Graves' kab mob hauv cov neeg laus

Cov thyroid caj pas yog ib qho me me ntawm cov kab mob endocrine nyob hauv qab ntawm daim tawv nqaij ntawm lub caj dab. Nws lub luag haujlwm tseem ceeb yog kev tso tawm cov thyroid hormones uas tswj cov txheej txheem metabolic (tso tawm lub zog rau cov haujlwm tseem ceeb ntawm cov hlwb thiab cov ntaub so ntswg). Yog tias muaj ntau yam laj thawj, lub caj pas pib ua haujlwm ntau dua li niaj zaus, qhov no tuaj yeem ua rau Graves' kab mob hauv cov neeg laus.

Lub npe no tau ib txwm nyob txij li hnub ntawm cov tshuaj Soviet thiab tam sim no suav tias yog siv tsis tau. Hauv cov ntaub ntawv thoob ntiaj teb thiab cov txheej txheem kho mob, lub npe hyperthyroidism lossis Graves Disease yog siv. Lwm lub npe uas siv nyob rau hauv ntau lub teb chaws muaj xws li cov ntsiab lus no:

• exophthalmic goiter;
• Graves 'hyperthyroidism;
• Parry tus kab mob;
• tshuaj lom diffuse goiter.

Tsis tas li ntawd, tseem muaj kev faib tawm sab hauv ntawm Graves 'tus kab mob, nyob ntawm seb qhov tseem ceeb ntawm qee yam tsos mob:

• dermopathy (thaum daim tawv nqaij cuam tshuam tshwj xeeb);
• osteopathy (cov teeb meem skeletal);
• ophthalmopathy (feem ntau yog qhov muag tsos mob).

Dab tsi yog Basedow's disease

Graves' kab mob los yog Graves' thyroiditis yog ib yam kab mob uas cuam tshuam rau cov thyroid caj pas, nrog rau cov tawv nqaij thiab qhov muag.

Cov thyroid caj pas yog ib qho khoom nruab nrog uas yog ib feem ntawm cov kab mob endocrine, lub network ntawm cov qog endocrine thiab cov ntaub so ntswg uas zais cov tshuaj hormones uas tswj cov txheej txheem tshuaj lom neeg (metabolism).

Cov tshuaj hormones cuam tshuam rau lub luag haujlwm tseem ceeb ntawm lub cev, thiab tseem tswj lub plawv dhia, lub cev kub thiab ntshav siab. Cov tshuaj hormones raug tso tawm ncaj qha mus rau hauv cov hlab ntsha, los ntawm qhov chaw lawv mus rau ntau qhov chaw ntawm lub cev.

Graves 'tus kab mob yog tus cwj pwm los ntawm qhov txawv txav ntawm cov thyroid caj pas (hu ua goiter) thiab nce tso tawm ntawm cov thyroid hormone (hyperthyroidism). Cov thyroid hormones koom nrog ntau lub cev sib txawv thiab, vim li ntawd, cov tsos mob tshwj xeeb thiab cov tsos mob ntawm Graves' kab mob tuaj yeem sib txawv ntawm cov neeg sib txawv ntawm poj niam txiv neej thiab hnub nyoog. Cov tsos mob tshwm sim muaj xws li kev poob phaus, tsis muaj qhov tsis haum rau qhov kub thiab txias nrog kev tawm hws ntau, cov leeg tsis muaj zog, qaug zog, thiab lub qhov muag qhov muag. Graves' kab mob yog ib qho kab mob autoimmune.

Cov duab ua ntej thiab tom qab Graves' kab mob

Ua rau Basedow tus kab mob hauv cov neeg laus

Graves' kab mob suav hais tias yog kab mob autoimmune, tab sis lwm yam, suav nrog caj ces, ib puag ncig, lossis ib puag ncig, tuaj yeem ua rau nws txoj kev loj hlob. Cov kab mob autoimmune tshwm sim thaum lub cev tiv thaiv kab mob ua yuam kev tawm tsam cov ntaub so ntswg noj qab haus huv.

Lub cev tiv thaiv kab mob feem ntau tsim cov protein tshwj xeeb hu ua antibodies. Cov tshuaj tiv thaiv no ua rau cov khoom txawv teb chaws (xws li kab mob, kab mob, co toxins) hauv lub cev, ua rau lawv raug puas tsuaj. Cov tshuaj tiv thaiv tuaj yeem tua cov kab mob ncaj qha los yog tsho tiv no kom lawv yooj yim dua los ntawm cov qe ntshav dawb. Cov tshuaj tiv thaiv tshwj xeeb raug tsim los teb rau qee cov ntaub ntawv lossis cov tshuaj uas txhawb kev tsim cov tshuaj tiv thaiv. Lawv hu ua antigens.

Hauv Graves tus kab mob, lub cev tiv thaiv kab mob tsim cov tshuaj tiv thaiv tsis zoo hu ua thyroid-stimulating immunoglobulin. Cov tshuaj tiv thaiv no ua rau kev ua haujlwm ntawm cov thyroid-stimulating hormone (uas yog secreted los ntawm pituitary caj pas). Cov tshuaj hormone no ua rau lub ntsej muag ntawm cov thyroid caj pas thiab ua rau cov hlwb tsim cov thyroid hormones, uas ua rau muaj ntau dhau ntawm cov ntshav. Muaj hyperactivity ntawm cov thyroid caj pas, nws txhim kho, ua haujlwm ntau dhau. Hauv Graves 'ophthalmopathy, cov tshuaj tiv thaiv no kuj tseem tuaj yeem cuam tshuam cov hlwb nyob ib puag ncig lub qhov muag.

Cov neeg muaj kev cuam tshuam tej zaum yuav muaj cov noob caj noob ces lossis cov caj ces ntawm cov kab mob Graves. Ib tug neeg uas muaj kab mob genetic predisposed rau ib tug kab mob yog nqa cov gene (los yog noob) rau tus kab mob no, tab sis cov pathology yuav tsis tshwm sim nws tus kheej yog hais tias tus gene tsis tshwm sim los yog "activated" nyob rau hauv tej yam tshwm sim, piv txwv li, vim yog ceev ceev hloov ib puag ncig yam. (hu ua multifactorial heredity).

Ntau yam noob tau raug txheeb xyuas uas cuam tshuam nrog Graves' kab mob, suav nrog cov uas:

• tsis muaj zog lossis hloov kho cov lus teb ntawm lub cev tiv thaiv kab mob (immunomodulators),
• uas cuam tshuam ncaj qha rau cov thyroid ua haujlwm, xws li thyroglobulin (Tg) lossis thyroid stimulating hormone receptor (TSHR) noob.

Gene Tg tsim thyroglobulin, ib qho protein uas pom tsuas yog hauv cov thyroid cov ntaub so ntswg thiab ua lub luag haujlwm hauv kev tsim cov tshuaj hormones.

Gene TSH tsim cov protein uas yog receptor thiab khi rau cov thyroid stimulating hormone. Lub hauv paus tseeb ntawm kev sib cuam tshuam ntawm caj ces thiab ib puag ncig yam uas ua rau Graves' kab mob tsis nkag siab tag nrho.

Ntxiv cov noob caj noob ces, hu ua modifier genes, tuaj yeem ua lub luag haujlwm hauv kev loj hlob lossis kev nthuav qhia ntawm tus kabmob. Ib puag ncig yam uas tuaj yeem ua rau muaj kev loj hlob ntawm hyperthyroidism muaj xws li kev xav lossis lub cev kev ntxhov siab, kev kis kab mob, lossis kev xeeb tub. Cov neeg haus luam yeeb muaj kev pheej hmoo ntau dua ntawm kev tsim kab mob Graves thiab ophthalmopathy. Cov tib neeg uas muaj lwm yam pathologies tshwm sim los ntawm kev ua haujlwm tsis zoo ntawm lub cev tiv thaiv kab mob, xws li hom 1 mob ntshav qab zib lossis mob caj dab rheumatoid, muaj kev pheej hmoo ntau dua ntawm kev tsim kab mob Graves.

Leej twg yuav kis tau tus kab mob Graves ntau dua?

Graves' kab mob cuam tshuam rau poj niam ntau dua li cov txiv neej, ntawm qhov sib piv ntawm 10: 1. Tus kab mob no feem ntau tshwm sim hauv cov hnub nyoog nruab nrab nrog qhov tshwm sim siab tshaj plaws ntawm hnub nyoog 40 thiab 60, tab sis kuj tuaj yeem cuam tshuam rau menyuam yaus, cov hluas, thiab cov neeg laus. Graves' kab mob tshwm sim nyob rau hauv yuav luag txhua qhov chaw ntawm lub ntiaj teb no. Nws kwv yees tias 2-3% ntawm cov pejxeem raug kev txom nyem los ntawm nws. Los ntawm txoj kev, Graves' kab mob yog qhov ua rau hyperthyroidism tshaj plaws.

Lwm yam teeb meem kev noj qab haus huv thiab tsev neeg keeb kwm kuj tseem ceeb heev. Cov neeg uas muaj Graves' kab mob feem ntau muaj keeb kwm ntawm lwm cov neeg hauv tsev neeg uas muaj teeb meem thyroid lossis kab mob autoimmune. Qee cov txheeb ze tej zaum yuav muaj hyperthyroidism lossis cov thyroid tsis ua haujlwm, lwm tus yuav muaj lwm yam kab mob autoimmune, suav nrog cov plaub hau ntxov ntxov (pib hauv lawv 20s). Los ntawm kev sib piv, tus neeg mob yuav muaj teeb meem tiv thaiv kab mob hauv tsev neeg, suav nrog cov menyuam yaus mob ntshav qab zib mellitus, pernicious anemia (vim vitamin B12 tsis txaus), lossis tsis mob dawb thaj ua rau thaj ntawm daim tawv nqaij (vitiligo).

Nws yog ib qho tseem ceeb kom txiav tawm lwm yam ua rau hyperthyroidism. Lawv suav nrog cov tshuaj lom nodular lossis multinodular goiter, uas yog tus cwj pwm los ntawm ib lossis ntau qhov nodules lossis pob hauv cov thyroid caj pas uas maj mam loj hlob thiab nce lawv cov haujlwm kom tag nrho cov khoom tsim tawm ntawm cov thyroid hormones rau hauv cov ntshav siab tshaj qhov qub.

Tsis tas li, tib neeg tuaj yeem tsim cov tsos mob ntawm hyperthyroidism ib ntus yog tias lawv muaj tus mob hu ua thyroiditis. Tus mob no yog tshwm sim los ntawm ib qho teeb meem ntawm lub cev tiv thaiv kab mob los yog kab mob viral uas ua rau lub caj pas xau cov thyroid hormones. Hom thyroiditis muaj xws li subacute, ntsiag to, kis kab mob, hluav taws xob kho mob, thiab postpartum thyroiditis.

Tsis tshua muaj, qee hom qog nqaij hlav qog noj ntshav thiab qee cov qog nqaij hlav, xws li TSH-tsim pituitary adenomas, tuaj yeem ua rau cov tsos mob zoo ib yam li cov pom hauv Graves' kab mob. Tsis tshua muaj, cov tsos mob ntawm hyperthyroidism tuaj yeem tshwm sim los ntawm kev noj cov thyroid ntau ntau hauv daim ntawv tshuaj.

Cov tsos mob ntawm Basedow's disease hauv cov neeg laus

Cov tsos mob cuam tshuam nrog Basedow tus kab mob feem ntau tshwm sim maj mam, qee zaum txawm tias imperceptibly rau tus kheej (lawv yuav yog thawj tus neeg txheeb ze). Lawv siv sij hawm ntau lub lis piam los yog hli los txhim kho. Cov tsos mob tuaj yeem suav nrog kev hloov pauv tus cwj pwm xws li kev ntxhov siab, ntxhov siab, ntxhov siab, tsis xis nyob, thiab pw tsaug zog nyuaj (insomnia). Cov tsos mob ntxiv muaj xws li kev poob phaus (tsis ua raws li kev noj zaub mov nruj thiab kev noj zaub mov tsis zoo), cov leeg nqaij tsis muaj zog, tsis muaj cua sov tsis haum, nce tawm hws, nrawm, lub plawv dhia tsis zoo (tachycardia), thiab qaug zog.

Graves' kab mob feem ntau cuam tshuam nrog pathologies cuam tshuam rau lub qhov muag, feem ntau hu ua ophthalmopathy. Ib daim ntawv me me ntawm ophthalmopathy muaj nyob rau hauv feem ntau cov neeg uas muaj hyperthyroidism nyob rau qee kis ntawm tus kab mob, tsawg dua 10% ntawm cov neeg mob muaj qhov muag tseem ceeb uas yuav tsum tau muaj kev kho mob. Cov tsos mob ntawm qhov muag yuav tshwm sim ua ntej, tib lub sijhawm, lossis tom qab kev loj hlob ntawm hyperthyroidism. Tsis tshua muaj, cov neeg uas muaj cov tsos mob ntawm qhov muag yeej tsis tsim hyperthyroidism. Qee qhov xwm txheej, qhov muag puas yuav tshwm sim thawj zaug lossis zuj zus tom qab kev kho mob rau hyperthyroidism.

Kev tsis txaus siab hauv ophthalmopathy yog qhov sib txawv heev. Rau qee tus neeg, lawv yuav nyob twj ywm tsis hloov mus rau ntau xyoo, thaum rau lwm tus, tus mob yuav zoo dua lossis hnyav dua hauv ob peb lub hlis xwb. Cov kev hloov pauv tuaj yeem ua raws li tus qauv: kev ua kom tsis zoo (exacerbation), thiab tom qab ntawd kev txhim kho tseem ceeb (kev zam txim). Hauv cov neeg feem coob, tus kab mob no mob me me thiab tsis muaj kev vam meej.

Feem ntau tshwm sim ntawm cov tsos mob ntawm lub qhov muag yog o ntawm cov ntaub so ntswg nyob ib ncig ntawm lub qhov muag, uas yuav ua rau nws bulge tawm ntawm lub orbit, ib tug mob hu ua proptosis (bulging ob lub qhov muag). Cov neeg mob kuj tseem tuaj yeem hnov ​​​​mob qhuav ntawm qhov muag, o ntawm daim tawv muag thiab lawv qhov kaw tsis tiav, qhov muag ntawm daim tawv muag, o, liab, mob thiab khaus ntawm lub qhov muag. Qee tus neeg piav txog qhov kev xav ntawm cov xuab zeb hauv lawv qhov muag. Tsawg zaus, qhov muag tsis pom kev lossis ob lub qhov muag, rhiab heev rau lub teeb, lossis qhov muag tsis pom kev yuav tshwm sim.

Tsis tshua muaj, cov neeg uas muaj Graves 'tus kab mob tsim cov tawv nqaij lesion hu ua pretibial dermopathy los yog myxedema. Cov tsos mob no tshwm sim los ntawm cov tsos ntawm thickened, reddish daim tawv nqaij nyob rau hauv pem hauv ntej ntawm ob txhais ceg. Feem ntau nws tsuas yog txwv rau lub shins, tab sis qee zaum nws kuj tuaj yeem tshwm sim ntawm ko taw. Tsis tshua muaj, gel zoo li o ntawm cov ntaub so ntswg ntawm tes thiab o ntawm cov ntiv tes thiab ntiv taw (acropachia) tshwm sim.

Cov tsos mob ntxiv cuam tshuam nrog Graves' kab mob muaj xws li:

• cardiopalmus;
• me ntsis tshee ( tshee tshee) ntawm tes thiab / los yog ntiv tes;
• plaub hau poob;
• nkig ntsia hlau;
• nce reflexes (hyperreflexia);
• nce qab los noj mov thiab nce plab hnyuv.

Cov poj niam uas muaj tus kab mob Graves tuaj yeem muaj kev hloov pauv hauv lawv cov kev coj khaub ncaws. Cov txiv neej tej zaum yuav muaj erectile kawg (impotence).

Qee zaum, Graves 'tus kab mob tuaj yeem ua tau zoo, ua rau lub plawv tsis ua haujlwm lossis qhov txawv txav thiab tsis muaj zog ntawm cov pob txha (osteoporosis), ua rau lawv nkig thiab ua rau pob txha los ntawm kev raug mob me me lossis ua tsis taus pa.

Kev kho mob ntawm Basedow's disease hauv cov neeg laus

Kev kuaj mob thiab kev kho mob ntawm Basedow's disease yog pom nyob rau hauv cov txheej txheem thoob ntiaj teb thiab cov txheej txheem kho mob hauv tebchaws. Cov phiaj xwm kev tshuaj ntsuam tau raug kos raws li nruj raws li qhov kev kuaj mob tau hais tseg thiab tau ua nyob rau theem.

diagnostics

Kev kuaj mob ntawm Graves 'tus kab mob yog tsim los ntawm cov ncauj lus ntxaws ntxaws ntawm tus neeg mob thiab nws tsev neeg (nrhiav paub yog tias cov neeg txheeb ze muaj teeb meem zoo sib xws), kev soj ntsuam xyuas kom meej, kev txheeb xyuas cov cim qhia, thiab lwm yam. Tom qab cov tsos mob tshwm sim. raug txheeb xyuas, kuaj kuaj thiab ntsuas ntsuas ntsuas raug sau tseg.

Kev kuaj dav dav (ntshav, zis, biochemistry) thiab kev kuaj tshwj xeeb xws li kev kuaj ntshav uas ntsuas cov thyroid hormone (T3 thiab T4) thiab cov thyroid stimulating hormone (TSH ntau ntau) tau qhia. Txhawm rau kom paub meej qhov kev kuaj mob, kev kuaj ntshav yuav ua kom pom qhov muaj cov tshuaj tiv thaiv tshwj xeeb rau thyrogloulin thiab thioperoxidase uas ua rau Graves' kab mob, tab sis qhov no feem ntau tsis tsim nyog.

Kev kho mob niaj hnub

Kev kho mob rau Graves' kab mob feem ntau yog ib qho ntawm peb txoj hauv kev:

• tshuaj antithyroid (tshwm sim ua haujlwm ntawm cov thyroid caj pas ntawm kev sib txuas ntawm cov tshuaj hormones);
• kev siv hluav taws xob iodine;
• kev phais mob.

Daim ntawv tshwj xeeb ntawm kev kho mob pom zoo yuav nyob ntawm lub hnub nyoog ntawm tus neeg mob thiab qhov ntev ntawm tus kab mob.

Cov txheej txheem kho mob

Txhua theem ntawm kev kho mob yog ua raws li cov lus pom zoo ntawm Clinical protocols

Kev kho mob tsawg kawg nkaus rau Graves' kab mob yog siv cov tshuaj uas txo cov thyroid hormones (cov tshuaj antithyroid). Lawv tshwj xeeb tshaj yog rau kev kho mob ntawm cov poj niam cev xeeb tub, cov neeg mob hyperthyroidism me, lossis cov neeg mob xav tau kev kho mob sai rau hyperthyroidism. Cov tshuaj tshwj xeeb raug xaiv los ntawm tus kws kho mob, raws li lub hnub nyoog ntawm tus neeg mob, nws tus mob thiab lwm yam ntxiv.

Cov kev kho mob tseem ceeb rau Graves 'tus kab mob yog cov uas ua rau cov thyroid caj pas, ua rau hypothyroidism. Radioactive iodine therapy yog kev kho mob tshaj plaws rau Graves' kab mob hauv ntau lub tebchaws. Iodine yog ib hom tshuaj siv los ntawm cov thyroid caj pas los tsim (synthesis) thyroid hormones. Yuav luag tag nrho cov iodine nyob rau hauv tib neeg lub cev yog absorbed los ntawm cov ntaub so ntswg ntawm cov thyroid caj pas. Cov neeg mob nqos cov tshuaj uas muaj cov xov tooj cua iodine, uas yuav taug kev los ntawm cov hlab ntsha thiab sib sau ua ke hauv cov thyroid caj pas, qhov chaw uas nws yuav ua rau cov thyroid puas thiab puas. Qhov no yuav txo qis cov thyroid caj pas thiab txo qis cov tshuaj hormones ntau dhau. Yog tias cov thyroid hormones poob qis dhau lawm, kev kho tshuaj hormone yuav xav tau los kho cov thyroid hormones txaus.

Lwm txoj kev kho radical yog kev phais kom tshem tawm tag nrho lossis ib feem ntawm cov thyroid caj pas (thyroidectomy). Hom kev kho mob ntawm tus kab mob no feem ntau yog tshwj tseg rau cov neeg uas lwm hom kev kho mob tsis tau ua tiav los yog contraindicated, los yog nyob rau hauv lub xub ntiag ntawm kev loj hlob ntawm cov qog nqaij hlav mus rau ib tug loj loj. Tom qab kev phais, hypothyroidism feem ntau tshwm sim - qhov no yog qhov xav tau, uas yog kho los ntawm kev kho cov tshuaj hormones los ntawm sab nraud.

Ntxiv rau peb txoj kev kho mob uas tau hais los saum toj no, cov tshuaj tuaj yeem raug sau tseg uas thaiv cov thyroid hormone uas twb ncig hauv cov ntshav (beta-blockers) los ntawm kev ua nws txoj haujlwm. Beta blockers xws li propranolol, atenolol, lossis metoprolol tuaj yeem siv. Thaum cov thyroid hormones normalizes, kev kho nrog beta-blockers tuaj yeem raug tso tseg.

Hauv ntau qhov xwm txheej, kev soj ntsuam tas mus li thiab kev soj ntsuam hauv chav kuaj yog tsim nyog. Qee qhov xwm txheej, kev kho tshuaj hormone hloov lub neej yuav tsum tau ua.

Cov mob me me ntawm ophthalmopathy tuaj yeem kho nrog looj tsom iav dub, tshuaj pleev, kua muag dag. Cov mob hnyav dua tuaj yeem kho nrog corticosteroids xws li prednisone kom txo qhov o ntawm cov ntaub so ntswg nyob ib ncig ntawm lub qhov muag.

Hauv cov xwm txheej hnyav dua, kev phais orbital decompression thiab orbital radiation kho kuj yuav tsum tau. Thaum lub sij hawm orbital decompression phais, tus kws phais tshem tawm cov pob txha ntawm lub qhov muag qhov (socket) thiab cov sinuses. Qhov no tso cai rau lub qhov muag rov qab mus rau nws txoj haujlwm ntuj hauv lub qhov (socket). Qhov kev phais no feem ntau yog tshwj tseg rau cov neeg uas muaj kev pheej hmoo rau qhov tsis pom kev vim yog lub siab ntawm lub paj hlwb lossis lwm yam kev kho mob uas tsis tau ua haujlwm.

Kev tiv thaiv kab mob Basedow hauv cov neeg laus hauv tsev

Kev kwv yees kev loj hlob ntawm tus kab mob ua ntej thiab tiv thaiv nws yog qhov nyuaj. Tab sis muaj cov kev ntsuas los txo cov kev pheej hmoo ntawm cov teeb meem thiab kev loj hlob ntawm hyperthyroidism.

Yog tias Graves' kab mob raug kuaj pom, ua kom lub hlwb thiab lub cev muaj kev noj qab haus huv yog qhov tseem ceeb.

Kev noj zaub mov kom raug thiab kev tawm dag zog tuaj yeem txhim kho qee cov tsos mob thaum kho thiab pab koj zoo tag nrho. Piv txwv li, vim hais tias cov thyroid caj pas tswj cov metabolism, hyperthyroidism yuav zoo li ua puv thiab nkig tom qab hyperthyroidism raug kho, thiab kev tawm dag zog yuav pab tswj cov pob txha thiab qhov hnyav.

Kev ntxhov siab txo tej zaum yuav muaj txiaj ntsig zoo vim nws tuaj yeem ua rau lossis ua rau Graves' kab mob hnyav dua. Cov suab paj nruag zoo nkauj, da dej sov lossis taug kev yuav pab koj so thiab txhim kho koj lub siab.

Kev tsis lees paub tus cwj pwm phem - tsis txhob haus luam yeeb. Kev haus luam yeeb ua rau Graves 'ophthalmopathy. Yog tias tus kab mob cuam tshuam rau koj cov tawv nqaij (dermopathy), siv cov tshuaj pleev tom khw los yog tshuaj pleev uas muaj hydrocortisone los txo qhov o thiab liab. Tsis tas li ntawd, compression ceg qhwv tuaj yeem pab tau.

Nrov lus nug thiab lus teb

Cov lus nug ntsig txog Basedow's disease, peb tau tham nrog General kws kho mob, endoscopist, lub taub hau ntawm lub koom haum thiab txheej txheem chaw ua hauj lwm Lidia Golubenko.