambiri mahomoni a chithokomiro. Mpaka pano, kuphatikiza kwa matenda awa ndi kuperewera kwa insulin ndikosowa kwenikweni. Malinga ndi ziwerengero, kuchokera pa 2 mpaka 6% ya odwala matenda a shuga amakhalanso ndi matenda a thyrotoxic goiter.
Kafukufuku angapo adawonetsa kuti shuga imapezeka mwa 7.4% ya odwala omwe ali ndi chithokomiro, ndipo kuchuluka kwa chithokomiro kumangokhala 1% ya anthu omwe ali ndi vuto la insulin.
Monga mukuwonera, matenda a shuga amatha kale kwambiri kuposa thyrotoxicosis kapena kupitiliza kumbali yake, zomwe ndizosowa kwambiri. Komanso, matenda onsewa amatha kuyamba mthupi la wodwalayo nthawi yomweyo.
Kuchuluka kwa ofufuza kumawona kuti endemic goiter ndi thyrotoxicosis ndi omwe ali pachiwopsezo cha kuchepa kwa insulin. Mu anthu omwe akudwala matenda a chithokomiro, amapezeka ndi matenda a shuga. Za iwo:
- 10% anali ndi matenda a shuga;
- mu 17% iwo unakhala wofanana;
- mu 31%, mayeso okhudzana ndi glucose anali okayikira.
Ndizodziwika kuti chithandizo cha opaleshoni ya thyrotoxic goiter chingakhudze kagayidwe kazakudya ndipo chitha kupangitsa kuti matendawa azikhala mwamphamvu.
Ngati izi sizinachitike, ndiye pamenepa titha kunena kuti thyrotooticosis inayamba kwambiri kuposa matenda ashuga.
Ngati matenda a shuga a chithokomiro amakhala ndi glucosuria ndi hyperglycemia asanagwidwe, ndiye kuti odwala omwe ali ndi vuto lotseguka la chithokomiro komanso mavuto omwe ali ndi insulin atachitidwa opaleshoni ya chithokomiro sangasiye kumva zizindikiro za matenda ashuga.
Zolinga zakukula kwa matenda amisala
Kusintha kwa chitetezo chathupi pakachitika motsutsana ndi matenda ashuga, makamaka njirayi imatha kufotokozedwa kuchokera pamalingaliro a immunology. Komabe, pathogenesis ndi etiology ya thyrotooticosis sizinaphunziridwe kwathunthu.
Kwa nthawi yayitali, akukhulupirira kuti chifukwa chachikulu chopezekera komanso kukulira kwa poizoni (matenda a Basedov) ndi chithokomiro cha chithokomiro, chomwe chimayamba chifukwa cha kuvutika m'maganizo.
Kuphatikiza pa kupsinjika ndi zotsatira zake zoyipa, thyrotoxic goiter imakwiya:
- kutengera kwa chibadwa;
- kusakwanira kwa mahomoni ogonana;
- matenda enieni komanso opatsirana (chifuwa chachikulu, chimfine).
Kuphatikiza apo, matendawa omwe amawaganizira, kuwonjezera kupukusa goiter, amatha kuwonedwa ndi kuchuluka kwa ayodini m'thupi, thyrotoxic adenoma, trophoblastic neoplasms yopanga chorionic gonadotropin, polynodous poyizoni, zotupa zowonjezera za TSH (chithokomiro cha chithokomiro), subacute ndi chithokomiro cha chithokomiro. .
Etiologically dissuse thyrotoxic goiter imatchulidwa ngati matenda a autoimmune organised. Poterepa, kufalikira kwa mitsempha ya m'mimba ndi kutsegula kwa chitetezo chathupi kumawonedwa. Njirayi imayendetsedwa ndi kuwoneka m'magazi a ma autoantibodies enieni ku TSH receptor ndi T-lymphocyte.
Amavomerezedwa kuti kuphatikiza poyizoni poyipa ndi njira ya polygenic multifactorial. Nthawi zambiri amakula mothandizidwa ndi zinthu zosiyanasiyana zachilengedwe. Izi zitha kukhala zovuta, matenda, komanso mankhwala.
Njira yothetsera chitetezo cha mthupi imachitika motsutsana ndi maziko opanga ma antibodies a B-lymphocytic ku recrotors a thyrotropin. Amatsutsa magwiridwe antchito a TSH achilengedwe, omwe amachititsa kuti mahomoni a chithokomiro amasulidwe mwatsatanetsatane m'magazi ndikuwonetsedwa kwa tsekwe.
Kubisala kwa ma antibodies oyambitsa chithokomiro omwe amakhudza kwambiri chithokomiro cha chithokomiro kumayambitsa goiter.
M'mabuku azachipatala muli malongosoledwe angapo osiyanasiyana a kagwiritsidwe ntchito kolephera kogwiritsa ntchito kagayidwe kazakudya kamene kamayambitsa matenda a thyrotoxicosis. Chifukwa chake, madokotala ena amakhulupirira kuti thyroxine imawonjezera katulutsidwe ka insulin pomwe imakulitsa makutidwe a oxidation.
Ndi tyrosinemia wa nthawi yayitali, zida zama insulin za anthu zimafooka, ndipo kusintha kwazomwe zimayambitsa maselo kumapangitsa shuga wamagazi ambiri komanso ketoacidosis.
Malinga ndi madokotala ena, kukulitsa kwa chithokomiro m'matenda a insulin kumayenderana ndi kupangika kwakukulu kwa mahomoni a steroid komanso kugwira ntchito moyenera kwa dongosolo la anthu achifundo.
Ndizachilendo kuti mawonekedwe oterewa amawonekera bwino pamene shuga ikulipiridwa.
Zolemba za thyrotooticosis
Njira zophatikizira zasintha kwa kapamba ndi chithokomiro zimasonyezedwa ndi umboni kuti chimodzi mwazinthu zomwe zimatsogolera izi:
- kutupa
- matenda
- kupsinjika kwa malingaliro.
Kuphatikiza apo, m'zaka zaposachedwa, zowona zadziwika kuti thyrotooticosis ndi shuga mellitus amadziwika ndi pathogenesis imodzi - autoimmunization. Zinapezeka kuti antigen ya HLAB8 yokhala ndi mafupikidwe omwewo imachitika pakati pa odwala matenda ashuga omwe amadalira insulin omwe amalephera kupweteka kwa impso ndi kupatsanso poyizoni.
Ngati thyrotoxicosis ikuphatikizidwa ndi matenda a shuga, ndiye kuti matenda onsewa amakula nthawi imodzi. Kukula kwa insulin hormone kukana ndi adrenal kusakwanira mwina.
Pofuna kulipirira mavuto omwe ali ndi misempha ya shuga ndi matenda ophatikizika, kugwiritsa ntchito mankhwala ochuluka a insulin amafunikira chifukwa cha kuchuluka kwa kagayidwe kotsutsana ndi maziko opanga mahomoni ambiri.
Wodwala wapadera chotere amakhala pachiwopsezo cha ketoacidosis, kholo kapena matenda a shuga. Pankhaniyi, kuchuluka kwa insulin tsiku lililonse kuyenera kuwonjezeka ndi 25 kapena 100%. Komanso, munthu ayenera kulabadira kuti pang'onopang'ono chifukwa cha kuwonongeka kwa matenda ashuga chifukwa chowonjezera cha thyrotooticosis, kukulitsa "pamimba pamimba" kapena kusanza kwa mtundu wa "malo a khofi" ndikotheka. Zikakhala choncho, dokotala angalakwitse ndikupereka mankhwala opatsirana.
Zinapezeka kuti shuga wowola pafupifupi nthawi zonse amathandizira pakuyamba ndi kukula kwa vuto la thyrotoxic. Kuphatikizidwa ndi matenda a shuga, pamakhala chiopsezo chachikulu pamoyo wa wodwalayo, chifukwa kudziwika kwa matendawa kumakhala kovuta kwambiri. Ndi chithunzichi, kudziwika ndi kovuta kwambiri.
Chifukwa chake, poyambira, ndikofunikira kuchotsa wodwala pamavuto, chifukwa chithandizo cha matenda a shuga sichingabweretse zotsatira zomwe zingachitike, ngakhale mutagwiritsidwa ntchito Mlingo wambiri wa insulin.
Kuchokera ku 8 mpaka 22% ya odwala omwe ali ndi matenda opatsirana adzadwala chifukwa cha kuchuluka kwa zizindikiro za thyrotooticosis.
Ngati thyrotoxicosis ndi yosavuta, ndiye mu nkhani iyi glucosuria ndi hyperglycemia zimatha kuonedwa. Amatha kuyambitsa mavuto pakuzindikira matenda ashuga.
Muzochitika izi, kuzindikira mosiyanasiyana kwa chithokomiro cha matenda a myrotoxicosis ndi matenda osokoneza bongo kuyenera kupangidwa mwa kuwunika nthawi yotsika msika wa shuga pansi pa vuto la shuga.
Kodi chiwopsezo cha thyrotooticosis mu shuga ndi chiyani?
Madokotala amalipira chidwi makamaka kwa odwala omwe ali ndi matenda osokoneza bongo omwe amakhala ndi matenda oopsa a myrotooticosis. Ngati matenda a shuga sazindikiridwa komanso kuvomerezedwa ngati chithokomiro cha chithokomiro, ndiye kuti izi ndizowopsa makamaka:
- kuchititsa opareshoni;
- kujowina matenda oyanjana.
Kukula kwa chikumbumtima choyambitsidwa ndi ketoacidosis pambuyo pa opaleshoni ya chithokomiro kumatha kukulitsa zovuta za odwala omwe ali ndi matenda osokoneza bongo a latent kapena osadziwika.
Kutsimikiza kwa shuga pamimba yopanda kanthu ndikuwunika kotheratu kwa wodwala yemwe ali ndi chithokomiro chazovomerezeka ndizovomerezeka mwanjira iliyonse.
Zilinso zowopsa kwambiri ngati matenda a chithokomiro cha matenda ashuga sanachitike. Madokotala ayenera kukhala atcheru nthawi zonse:
- kuchepa thupi kwa thupi;
- kuchuluka kwa mkwiyo;
- thukuta kwambiri;
- kubwereza pafupipafupi kwa matenda a shuga malinga ndi zakudya komanso kugwiritsa ntchito mankhwala mwanjira yochepetsera shuga.
Kuyambira pomwe chidwi cha thyrotoxicosis chayamba, zizindikirozi mu matenda ashuga ziyamba kuzimiririka. Pankhaniyi, zizindikiro za kuchepa kwa insulin zimayamba kuchuluka msanga ndipo wodwalayo mwina amagwa. Komanso, ngati njira yotupa imatha milungu yopitilira isanu, zizindikiro za thyrotooticosis zidzayamba kuvutitsa wodwalayo kwambiri. Mlingo wa kuthamanga kwa magazi sungakhale wokhazikika, wokhala ndi chizolowezi chowonjezeka. Kugunda kumakhala kofikira komanso kowonjezereka.
Mukamawunika magazi kuti muonetsetse za thyroxine, ayodini komanso makatekisolidi mwa anthu oterewa ndi matenda ophatikizika, zidzakhazikitsidwa kuti poyambira kukula kwa njira yopatsirana, kuchuluka kwa thyroxine kumachepa. Ngati nthendayi imatenga nthawi yayitali, ndiye kuti katulutsidwe ka timadzi timeneti timapangidwa limodzi ndi kuchepa komweko mu kuchuluka kwa triiodothyronine ndi mapuloteni omangidwa. Nthawi yomweyo, ndende ya norepinephrine ndi adrenaline imakwera kwambiri.
Madokotala ena amakhulupirira kuti kuopsa kwa nthawi ya chithokomiro chanu kumadalira kukula kwa zovuta za zida za endocrine pancreatic. Komabe, madotolo ena amatsutsa kuti odwala omwe ali ndi chithokomiro chachikulu amatha kukhala ndi mtundu wovuta wa matenda ashuga. Ndi thyrotooticosis yofatsa, kusowa kwambiri kwa insulin kudzakulirakulira.
Chithandizo cha thyrotooticosis
Kuphatikiza kwa matenda a thyrotoxic goiter ndi matenda ashuga, omwe amalemetsa wina ndi mnzake, kuchitapo kanthu pa opaleshoni ya chithokomiro kumasonyezedwa, mosasamala kanthu za kuopsa kwa matenda.
Mkhalidwe woyamba wochepetsera zoopsa zogwirira ntchito udzakhala chindapusa cha matenda ashuga komanso matenda a chithokomiro. Zomwezi zikuwonetsa chindapusa:
- kutsika kwa glucose ndende ku 8.9 mmol / l;
- normalization wa kagayidwe ka electrolyte ndi CBS;
- kuthetsa ketonuria ndi glucosuria.
Ndikofunikanso kuchepetsa kagayidwe kokwanira mthupi kuti kazungulira 10%, kusintha zamkati, kutha kwa zovuta zake, kusintha matendawa, kuonjezera kulemera kwa wodwalayo. Ngati izi zakwaniritsidwa, ndiye kuti wodwalayo ndi wokonzeka kuchita opareshoni pa chithokomiro cha chithokomiro.
Chifukwa chophwanya magwiridwe antchito a chiwindi (mapuloteni, antitoxic), kusintha kwamphamvu kwa magazi ndi kupangika kwakukulu kwa magazi, kuchuluka kwa mtima, kuchepa kwamitsempha yamagazi, kubwezeretsa pafupipafupi kwa matenda ashuga, kuphatikizana kwa matenda oopsa ndi chithokomiro chovuta, kukonzekera opaleshoni kungachedwetsedwe kwa milungu 8 mpaka 12.
Kuchita opareshoni yothandizirana ndi mankhwala kuyenera kukonzedwa poyerekeza zaka za wodwalayo, kuopsa kwa zizindikiro za matendawa, kuopsa kwa matenda a chithokomiro komanso kuchuluka kwa chithokomiro cha chithokomiro. Nthawi zambiri amagwiritsidwa ntchito pazolinga izi:
- beta blockers;
- mankhwala a ayodini;
- lithiamu carbonate;
- chithira.
Pa palpation komanso kunja, kuchepa kwa kukula kwake ndi kachulukidwe kake ka chinyezi kumaonekera. Pochita opaleshoni, chiwalo chimatuluka magazi ochepa.
Komabe, ayodini yekha sangathe kugwiritsidwa ntchito kwa nthawi yayitali. Pakatha pafupifupi milungu iwiri, kukhazikika kwa kuphatikizika kwa mahomoni a chithokomiro kumatha.
Mankhwala a thyrotoxic goiter, lithiamu carbonate imagwiritsidwa ntchito voliyumu 900 mpaka 1200 mg patsiku. Thupi limathandizira kukhazikika kwa ziwalo za cell za gland, ndikuchepetsa mphamvu ya TSH komanso ma antibodies oyambitsa chithokomiro. Kuphatikiza apo, kuchuluka kwa mahomoni a T ndi T4 mu seramu yamagazi kumachepa.
Ngati wodwalayo amalephera kuthana ndi chithokomiro komanso mtundu wofatsa wa chithokomiro, ndiye kuti mankhwalawa amachitika miyezi iwiri. Ndi munthawi imeneyi kuti mphamvu yolepheretsa ya lithiamu carbonate pazinthu zosakwanira ntchito za chithokomiro itheretu.
Nthawi zina, nthawi yamankhwala imatha kuwonjezeka mpaka zaka 1.5. Sizoletsedwa kupereka kukonzekera kwa ayodini kwa odwala omwe ali ndi chithokomiro chotupa, ngati euthyroidism imatheka ndi thyreostatics chifukwa choopsa chachikulu choyambiranso.
