Congenital hypothyroidism

Cov thyroid caj pas tsim cov thyroid hormones & nws nyob hauv qab Adas cov kua hauv qab ntawm lub caj dab. Lub caj pas yog nyob ib ncig ntawm lub raj cua (trachea) & nws muaj ib tug zoo li ib tug npauj npaim - tsim los ntawm ob tis (lobes) & txuas los ntawm ib nrab (isthmus). Cov thyroid caj pas tsim cov thyroid hormones los ntawm kev siv iodine & feem ntau nws muaj los ntawm kev noj haus los ntawm cov khoom noj xws li qhob cij, nqaij nruab deg & ntsev. Ob lub thyroid hormones uas tsim los ntawm cov thyroid caj pas yog thyroxine-tetra-iodothyronine los yog T4 & tri-iodothyronine los yog T3. T3 tso nyiaj rau 1% & T4 tso nyiaj rau 99% ntawm cov thyroid hormones. Ob leeg raug tso tawm rau hauv cov ntshav tom qab tso tawm los ntawm cov thyroid caj pas.

Cov tshuaj lom neeg feem ntau ntawm cov tshuaj hormones yog T3. Thaum T4 tso rau hauv cov ntshav los ntawm cov thyroid caj pas, T4 hloov mus rau T3, thiab cov tshuaj hormones no cuam tshuam rau cov metabolism hauv cov hlwb. Thaum cov thyroid hormone ntau lawm qeeb, lub cev cov txheej txheem kuj qeeb thiab hloov. Hypothyroidism yuav cuam tshuam rau ntau yam hauv lub cev.

Congenital hypothyroidism lossis tsis ua haujlwm ntawm cov thyroid yog ib qho mob uas cov qog thyroid yuav tsis tsim cov tshuaj hormones thyroid txaus. Cov poj niam, hnub nyoog tshaj 60 xyoo, feem ntau xaus nrog hypothyroidism. Hypothyroidism ua rau muaj kev tsis sib npaug ntawm cov tshuaj lom neeg hauv lub cev. Yog tias cov tshuaj hormones thyroid txaus tsis tsim tawm hauv cov ntshav, lub cev cov metabolism qeeb qeeb. Cov cim qhia ntawm cov thyroid tsis ua haujlwm yog qaug zog, hnyav nce & kev xav ntawm kev nyuaj siab. Thaum ntxov, nws cov tsos mob tsis tshua muaj, tab sis yog tias tsis kho, hypothyroidism ua rau muaj ntau yam teeb meem kev noj qab haus huv xws li kab mob plawv, rog, mob pob qij txha, infertility. Nws yog ib qho mob tshwm sim rau txhua pawg hnub nyoog & haiv neeg. Txawm li cas los xij, cov poj niam, tshwj xeeb tshaj yog cov poj niam laus muaj kev pheej hmoo ua rau hypothyroidism dua li cov txiv neej.

Kev ntsuam xyuas cov thyroid ua haujlwm pab kuaj mob hypothyroidism. Kev kho mob nrog hluavtaws thyroid hormone feem ntau yog yooj yim, nyab xeeb & ua haujlwm tau zoo. Tsis muaj kev tiv thaiv rau cov thyroid tsis ua haujlwm. Cov thyroid tsis muaj zog yog tshwm sim los ntawm lub cev tiv thaiv kab mob ua rau cov thyroid caj pas & ua rau nws puas tsuaj los yog kev puas tsuaj rau cov thyroid uas tshwm sim thaum qee qhov kev kho mob rau cov thyroid ntau dhau los yog cov thyroid mob cancer.

Ob leeg txiv neej thiab poj niam tuaj yeem cuam tshuam los ntawm cov thyroid tsis ua haujlwm, tab sis nws feem ntau tshwm sim rau cov poj niam. Hauv cov tebchaws sab hnub poob, nws cuam tshuam txog kaum tsib ntawm txhua txhiab tus poj niam & ib ntawm ib txhiab tus txiv neej. Cov menyuam yaus kuj tuaj yeem tsim cov thyroid tsis muaj zog. Nyob ib ncig ntawm ib ntawm 3,500-4,000 tus menyuam mos yug los nrog cov thyroid tsis ua haujlwm hu ua congenital hypothyroidism. Cov menyuam mos yuav raug tshuaj xyuas rau lub cev xeeb tub los ntawm kev kuaj ntshav thaum tus menyuam muaj hnub nyoog li tsib hnub.

Feem ntau ua rau hypothyroidism yog

• Hashimoto's thyroiditis
• Kev puas tsuaj rau cov thyroid (los ntawm radioactive iodine los yog phais)
• Lymphocytic thyroiditis (uas yuav tshwm sim tom qab hyperthyroidism)
• Cov tshuaj
• Pituitary lossis hypothalamic kab mob
• Mob hnyav iodine deficiency

Hashimoto's thyroiditis

Ib qho mob uas muaj npe hu ua Hashimoto's thyroiditis yog qhov ua rau hypothyroidism tshaj plaws. Dr. Hakaru Hashimoto piav txog tus mob no nyob rau hauv 1912 & yog li ntawd lub npe hu ua nws. Hauv Hashimoto's thyroiditis, cov thyroid caj pas yog loj goiter thiab muaj peev xwm ua rau cov thyroid hormones txo. Hashimoto's yog ib hom kab mob autoimmune uas lub cev tiv thaiv kab mob tawm tsam cov thyroid cov ntaub so ntswg. Tus mob no yog caj ces & khiav hauv tsev neeg. Cov poj niam muaj 5 mus rau 10 npaug ntau cuam tshuam thaum piv rau cov txiv neej. Cov tshuaj tiv thaiv kab mob rau cov enzyme, thyroid peroxidase (anti-TPO antibodies) tau nce hauv qhov xwm txheej no.

Lymphocytic thyroiditis tom qab hyperthyroidism

Kev mob ntawm cov thyroid caj pas yog hu ua thyroiditis. Raws li qhov mob tshwm sim los ntawm lymphocyte, ib hom WBC hlwb, tus mob hu ua lymphocytic thyroiditis. Nws cuam tshuam 8% ntawm cov poj niam tom qab yug me nyuam. Hauv cov neeg mob no, thawj zaug, theem hyperthyroid uas muaj ntau cov thyroid hormones tsim los ntawm cov qog nqaij hlav, ua raws li theem hypothyroid uas kav mus txog rau lub hlis. Feem ntau ntawm cov poj niam rov qab mus rau lub xeev ntawm cov thyroid ua haujlwm li qub, tab sis qee tus nyob hauv lub xeev hypothyroid.

Kev puas tsuaj rau cov thyroid thib ob mus rau radioactive iodine lossis phais

Thaum cov mob hyperthyroid (xws li Graves' kab mob) cov neeg mob tau txais xov tooj cua iodine, lawv muaj tsawg heev ntawm cov thyroid cov ntaub so ntswg tom qab kho.

Qhov tshwm sim ntawm qhov no yog nyob ntawm qee yam xws li koob tshuaj iodine muab, nrog rau qhov loj me & kev ua haujlwm ntawm cov thyroid caj pas. Yog tias tsis muaj cov haujlwm tseem ceeb ntawm cov thyroid caj pas rau lub hlis tom qab kev kho mob iodine, nws feem ntau xav tias cov thyroid yuav tsis ua haujlwm txaus. Qhov tshwm sim yog hypothyroidism. Ib yam li ntawd, tshem tawm cov thyroid caj pas thaum phais yuav ua raws li hypothyroidism.

Hypothalamic lossis Pituitary kab mob

Yog tias vim qee yam ntawm lub caj pas pituitary lossis hypothalamus tsis tuaj yeem qhia cov thyroid thiab qhia nws los tsim cov thyroid hormones, qhov txo qis ntawm T4 & T3 yuav ua rau, txawm tias cov thyroid caj pas nws tus kheej yog qhov qub. Yog tias qhov teeb meem no tshwm sim los ntawm tus kab mob pituitary, tus mob hu ua "secondary hypothyroidism." Yog tias qhov tsis xws luag yog vim tus kab mob hypothalamic, nws hu ua "tertiary hypothyroidism."

Pituitary raug mob

Kev raug mob pituitary tuaj yeem tshwm sim los ntawm kev phais mob hlwb lossis yog tias tau muaj qhov txo qis hauv cov ntshav mus rau thaj chaw. Nyob rau hauv cov ntaub ntawv ntawm pituitary raug mob, TSH uas yog tsim los ntawm pituitary caj pas yog tsis txaus thiab cov ntshav ntawm TSH yog tsawg. Hypothyroidism tshwm sim vim hais tias cov thyroid caj pas tsis muaj zog los ntawm pituitary TSH. Daim ntawv no ntawm hypothyroidism tuaj yeem ua qhov txawv ntawm hypothyroidism uas yog tshwm sim los ntawm cov thyroid caj pas, nyob rau hauv uas TSH qib nce siab vim lub caj pas pituitary sim txhawb cov thyroid hormone tsim los ntawm stimulating cov thyroid caj pas nrog ntau TSH. Feem ntau, hypothyroidism los ntawm pituitary caj pas raug mob tshwm sim nrog rau lwm yam tshuaj hormones, txij li lub pituitary tswj hwm lwm yam txheej txheem xws li kev loj hlob, kev loj hlob, thiab adrenal muaj nuj nqi.

Tshuaj

Cov tshuaj uas siv los kho cov thyroid ntau dhau tuaj yeem ua rau hypothyroidism. Cov tshuaj no yog Methimazole (Tapazole) & Propylthiouracil (PTU). Cov tshuaj puas siab puas ntsws, lithium (Eskalith, Lithobid), kuj paub tias hloov cov thyroid ua haujlwm & ua rau hypothyroidism. Qhov zoo siab, cov tshuaj uas muaj cov iodine tseem ceeb xws li amiodarone (Cordarone), potassium iodide (SSKI, Pima), & Lugol cov tshuaj tuaj yeem ua rau muaj kev hloov pauv hauv cov thyroid ua haujlwm, uas yuav ua rau cov thyroid hormones qis.

Mob hnyav iodine deficiency

Kev tsis txaus iodine hauv kev noj zaub mov ua rau mob hnyav hypothyroidism. Nws cuam tshuam 5% mus rau 15% ntawm cov pejxeem. Nws tau pom hauv thaj chaw xws li Is Nrias teb, Zaire, Chile, Ecuador. Kev tsis txaus iodine hnyav kuj pom nyob rau thaj chaw roob xws li Himalayas & Andes. Kev tsis txaus iodine tsis tshua pom nyob hauv Tebchaws Meskas vim yog qhov sib ntxiv ntawm iodine bread & table salt.

Cov tsos mob thiab cov tsos mob ntawm hypothyroidism txawv nyob ntawm qhov hnyav ntawm cov tshuaj hormones tsis txaus. Nws yuav siv sij hawm ntau xyoo los txhim kho hypothyroidism. Thaum xub thawj, ib tus neeg yuav tsis tshua pom cov tsos mob ntawm hypothyroidism, xws li qaug zog & hnyav nce, lossis tus neeg tsuas yog ua rau lawv laus dua. Tab sis raws li cov metabolism hauv txuas ntxiv qeeb, cov cim pom tseeb thiab cov tsos mob tshwm sim.

Cov tsos mob thiab cov tsos mob yuav muaj xws li:

• nkees nkees
• Nce rhiab heev rau txias
• cem quav
• Qhuav ntawm daim tawv nqaij
• Qhov hnyav nce
• Puffy ntsej muag
• Hoarseness
• Cov leeg tsis muaj zog
• Ua kom cov roj (cholesterol) siab
• Cov leeg mob, rhiab, thiab tawv nqaij
• Mob, txhav lossis o hauv koj cov pob qij txha
• Hnyav tshaj li ib txwm / lub caij nyoog tsis xwm yeem
• Thinning ntawm plaub hau
• Lub plawv dhia qeeb
• Kev nyuaj siab
• Tsis nco qab

Thaum hypothyroidism tsis kho, cov tsos mob thiab cov tsos mob tuaj yeem maj mam hnyav dua. Kev ua kom tsis tu ncua ntawm cov thyroid caj pas kom tso tawm ntau cov tshuaj hormones tuaj yeem ua rau cov thyroid loj (goiter). Tsis tas li ntawd, tus neeg tuaj yeem hnov ​​​​qab ntau dua, cov txheej txheem xav tau qeeb, lossis kev xav ntawm kev nyuaj siab yuav tshwm sim.

Advanced hypothyroidism, tseem hu ua myxedema, tsis tshua muaj, tab sis thaum nws tshwm sim, nws tuaj yeem ua rau muaj kev phom sij rau lub neej. Cov tsos mob thiab cov tsos mob muaj xws li qis ntshav siab, txo qis ua pa, txo lub cev kub, tsis hnov ​​​​tsw & txawm coma. Hauv qhov xwm txheej hnyav, myxedema tuaj yeem ua rau tuag taus.

Hypothyroidism hauv cov menyuam mos

Txawm hais tias hypothyroidism feem ntau cuam tshuam rau cov poj niam hnub nyoog nruab nrab thiab cov laus, leej twg tuaj yeem tsim tus mob, suav nrog cov menyuam mos. Thaum pib, cov me nyuam yug los tsis muaj cov thyroid caj pas lossis lub caj pas uas tsis ua haujlwm zoo yuav muaj ob peb yam tsos mob. Thaum cov me nyuam mos muaj teeb meem nrog hypothyroidism, lawv pom cov teeb meem hauv qab no:

• Yellowing ntawm daim tawv nqaij & dawb ntawm lub qhov muag (dajntoo) - feem ntau, qhov no tshwm sim thaum tus menyuam lub siab tsis tuaj yeem metabolize ib yam khoom hu ua bilirubin, uas feem ntau tshwm sim thaum lub cev rov ua dua qub lossis puas RBCs.
• Nquag nqhis
• Ib tug loj & protruding tus nplaig
• Puffy tsos rau lub ntsej muag

Raws li tus kab mob no zuj zus, cov me nyuam mos yuav muaj teeb meem noj & tej zaum yuav tsis loj hlob & loj hlob ib txwm. Lawv kuj yuav muaj:

• cem quav
• Cov leeg nqaij tsis zoo
• Kev tsaug zog ntau dhau

Thaum hypothyroidism hauv cov menyuam mos tsis kho, txawm tias mob me tuaj yeem ua rau lub cev tsis taus thiab kev txawj ntse.

Hypothyroidism hauv cov menyuam yaus thiab cov hluas

Feem ntau, cov menyuam yaus thiab cov hluas uas tsim cov thyroid caj pas muaj cov tsos mob thiab cov tsos mob zoo ib yam li cov neeg laus ua, tab sis lawv kuj tuaj yeem ntsib:

• Txo kev loj hlob, ua rau luv luv stature
• ncua kev loj hlob ntawm cov hniav mus tas li
• ncua kev puberty
• Kev loj hlob ntawm lub hlwb tsis zoo

Hypothyroidism tuaj yeem cuam tshuam rau leej twg, tab sis muaj kev pheej hmoo ntau ntxiv hauv:

• Cov poj niam laus dua 60 xyoo
• Muaj cov kab mob autoimmune
• Tsev neeg keeb kwm ntawm thyroid kab mob
• Cov neeg mob rheumatoid kev mob caj dab los yog lupus, mob inflammatory mob
• Kev kho mob nrog radioactive iodine los yog tshuaj tiv thaiv thyroid
• Radiation rau lub caj dab lossis lub hauv siab
• Tau muaj cov thyroid phais (ib nrab thyroidectomy)
• Tau xeeb tub lossis yug menyuam hauv rau lub hlis dhau los

Hypothyroidism tuaj yeem raug xav tias nyob rau hauv cov neeg mob uas qaug zog, txias intolerance, cem quav & qhuav, flaky ntawm daim tawv nqaij. Yuav tsum tau kuaj ntshav kom paub meej tias qhov kev kuaj mob.

Yog tias hypothyroidism tshwm sim, cov ntshav ntawm cov thyroid hormones tuaj yeem ntsuas ncaj qha. Lawv feem ntau pom muaj tsawg. Txawm li cas los xij, thaum ntxov hypothyroidism, theem ntawm cov thyroid hormones (T3 thiab T4) yuav zoo li qub. Yog li, cov cuab yeej tseem ceeb rau kev tshawb pom ntawm hyperthyroidism yog qhov ntsuas ntawm TSH, cov thyroid-stimulating hormone. TSH yog secreted los ntawm pituitary caj pas thiab yog hais tias ib tug txo nyob rau hauv cov thyroid hormone tshwm sim, lub pituitary caj pas reacts thiab tsim ntau TSH & cov ntshav TSH theem txhawb zus tau tej cov thyroid hormones. Qhov kev nce hauv TSH tuaj yeem ua ntej lub caij nplooj zeeg hauv cov thyroid hormones los ntawm lub hlis lossis xyoo. Yog li, qhov ntsuas ntawm TSH yuav tsum tau nce siab hauv cov neeg mob hypothyroidism.

Txawm li cas los xij, muaj kev zam. Yog tias qhov txo qis hauv cov thyroid hormone yog vim qhov tsis xws luag ntawm pituitary lossis hypothalamus, ces qib TSH yog qhov txawv txav. Raws li tau sau tseg saum toj no, hom kab mob thyroid no hu ua "secondary" lossis "tertiary" hypothyroidism. Kev kuaj tshwj xeeb, hu ua TRH test, tuaj yeem pab paub qhov txawv yog tias tus kab mob no tshwm sim los ntawm qhov tsis xws luag hauv pituitary lossis hypothalamus. Qhov kev kuaj no yuav tsum tau txhaj tshuaj TRH hormone & ua los ntawm tus kws kho mob endocrinologist (tus kws kho mob tshwj xeeb).

Cov ntshav ua haujlwm tau hais los saum toj no lees paub qhov kev kuaj mob ntawm hypothyroidism tab sis tsis taw tes rau qhov laj thawj. Kev sib xyaw ua ke ntawm tus neeg mob keeb kwm kho mob, kev tshuaj ntsuam xyuas cov tshuaj tiv thaiv kab mob & cov thyroid scan tuaj yeem pab txheeb xyuas qhov teeb meem hauv cov thyroid ntau dua. Yog tias xav tias muaj pituitary lossis hypothalamic ua rau, ib qho MRI ntawm lub hlwb & lwm yam kev tshawb fawb yuav ua tau.

Cov thyroid tsis ua haujlwm (hypothyroidism) feem ntau yog kho los ntawm kev noj cov tshuaj hormone hloov txhua hnub hu ua levothyroxine. Levothyroxine hloov cov tshuaj thyroxine thaum cov thyroid tsis ua kom txaus.

Thaum xub thawj, tus neeg mob yuav kuaj ntshav tsis tu ncua los kho cov koob tshuaj levothyroxine kom raug. Tus neeg mob pib nrog ib koob tshuaj tsawg tsawg ntawm levothyroxine, uas yuav nce ntxiv, nyob ntawm tus neeg mob lub cev teb. Qee tus neeg pib hnov ​​​​zoo sai sai tom qab pib kho, thaum lwm tus tsis pom qhov kev txhim kho ntawm lawv cov tsos mob rau ob peb lub hlis.

Thaum tus neeg mob noj cov koob tshuaj kom raug, nws feem ntau yuav kuaj ntshav ib xyoos ib zaug txhawm rau saib xyuas cov tshuaj hormones.

Yog tias kev kuaj ntshav qhia tias muaj cov thyroid tsis ua haujlwm, tab sis tsis muaj cov tsos mob tshwm sim, lossis tsuas yog pom cov tsos mob me, tus neeg mob yuav tsis xav tau kev kho mob. Hauv cov xwm txheej no, tus kws kho mob feem ntau yuav tshawb xyuas cov tshuaj hormones rau txhua ob peb lub hlis & muab tshuaj levothyroxine yog tias tus neeg mob tsim cov tsos mob.

Noj Levothyroxine

Yog tias tus neeg mob tau muab tshuaj levothyroxine, ib ntsiav tshuaj tib lub sijhawm txhua hnub yog noj. Tus neeg mob feem ntau siv cov ntsiav tshuaj thaum sawv ntxov, txawm tias qee cov neeg nyiam noj lawv thaum hmo ntuj.

Kev ua tau zoo ntawm cov ntsiav tshuaj tuaj yeem hloov pauv los ntawm lwm yam tshuaj, tshuaj ntxiv lossis khoom noj, yog li lawv yuav tsum tau nqos dej ntawm lub plab khoob, thiab yuav tsum tsis txhob noj 30 feeb tom qab. Yog tias tus neeg mob tsis noj tshuaj, koob tshuaj yuav tsum tau noj sai li sai tau thaum tus neeg mob nco qab.

Cov thyroid tsis ua haujlwm yog ib qho mob mus ntev, yog li tus neeg mob feem ntau yuav tsum tau noj levothyroxine rau tag nrho lub neej.

Tej Teebmeem

Levothyroxine feem ntau tsis muaj kev phiv vim tias cov ntsiav tshuaj tsuas yog hloov cov tshuaj hormones uas ploj lawm.

Kev mob tshwm sim feem ntau tshwm sim yog tias tus neeg mob noj levothyroxine ntau dhau. Nws tuaj yeem ua rau muaj teeb meem xws li mob taub hau, tawm hws, mob hauv siab, ntuav & raws plab.

Kev Kho Mob Ua Ke

Kev sib xyaw ua ke (siv levothyroxine & triiodothyronine (T3) ua ke) - Nws tsis yog siv niaj hnub vim tias tsis muaj pov thawj txaus los qhia tias nws zoo dua li siv levothyroxine ib leeg (monotherapy).

Feem ntau, inhibiting thyroid-stimulating hormone (TSH) uas siv cov tshuaj thyroid hloov kho siab yuav tsum zam vim tias nws muaj kev pheej hmoo ua rau muaj kev phiv tsis zoo, xws li atrial fibrillation (tsis xwm yeem thiab lub plawv dhia ceev), strokes, txha txha caj qaum, & tawg.

Txawm li cas los xij, hom kev kho mob no tej zaum yuav raug pom zoo nyob rau hauv cov neeg mob uas muaj keeb kwm ntawm thyroid cancer & muaj kev pheej hmoo loj ntawm nws rov tshwm sim.

Cov thyroid tsis muaj zog thiab cev xeeb tub

Nws yog ib qho tsim nyog los kho cov thyroid tsis muaj zog ua ntej cev xeeb tub. Yog tias tus neeg mob cev xeeb tub los yog sim xeeb tub & muaj hypothyroidism. Tej zaum lawv yuav xa mus rau tus kws kho mob tshwj xeeb rau kev kho mob & saib xyuas thaum cev xeeb tub.

Feem ntau ua rau hypothyroidism yog Hashimoto's thyroiditis, uas tiv thaiv tsis tau. Txawm hais tias hypothyroidism tsis tuaj yeem tiv thaiv, qee cov tsos mob ntawm tus kab mob yuav tsum tau saib xyuas, thiaj li yuav kho tau zoo. Qee cov neeg mob uas muaj kev pheej hmoo siab ntawm hypothyroidism tab sis tsis muaj cov tsos mob tuaj yeem kuaj xyuas seb lawv puas muaj mob me, lossis subclinical, hypothyroidism.

• Tsis txhob haus luam yeeb
• Kev tawm dag zog txhua hnub thiab tswj kom haum
• Txo kev ntxhov siab
• Cov dej lim dej yuav tsum tau siv rau kev haus, dej uas muaj cov tshuaj fluoride yuav ua rau muaj kev pheej hmoo ntawm cov thyroid teeb meem.
• Cov ntsiab lus iodine noj yuav tsum yog me ntsis txwv tsis pub nws yuav ua rau lwm yam teeb meem kev noj qab haus huv.
• Tsis txhob noj zaub mov uas muaj roj ntau dhau