tib neeg thyroid caj pas

Cov thyroid caj pas me me, tab sis nws yog qhov loj tshaj plaws ntawm cov kab mob endocrine ntawm lub cev. Nws yog "kindled" nyob rau hauv cov ntaub ntawv kho mob nrog ntau lub npe poetic: nws raug hu ua ob qho tib si "tus poj huab tais ntawm cov tshuaj hormones" thiab "tus poj niam ntawm lub cev." Vim li cas?

Qhov tseeb yog tias cov thyroid caj pas tsim cov tshuaj hormones uas tswj cov txheej txheem metabolic hauv tib neeg lub cev, tswj hwm lub zog tsim khoom thiab cov pa oxygen rau cov ntaub so ntswg.

- Cov thyroid hormones cuam tshuam rau kev ua haujlwm ntawm txhua lub cev thiab lub cev, - piav qhia Tus kws kho mob endocrinologist Elena Kulikova. - Thaum lub luag haujlwm ntawm cov thyroid caj pas hloov pauv, lub cev hnyav, lub zog thiab zaus ntawm lub plawv contractions, kev ua pa ntawm lub ntsws thiab kev ua haujlwm ntawm lub plab zom mov hloov. Qhov ceev ntawm kev xav thiab lub siab lub ntsws ntawm ib tug neeg nyob ntawm seb qhov kev ua ntawm cov thyroid caj pas. Thiab txawm tias muaj peev xwm muaj menyuam, cev xeeb tub thiab yug me nyuam noj qab haus huv kuj tseem nyob ntawm qib ntawm cov thyroid hormones.

Yog tias koj pom cov kev hloov pauv ntawm cov tsos mob thiab qhov zoo ntawm daim tawv nqaij, qhia qhov o ntawm daim tawv muag, koj txhawj xeeb txog cov plaub hau dull thiab nkig, plaub hau poob, nws muaj peev xwm hais tias qhov no yog vim muaj cov thyroid teeb meem.

Dab tsi yog qhov tseem ceeb kom paub txog tib neeg cov thyroid caj pas

Tib neeg cov thyroid nyob qhov twg?

Cov thyroid caj pas yog nyob rau hauv cheeb tsam ntawm lub anterior daim duab peb sab ntawm lub caj dab, uas yog bounded los ntawm saum toj no los ntawm lub hauv paus ntawm lub puab tsaig, los ntawm hauv qab no los ntawm lub jugular notch ntawm lub sternum, nyob rau hauv lub sab ntawm lub anterior ntug ntawm sab xis thiab sab laug sternocleidomastoid cov leeg¹.

Tuav ib txhais tes rau ntawm caj dab, koj tuaj yeem hnov ​​​​cov pob txha mos ntawm cov thyroid (ib qho uas hu ua Adas txiv apple) - qhov ntom ntom lossis txawm tias muaj cov khoom tsim tawm. Thaum nqos, nws plam. Ncaj nraim hauv qab nws yog cov thyroid caj pas nws tus kheej - feem ntau nws hnov ​​​​hauv daim ntawv ntawm "loj hlob" ntawm lub trachea.².

Cov thyroid caj pas zoo li cas thiab nws ua haujlwm li cas?

Cov duab ntawm cov thyroid caj pas feem ntau piv rau npauj npaim. Nws txoj cai thiab sab laug lobes txuas nrog lub isthmus, thiab nyob rau hauv 30% ntawm cov neeg mob kuj muaj ib tug pyramidal lobe uas txuas los ntawm isthmus.³.

Cov thyroid caj pas muaj cov yam ntxwv zoo li cov vesicles nyob rau hauv tsos - lub follicle. Muaj txog 30 lab ntawm lawv². Txhua follicle yog ntim nrog cov khoom zoo li gel hu ua colloid. Tsuas yog nws muaj cov tshuaj hormones tsim los ntawm cov hlwb. Tag nrho cov follicles yog pawg los ntawm 20-30 daim: xws li pawg hu ua thyreons.

Cov thyroid caj pas yog tswj los ntawm 3 mechanisms.

1. Thawj txheej txheem yog hypothalamic-pituitary system, uas nyob rau hauv lub hlwb. Kev sib pauv ntawm cov ntaub ntawv ntawm cov thyroid caj pas, hypothalamus thiab pituitary caj pas tshwm sim nrog kev pab ntawm thyroid-stimulating hormone (TSH) thiab thyreoliberin (TRH).
2. Lub hauv paus paj hlwb yog lub luag haujlwm rau kev tswj hwm thib ob. Ib qho piv txwv zoo yog qhov nce hauv cov thyroid hormones thaum lub sij hawm muaj kev ntxhov siab.
3. Qhov thib peb txheej txheem ntawm kev tswj yog cov ntsiab lus ntawm inorganic iodine nyob rau hauv ib puag ncig (feem ntau yog dej thiab zaub mov). Nrog kev noj zaub mov tsis txaus ntawm iodine hauv lub cev, qib ntawm cov thyroid hormones txo qis thiab ntau yam pathologies ntawm cov thyroid caj pas.

Yog vim li cas cov thyroid caj pas ua mob rau tib neeg

Tsis yog txhua tus tuaj yeem paub qhov teeb liab los ntawm cov thyroid caj pas. Feem ntau, ib tug neeg tsis meej pem qhov mob hauv cheeb tsam no nrog cov tsos mob ntawm osteochondrosis lossis xav tias nws mob khaub thuas hauv nws caj pas.

Los ntawm txoj kev, ib tug neeg yeej tsis hnov ​​mob. Feem ntau, qhov mob yog cov tsos mob ntawm tus kab mob thyroiditis (mob), thiab nrog hypothyroidism thiab hyperthyroidism, nrog rau kev tsim cov thyroid nodules, raws li txoj cai, nws tsis mob.

Ntxiv mus, ib tug neeg yuav tsis xyuam xim rau cov cim ntawm lub cev ntev thiab tsis xav tias nws muaj teeb meem kev noj qab haus huv. Yog li ntawd, nws yog ib qho tseem ceeb kom paub cov tsos mob ntawm cov thyroid teeb meem. Cov no muaj xws li: kev ua haujlwm tsis zoo, nce kev chim siab, nqos nyuaj, pw tsaug zog, ntxhov siab vim (mus txog rau paranoia), poob phaus nrog kev noj qab haus huv zoo, thiab lwm yam kab mob sib txawv muaj lawv tus kheej cov tsos mob.

Ib qho ntawm feem ntau ua rau cov thyroid teeb meem yog qhov tsis muaj iodine hauv kev noj haus.

Elena Kulikova sau hais tias "Iodine deficiency yog ib yam rau ntau thaj tsam ntawm peb lub teb chaws: los ntawm me me mus rau hnyav heev," sau tseg Elena Kulikova. - Kev xav tau ntxiv ntawm cov tshuaj uas muaj iodine lossis cov khoom noj uas muaj iodine yog qhov tshwj xeeb tshaj yog rau cov menyuam yaus, cev xeeb tub thiab lactating poj niam. Kev noj zaub mov raws sijhawm ntawm iodized yog qhov tseem ceeb tiv thaiv kev tiv thaiv cov thyroid kab mob hauv cov menyuam yaus thiab cov neeg laus.

Ntawm qhov ua rau cov kab mob thyroid tuaj yeem yog: kab mob thiab kab mob, autoimmune aggression, oncology. Ib qho txiaj ntsig zoo rau qhov tshwm sim ntawm cov teeb meem nrog cov thyroid caj pas yog kev ntxhov siab ntev, iodine tsis muaj peev xwm, thiab tsis zoo ecology.

Cov kab mob ntawm cov thyroid yog cov feem ntau pathology ntawm endocrine system. Lawv yog 10-17 npaug ntau dua rau cov poj niam dua li cov txiv neej.⁵.

Tag nrho cov kab mob ntawm cov thyroid caj pas tau muab faib ua 3 pawg nyob ntawm theem ntawm cov thyroid hormones:

1. Thyrotoxicosis yog ib yam mob tshwm sim los ntawm kev nce qib ntawm cov thyroid hormones. Cov kab mob ntau tshaj plaws uas tau nrog thyrotoxicosis syndrome yog Graves' kab mob (txog 80% ntawm cov neeg mob hauv Russia.⁶), diffuse toxic goiter lossis nodular toxic goiter.

   Kev nce qib ntawm cov thyroid hormones kuj tseem tuaj yeem xav tau nrog kev ua rau mob ntev thiab tshwm sim ntawm mob hnyav thiab subacute thyroiditis.

2. Hypothyroidism. Ua ke nrog kev txo qis hauv cov thyroid hormone ntau ntau. Feem ntau, hypothyroidism tshwm sim tawm tsam keeb kwm ntawm autoimmune thyroiditis (mob ntawm cov thyroid caj pas) thiab yuav zoo li tom qab resection (tshem tawm ib feem) ntawm cov thyroid caj pas.
3. Cov kab mob ntawm cov thyroid uas tshwm sim yam tsis muaj kev cuam tshuam hormonal (euthyroid goiter, qog, thyroiditis).

Cia peb txheeb xyuas cov kab mob ntau tshaj plaws.

Kev Hypothyroidism

Lub hauv paus ntawm tus mob no yog qhov tsis txaus ntawm cov thyroid hormones, lossis txo qis hauv lawv cov kev cuam tshuam rau cov ntaub so ntswg hauv lub cev.⁷.

Primary hypothyroidism feem ntau tsim tawm tsam keeb kwm ntawm autoimmune thyroiditis. Cov tsos mob tuaj yeem sib txawv heev, thiab feem ntau txawm tias tus kws kho mob tsis tuaj yeem kuaj xyuas hypothyroidism tam sim ntawd. Cov pab pawg muaj kev pheej hmoo suav nrog cov neeg uas tau kho cov thyroid phais, cov neeg mob ntshav qab zib mellitus thiab Addison tus kab mob, cov neeg haus luam yeeb hnyav. Cov poj niam yuav tsum ceev faj tshwj xeeb tom qab yug me nyuam.

Nws yuav tsis yog superfluous los kuaj xyuas hypothyroidism yog tias tsis muaj laj thawj tshwj xeeb, qhov hnyav pib loj hlob, qaug zog, tsaug zog, tsis tsim nyog kev ntxhov siab thiab kev nyuaj siab tshwm sim. Tsis tas li ntawd, hypothyroidism tuaj yeem tshwm sim los ntawm kev txo qis hauv kev nco thiab kev mloog, o ntawm lub ntsej muag thiab ob txhais ceg, thiab plaub hau poob. Hauv cov txiv neej, tus mob no tuaj yeem nrog kev txo qis hauv libido thiab potency, hauv cov poj niam - kev ua txhaum ntawm kev coj khaub ncaws. Anemia yog lwm cov tsos mob ntawm hypothyroidism.

Graves' kab mob (diffuse toxic goiter)

Thaum muaj tus kab mob no, lub cev tiv thaiv kab mob tsim cov tshuaj tiv thaiv "txhawb" cov thyroid caj pas ua haujlwm ntau dua li qhov yuav tsum tau ua. Raws li qhov tshwm sim, ntau cov thyroid hormones tshwm sim hauv lub cev, uas cuam tshuam tsis zoo rau ntau lub cev thiab lub cev, tshwj xeeb tshaj yog cov paj hlwb thiab cov hlab plawv.

Thawj cov tsos mob ntawm Graves 'tus kab mob yog: palpitations, tawm hws, poob phaus tawm tsam keeb kwm ntawm kev noj qab haus huv, nqaij tsis muaj zog, chim siab thiab chim siab.⁸. Feem ntau, cov thyroid caj pas loj tuaj thiab pom. Feem ntau, Graves' kab mob yog nrog los ntawm endocrine ophthalmopathy, uas yog tshwm sim los ntawm exophthalmos (bulging ob lub qhov muag) thiab o ntawm daim tawv muag.

"Qhov muaj ophthalmopathy nyob rau hauv feem ntau ntawm cov neeg mob yog ib tug yam ntxwv cim ntawm diffuse toxic goiter," hais tias peb cov kws txawj. - Nws yog ib qho tseem ceeb kom nco ntsoov tias Graves' kab mob yog ib qho kab mob rov qab los. Feem ntau, nws rov qab los, uas ua rau koj xav txog kev xaiv ib txoj kev kho radical.

Diffuse thiab nodular euthyroid goiter

Euthyroid goiter tseem hu ua non-toxic. Hauv qhov xwm txheej no, muaj qhov nce hauv qhov loj ntawm cov thyroid caj pas yam tsis muaj kev cuam tshuam nws txoj haujlwm. Qhov ntsuas ntawm qhov teeb meem tuaj yeem txawv: tus kab mob goiter qee zaum tsuas yog palpable, thiab qee zaum nws tuaj yeem pom ntawm qhov muag liab qab.

Muaj ntau ntau qhov laj thawj rau kev txhim kho ntawm cov kab mob no, tab sis feem ntau ntawm lawv yog qhov tsis muaj iodine, uas tsim nyog rau kev tsim cov thyroid hormones. Txhawm rau tsim cov tshuaj hormones, cov thyroid caj pas pib loj tuaj.

Nrog diffuse goiter, hlau nce tusyees, thiab nrog nodular goiter, cais volumetric formations los yog nodes tshwm nyob rau hauv nws. Lawv tuaj yeem yog ib leeg lossis ntau yam. Kuj tseem muaj qhov sib xyaw - diffuse-nodular daim ntawv ntawm tus kab mob. Hauv 95% ntawm cov neeg, nodules yog benign. Txawm li cas los xij, qhov pathology no yuav tsum tau kuaj xyuas kom zoo txhawm rau txhawm rau tshem tawm cov thyroid cancer.

Tus mob qog ua rau mob qog

Cov kab mob ntawm cov thyroid kab mob ntawm autoimmune etiology tuaj yeem ua rau hypothyroidism. autoimmune thyroiditis tuaj yeem kuaj pom qhov xwm txheej thiab tsis tuaj yeem nrog kev ua haujlwm ntawm cov thyroid caj pas.

Cov yam uas ua rau kev loj hlob ntawm tus kab mob no muaj xws li: heredity, unfavorable ecology, malfunctions ntawm lub cev tiv thaiv kab mob.

Elena Kulikova tus kws kho mob endocrinologist hais tias "Raws li tus kab mob no zuj zus lawm, cov thyroid caj pas tau hloov pauv thiab maj mam txo nws txoj haujlwm ua haujlwm," tus kws kho mob endocrinologist Elena Kulikova hais. - Cov kab mob tuaj yeem ua rau qeeb thiab nrawm. Koj tsis tuaj yeem paub ua ntej sai npaum li cas cov thyroid caj pas yuav poob nws txoj haujlwm. Txhawm rau kom tsis txhob nco lub sijhawm no thiab pib hloov kho raws sijhawm, peb qhia koj kom pub ntshav rau TSH tsawg kawg ib xyoos ib zaug.

Mob qog noj ntshav

Cov qog nqaij hlav hauv cov thyroid feem ntau yog qhov sib txawv heev. Qhov no txhais tau hais tias kev loj hlob thiab kev loj hlob ntawm cov qog nqaij hlav qeeb heev. Txawm li cas los xij, kuj tseem muaj cov kab mob hnyav heev, yog li koj yuav tsum tau ceev faj heev thiab raws sij hawm mus rau ultrasound ntawm cov thyroid caj pas thiab, yog tias tsim nyog, ua qhov zoo-koob aspiration biopsy.

Nyob ntawm lub hauv paus chiv keeb, muaj papillary, follicular thiab medullary thyroid cancer. Feem ntau, cov ntaub ntawv tsis nruj ntawm papillary thiab follicular cancer tshwm sim. Nrog rau kev kho mob raws sij hawm, lub neej zoo ntawm tus neeg mob xyaum tsis raug kev txom nyem. Nyob rau hauv xws li mob, minimally invasive txoj kev kho mob phais yog txaus. Txawm li cas los xij, thaum tus txheej txheem ua haujlwm lossis tsis pom lub sijhawm, yuav tsum muaj kev ua haujlwm hnyav.

Tib neeg cov thyroid kho li cas?

Cov kab mob cuam tshuam nrog qhov tsis muaj cov thyroid hormones raws li "tus qauv kub" qhia txog kev hloov kho. Feem ntau siv levothyroxine sodium⁹. Cov lus qhia rau kev teem caij ntawm L-thyroxine tsuas yog hypothyroidism. Hauv lwm qhov xwm txheej, nws qhov kev teem caij tsis tsim nyog thiab tuaj yeem ua rau muaj kev phom sij.

Cov tshuaj thyrostatic yog siv los kho ntau cov thyroid kab mob cuam tshuam nrog nws cov haujlwm ntau dhau.

Radical txoj kev kho mob muaj xws li radioiodine therapy thiab kev phais phais. Yuav kom nkag siab txog txoj kev kho mob twg yog qhov zoo rau koj, koj yuav tsum tau sab laj nrog kws kho mob.

Kev hloov kho

Hom kev kho mob no tau raug sau tseg rau hauv cov xwm txheej uas txo qis kev ua haujlwm ntawm cov thyroid caj pas, thiab nws hloov tag nrho lossis ib feem yog qhov tsim nyog. Lub luag haujlwm ntawm kev kho cov tshuaj hormone hloov pauv yog kom normalize cov thyroid hormones.

Cov tshuaj ntawm kev xaiv yog L-thyroxine. Nws yog ib qho tseem ceeb heev uas yuav tau xaiv ib tus neeg kom txaus thiab noj cov tshuaj kom raug: nruj me ntsis ntawm lub plab khoob, thaum sawv ntxov, 30 feeb ua ntej noj mov, nrog dej. Yog tias cov lus qhia raug ua txhaum cai, kev noj qab haus huv yuav ua rau tsis zoo.

Cov thyroid hormones ib txwm muaj tshwj xeeb tshaj yog thaum cev xeeb tub. L-thyroxine yog muab rau cov poj niam cev xeeb tub yog tias tsim nyog, nws muaj kev nyab xeeb tag nrho rau leej niam thiab tus menyuam hauv plab.

Kev kho mob thyrostatic

Nws yog siv los kho thyrotoxicosis. Hauv qhov no, thiourea npaj (thiamazole, propylthiouracil) yog siv. Lawv tsim nyob rau hauv cov thyroid caj pas thiab thaiv cov synthesis ntawm cov thyroid hormones. Thyrostatic therapy yog muab rau ib chav kawm ntawm 1-1,5 xyoo, los yog siv raws li kev npaj ua ntej kev phais.

Thaum noj thyreostatics, qee zaum, cov kev mob tshwm sim los ntawm lub siab thiab cov hlab ntsha tuaj yeem ua tau. Yog li ntawd, thaum lub sij hawm kev tswj xyuas, nws yog ib qho tsim nyog yuav tsum tau kuaj ntshav tsis yog rau cov thyroid hormones xwb, tab sis kuj kuaj ntshav kuaj thiab lub siab tsis zoo.

Tawm tsam keeb kwm yav dhau los ntawm kev kho thyreostatic, cov tawv nqaij ua xua tuaj yeem ua tau. Nws yog ib qho tseem ceeb heev uas yuav tau soj ntsuam qhov ntau npaum thiab hom kev noj cov tshuaj.

Txoj kev phais

Qhov xav tau thiab qhov ntev ntawm kev phais yog nyob ntawm hom kab mob thyroid. Nrog diffuse toxic goiter, thyroidectomy yog qhia (kev tshem tawm tag nrho cov thyroid caj pas). Rau ntau yam qog nqaij hlav, thyroidectomy lossis hemithyroidectomy (tshem tawm ib nrab). Qhov ntim ntawm kev phais yog txiav txim los ntawm tus kws phais-endocrinologist lossis tus kws kho mob endocrinologist tshwj xeeb.

Kev ua haujlwm tuaj yeem ua tau nyob rau hauv txoj kev qhib (classical) lossis minimally invasive (endoscopic). Endoscopic txoj kev (tsis muaj qhov loj me me) muaj qhov zoo tsis txaus ntseeg ntawm kev phais qhib: tsawg dua cov ntaub so ntswg puas, lub sijhawm rov ua haujlwm luv dua, yuav luag pom tsis pom tom qab phais.

Kev phais mob ntawm cov thyroid pathology muaj nws tus kheej cov lus qhia nruj. Muaj ntau qhov xwm txheej (piv txwv li, colloid nodes) uas tsis tas yuav muaj kev kho mob phais thiab raug saib xyuas zoo.

Kev kho mob radioiodine

Kev kho mob nrog radioactive iodine yog lwm txoj kev kho radical ntawm ntau hom kab mob goiter. Nws yog siv nyob rau hauv cov xwm txheej uas tus kab mob tas li rov qab los, thiab kev kho thyreostatic tsis tau txais txiaj ntsig. Radioiodine therapy yog pom zoo rau cov goiters me kom tsis txhob phais. 

Cov kws kho mob tau ntseeg tias kev kho mob radioactive iodine tsis cuam tshuam qhov kev pheej hmoo ntawm kev tsim cov thyroid cancer¹⁰. Contraindications: cev xeeb tub, lactation, endocrine ophthalmopathy.

Yuav ua li cas kom koj cov thyroid noj qab nyob zoo nyob hauv tsev

Ib qho tseem ceeb heev rau kev ua haujlwm ntawm cov thyroid caj pas yog iodine. Qhov kev xav tau niaj hnub rau nws nyob ntawm lub hnub nyoog: mus txog 5 xyoos - 90 mcg, mus txog 12 xyoos - 120 mcg, los ntawm 12 xyoos - 150 mcg, rau cov poj niam cev xeeb tub thiab lactating - 250 mcg¹¹.

Tsis yog txhua hnub ib feem ntawm iodine tuaj yeem tau los ntawm cov zaub mov, yog li cov kws kho mob feem ntau sau cov tshuaj uas muaj iodine. Txawm li cas los xij, ib tus yuav tsum tsis txhob mob siab rau kev noj tshuaj iodine. Qee zaum, koob tshuaj txhua hnub tuaj yeem tau txais los ntawm kev siv iodized lossis hiav txwv ntsev hauv kev noj haus.

Cov kab mob thyroid tuaj yeem tshwm sim los ntawm kev ntxhov siab, kev ua haujlwm dhau, kab mob kis kab mob thiab kab mob, kab mob ntev ntawm cov kab mob ua pa sab saud. Yog tias koj xav kom koj lub caj pas thyroid zoo thiab ua haujlwm yam tsis muaj kev poob haujlwm, koj yuav tsum ntxiv dag zog rau koj lub cev tiv thaiv kab mob, ua lub neej noj qab haus huv, zam kev ntxhov siab thiab pw tsaug zog txaus.

Alas, qee yam (piv txwv li, genetic predisposition) tsis tuaj yeem cuam tshuam. Yog li ntawd, yog tias koj paub tias koj muaj tsev neeg keeb kwm ntawm cov thyroid kab mob, saib xyuas nws tus mob nrog ultrasound txhua xyoo thiab kuaj ntshav rau TSH.

Nrov lus nug thiab lus teb

Peb tus kws tshaj lij, kws kho mob endocrinologist Elena Kulikova, teb cov lus nug txog kev ua haujlwm ntawm cov thyroid caj pas.

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