I-Thyrotooticosis yisifo esibonakala ngokukhiqizwa ngokweqile kwama-hormone egilo. Kuze kube manje, ukuhlanganiswa kwale patology nokuntuleka kwe-insulin akuvamile kakhulu. Ngokwezibalo, kusuka ku-2 kuya ku-6% weziguli ezinesifo sikashukela nazo zihlushwa i-thyrotoxic goiter.
Ucwaningo oluningi luye lwabonisa ukuthi isifo sikashukela senzeka ku-7.4% weziguli ezine-thyrotooticosis, futhi sanda umsebenzi we-thyroid kubantu abayi-1% kuphela abane-insulin.
Njengoba ukwazi ukubona, isifo sikashukela singakhula ngaphambi kwe-thyrotooticosis noma siqhubeke simelane nesizinda saso, okungajwayelekile kakhulu. Ngaphezu kwalokho, zombili lezi zifo zingaqala emzimbeni wesiguli ngasikhathi sinye.
Iningi labaphenyi liqaphela ukuthi i-endemic goiter ne-thyrotoxicosis yizici eziyingozi zokuntuleka kwe-insulin. Kubantu abahlushwa i-pathologies ye-yegilo gland, kutholakale uhlobo lweshukela likashukela. Zabo:
- I-10% yaba nesifo sikashukela i-mellitus;
- ku-17% iqhubeke ngendlela efikile;
- kuma-31%, ukuhlolwa kokubekezelela ushukela kwakungabaza.
Kuyisici ukuthi ukwelashwa kokuhlinzwa kwe-thyrotoxic goiter kuzothinta kahle i-carbohydrate metabolism futhi kungaba nomthelela ekuthini kube ngokwejwayelekile ngokuphelele.
Uma lokhu kungenzekanga, khona-ke kulokhu singasho ukuthi i-thyrotooticosis yathuthuka kakhulu emuva kwesifo sikashukela.
Uma i-mellitus yesifo sikashukela i-thyrogenic iboniswa yi-glucosuria ne-hyperglycemia kuphela ngaphambi kokuhlinzwa, khona-ke iziguli ezine-gorotootic goiter nezinkinga nge-insulin ngemuva kokuhlinzwa ku-gland yegilo ngeke ziyeke ukuzwa izimpawu zesifo sikashukela.
Izizathu zokuthuthuka kwe-pathology
Lapho kwenzeka ushintsho emasosheni omzimba ngokumelene nesizinda sesifo sikashukela, ngokwengxenye le nqubo ingachazwa ngokubuka kwe-immunology. Kodwa-ke, i-pathogenesis kanye ne-etiology ye-thyrotooticosis ayikafundwa ngokuphelele.
Esikhathini eside, kukholelwa ukuthi isizathu esiyinhloko sokuvela nokuthuthuka kobuthi obunobuthi (isifo se -ovsov) isifo se-thyrotooticosis, esibangelwa ukuhlukumezeka kwengqondo.
Ngaphezu kwengcindezi nemiphumela yako elimazayo, i-thyrotoxic goiter iyacasulwa:
- isakhi sofuzo;
- ukukhiqizwa okunganele kwama-hormone ocansi;
- izifo ezithize nezifo ezithathelwanayo (isifo sofuba, umkhuhlane).
Ngaphezu kwalokho, i-syndrome ebhekwayo, ngaphezu kokudlulisela i-goiter, ingabonakala ngokweqile kwe-iodine emzimbeni, i-thyrotoxic adenoma, i-trophoblastic neoplasms ekhiqiza i-chorionic gonadotropin, i-polynodous toct goiter, secretion ekhulayo ye-TSH (i-thyroid evuselela i-hormone), i-subacute ne-thyroid fibroids, .
I-Etiologically disuse i-thyrotoxic goiter ihlukaniswa njengesifo se-autoimmune isifo esithile. Kulokhu, ukungena kwe-lymphocytic gland kanye nokusebenza kwamasosha omzimba kuyabonakala. Le nqubo ihambisana nokuvela emgudwini wegazi wama-autoantibodies athile ku-TSH receptor ne-T-lymphocyte.
Kuyamukelwa ngokuvamile ukuthi i-gouse i-goiter enobuthi yi-polygenic multifactorial pathology. Imvamisa ikhula ngaphansi kwethonya lezinto ezahlukahlukene zemvelo. Lezi kungaba yizimo ezicindezelayo, izifo kanye nemithi.
Inqubo yokwenza kusebenze izivikeli mzimba kwenzeka ngokumelene nesizinda sokukhiqizwa kwama-antibodies e-B-lymphocytic kuma-recrotors e-thyrotropin. Zilingisa ukusebenza kwe-TSH yemvelo, okuholela kokukhishwa okuhleliwe kwamahomoni e-thyroid ukungena egazini nokubonakaliswa kwe-goiter enobuthi.
Ukuqothuka kwama-antibodies ashukumisayo avimbela ukuthinta i-yegilo gast kudala.
Ezincwadini zezokwelapha kunezincazelo eziningana ezahlukahlukene ngomshini wokwehluleka kwe-carbohydrate metabolism esimweni se-thyrotooticosis. Ngakho-ke, abanye odokotela bakholelwa ukuthi i-thyroxine inyusa imfihlo ye-insulin ngenkathi ithuthukisa i-oxidation yama-carbohydrate.
Nge-tyrosinemia yesikhathi eside, izinto ezisetshenziselwa ukufakwa emzimbeni zabantu ziya buthaka, futhi nezinguquko eziwohlokayo zomzimba zibangela ushukela wegazi ophakeme kanye ne-ketoacidosis.
Ngokusho kwabanye odokotela, ukuthuthukiswa kwe-thyrotooticosis ezinkingeni nge-insulin kuhlotshaniswa nokukhiqizwa ngokweqile kwama-hormone e-steroid kanye nokusebenza okunganele kohlelo lokuzwela-i-adrenal.
Kuyaphawuleka ukuthi iphethini enjalo ibonakala ngokucacile lapho isifo sikashukela sinqunyiwe.
Izici ze-thyrotooticosis
Indlela ehlanganisiwe yezinguquko ema-pancreas naseglandini yegilo ikhonjiswa ubufakazi bokuthi enye yezinto ezandulelayo yilezi zimbangela:
- ukuvuvukala
- ukutheleleka
- ukucindezelwa kwengqondo.
Ngaphezu kwalokho, eminyakeni yamuva, amaqiniso ave kwaziwa ukuthi i-thyrotooticosis ne-mellitus yesifo sikashukela kubonakaliswa yi-pathogeneis eyodwa - i-autoimmunization. Kwatholakala ukuthi i-antigen ye-HLAB8 enemvamisa efanayo yenzeka phakathi kwabanesifo sikashukela abangathembekile nge-insulin abahlushwa ukwehluleka kwezinso i-idiopathic futhi bahambisa ubuthi obunobuthi.
Uma i-thyrotooticosis ihlanganiswa nesifo sikashukela, khona-ke zombili lezi zifo ziba zimbi kanyekanye. Ukuthuthukiswa kokumelana kwama-insulin kwama-insulin nokuntuleka kwe-adrenal kungenzeka.
Ukuze unxeshezelele ezinkingeni ezinamazinga kashukela nge-pathology ehlanganisiwe, ukusetshenziswa kwemithamo ephezulu kakhulu ye-insulin kuyadingeka ngenxa yokwanda kwe-metabolism ngokumelene nesizinda sokukhiqizwa ngokweqile kwama-hormone.
Isiguli esikhethekile njalo siba sengozini ye-ketoacidosis, idlozi noma isifo sikashukela. Kulokhu, inani le-insulin yansuku zonke kufanele lenyuswe ngo-25 noma ngisho ne-100%. Ngaphezu kwalokho, umuntu kufanele anake iqiniso lokuthi ngokuncipha kwesifo sikashukela ngenxa yokungezelelwa kwe-thyrotooticosis, ukuthuthukiswa "kwesisu esibuhlungu" samanga noma ukuhlanza kohlobo "lwezinkundla zekhofi" kungenzeka. Esimweni esinjalo, udokotela angenza iphutha futhi anikeze i-laparotomy.
Kwatholakala ukuthi isifo sikashukela esibolile cishe ngaso sonke isikhathi siba nomthelela ekuqaleni nasekuthuthukeni kwenhlekelele ye-thyrotoxic. Lapho kuhlanganiswa ikhehla lesifo sikashukela, kunengozi enkulu empilweni yeziguli, ngoba ukukhonjwa kwalezi zifo kuyinkinga enkulu kakhulu. Ngalesi sithombe, ukuthola isifo kunzima kakhulu.
Ngakho-ke, ukuqala, kuyadingeka ukuthatha isiguli kusuka enkingeni, ngoba ukwelashwa kwe-coma yesifo sikashukela ngeke kulethe umphumela okuhlosiwe, noma ngabe kusetshenziswa imithamo ephezulu kakhulu ye-insulin ye-hormone.
Ukusuka ku-8 kuya ku-22% weziguli ezinesifo esijwayelekile bazohlupheka ngenxa yokuxhaphaka kwezimpawu ze-thyrotooticosis.
Uma i-thyrotooticosis ilula, khona-ke kulokhu i-glucosuria ne-hyperglycemia kungabhekwa kaningi. Zingadala izinkinga ekuhloleni isifo sikashukela.
Kulezi zimo, ukuxilongwa okuhlukile kwe-thyrotooticosis ne-mellitus yesifo sikashukela kufanele kwenziwe ngokubheka isikhathi sokwehla kwezinga likashukela ngaphansi kwesimo somthwalo weglucose.
Kuyini ingozi ye-thyrotooticosis kushukela?
Odokotela banaka ngokukhethekile iziguli ezinesifo sikashukela esibuhlungu esine-thyrotooticosis enzima. Uma isifo sikashukela singaziwa futhi samukelwa njenge-hyprogenlycemia ye-androgenic, khona-ke lokhu kuyingozi enkulu okunikezwe:
- ukwenza umsebenzi;
- ukujoyina isifo esijwayelekile.
Ukuthuthuka komthambo obangelwe yi-ketoacidosis ngemuva kokuhlinzwa kwe-yegilo kungakhulisa amathuba okuba nezinkinga ezigulini ezinesifo sikashukela esingajwayelekile.
Ukunqunywa koshukela wegazi esiswini esingenalutho ngokuhlolwa okugcwele kwesiguli esine-thyrotoxic goiter kuyimpoqo ngaphansi kwanoma yiziphi izimo.
Akuyona ingozi kangako lapho kutholakala ukuthi isifo se-thyrotooticosis sikashukela asenziwanga. Odokotela kufanele bahlale beqaphile:
- ukwehla kwesisindo okungashintshiwe;
- ukungaphatheki kahle ngokweqile;
- ukujuluka ngokweqile;
- ukubola okuvame kakhulu kweshukela kuncike ekudleni kanye nokusetshenziswa okuhleliwe kwezidakamizwa ukunciphisa ushukela.
Kusukela esikhathini sokugxila kokuhlanjululwa kwe-thyrotooticosis, lezi zimpawu kusifo sikashukela zizoqala ukuqeda. Kulokhu, izimpawu zokushoda kwe-insulin zizoqala ukwanda ngokushesha kanti isiguli singaze siwele phansi. Ngaphezu kwalokho, uma inqubo yokuvuvukala ihlala ngaphezu kwamasonto ayi-5, izimpawu ze-thyrotooticosis zizoqala ukuhlukumeza isiguli kakhulu. Izinga lomfutho wegazi lizoba lingazinzile, kuthambekele ekwandeni. Ukushayela kuzoba okuguquguqukayo futhi okukhulu.
Lapho uhlola igazi lokuqukethwe kwe-thyroxine, iodine kanye ne-catecholamines kubantu abanjalo abane-pathology ehlanganisiwe, kuzosungulwa ukuthi ngokuqala kokuqala kwenqubo yokutheleleka, ukuqina kwe-thyroxine kunciphile. Uma inqubo yokutheleleka ihlala isikhathi eside, khona-ke ukukhululeka kwehomoni kuthuthukiswa ngokuncipha okuhambisanayo kwenani le-triiodothyronine ne-protein eboshwe. Ngesikhathi esifanayo, ukuqoqwa kwe-norepinephrine ne-adrenaline kukhuphuka kakhulu.
Abanye odokotela bakholelwa ukuthi ubukhulu be-androtooticosis kuzoncika ebubini bokuphazamiseka kwezixhobo ze-endocrine pancreatic. Kodwa-ke, abanye odokotela baphikisana nokuthi iziguli ezine-thyrotooticosis enzima zingase zibe nefomathi yesifo sikashukela emnene. Nge-thyrotooticosis emnene, ukuntuleka kwe-insulin okunzima kuzokhula.
Ukwelashwa kwe-thyrotooticosis
Ngokuhlanganiswa kwe-thyrotootic goiter kanye nesifo sikashukela, esisindayo komunye nomunye, ukungenelela kokuhlinzwa ku-gland yegilo kubonisiwe, noma ngabe ukuqina kwe-pathology.
Isimo sokuqala sokunciphisa ubungozi ekusebenzeni sizonxeshezelwa isinxephezelo sikashukela kanye nokusebenza ngokwejwayelekile komsebenzi we-yegilo. Imininingwane enjalo izokhombisa isinxephezelo:
- ukwehla kokuxineka koshukela ukuya ku-8.9 mmol / l;
- ukulungiswa okuvamile kwe-electrolyte metabolism kanye ne-CBS;
- ukuqedwa kwe-ketonuria ne-glucosuria.
Kubalulekile futhi ukunciphisa isamba semetabolism emzimbeni ukuze ibe ngu-10%, yenza ishayela ngamandla, ukunyamalala kokusebenza kwayo, yenze kube yiphuze ukulala, ikhulise isisindo sesiguli. Uma lezi zimo zihlangabezana, khona-ke isiguli sikulungele ngokuphelele ukuhlinzwa ku-gland yegilo.
Ngenxa yokwephulwa kwemisebenzi ejwayelekile yesibindi (iprotheni, i-antitoxic), ushintsho ekwakhekeni kwegazi okuncane kanye nokwenziwa macroelement kwegazi, ukweqisa kwenhliziyo, ukungakwazi kwemithambo yegazi, ukubethelwa kaningi kwesifo sikashukela, ukuqina komfutho we-hypertension kanye ne-thyrotooticosis eyinkimbinkimbi, ukulungiselela ukuhlinzwa kungabambezeleka isikhathi esingamaviki ayi-8 kuye kwayi-12.
Ukwenza ukwelashwa okwenziwa ngokubambisana nezidakamizwa kufanele kuhlelwe kucatshangelwa ubudala besiguli, ubukhulu bezimpawu zalesi sifo, ubukhulu be-pathologies ehambisanayo kanye nezinga lokukhuphuka kwe-gland yegilo. Ngokuvamile kusetshenziselwa lezi zinhloso:
- ama-beta blockers;
- iodine ihlangana;
- i-lithium carbonate;
- i-thyreostatics.
Ngokubhekisisa nangaphandle, kuzokwehla ubukhulu nosayizi we-gland. Ngesikhathi sokuhlinzwa, isitho siphuma ngaphandle kakhulu.
Kodwa-ke iodide iyodwa ayikwazi ukusetshenziswa isikhathi eside. Ngemuva kwamaviki ama-2, ukuzinza kwe-blockade yokukhiqizwa kwe-thyroid hormone kuzoma.
Ukwelashwa kwe-thyrotootic goiter, i-lithium carbonate isetshenziswa ivolumu engama-900 kuya kwangama-1200 mg ngosuku. Umuthi usiza ukuqinisa ama-membrane weseli we-gland, futhi unciphise umphumela ovuselelayo we-TSH kanye nama-antibodies ashukumisa umzimba we-thyroid. Ngaphezu kwalokho, ukuqoqwa kwe-hormone T ne-T4 ku-serum yegazi kuyancipha.
Uma isiguli singakubekezeleli i-thyreostatics nefomu elithambile le-thyrotooticosis, khona-ke ukwelashwa kwenziwa izinyanga ezingama-2-3. Kungalesi sikhathi lapho umphumela wokuvimba we-lithium carbonate ekusebenzeni okunganele kwe-gland yegilo ushabalale ngokuphelele.
Kwezinye izimo, isikhathi sokwelashwa singangezelwa eminyakeni eyi-1.5. Kwenqatshelwe ukunquma amalungiselelo e-iodine ezigulini ezinesifo se-thyrotootic, inqobo nje uma ngabe i-euthyroidism itholakala nge-thyreostatics ngenxa yengozi enkulu yokuqalwa kabusha.
