Thyrotoxic goiter: zvikonzero uye kurapwa

Thyrotoxic goiter - chirwere autoimmune chirwere pamusoro thyroid shwanu mavambo. Etotnedug achiperekedzwa zvakawedzera secretion pamusoro thyroid mahormone, izvo maererano kunokanganisa mamiriro yose muviri. Sezvo chirwere mberi chinokosha ichi kwemakemikari anobudiswa nhengo hypertrophy kutanga - shwanu kunowedzera ukuru. Panzira, mune zvokurapa, zvirwere izvi aizivikanwawo neshoko rokuti Basedow nehosha pashure chiremba okuGermany akatanga kurondedzera zviratidzo.

Zvinosuruvarisa matambudziko akafanana vakasangana nevanhu vakuru vakawanda. Uye, chokwadi, pakarepo vanotanga kutsvaka mashoko diffuse thyrotoxic goiter uye nei unomuka. Ndezvipi zviratidzo vanofanira kuteerera? Chii dzokurapa murwere anogona kutarisira? Chii chingava pezvingazoitika chirwere? Mhinduro dzemibvunzo iyi ichava kubatsira vaverengi vazhinji.

Diffuse hunokachidza goiter: Vhuṱanzi pamusoro chirwere

Chokwadi, pakutanga, ndiko kutaura zvinhu thyrotoxic goiter. The pathogenesis chirwere pachena kana isu kunzwisisa rezita thyroid shwanu mabasa.

Thyroid - kwemakemikari anobudiswa shwanu randinogara kuruboshwe nezvakarurama akafukidza, zvakabatanidzwa neimwe nekamukwavarara. Basa muviri ichi kwakakosha, nokuti pano synthesized mahormone inokosha zvakadaro thyroxine uye triiodothyronine. Izvi pakugadzira vanoshingaira zvinhu inodzora zvinenge zvose zvorwendo muviri mumuviri womunhu, kupa hwandaiva kukura, chengetedza simba muviri. Uyezve, masero chaizvo synthesize thyroid kemikari calcitonin, iyo inopa zvakajairika karusiyamu muviri mumuviri, kunotadzisa kukura osteoporosis.

Basa shwanu iri nokudzorwa hypothalamic-pituitary hurongwa dzinovaka. Panzira, kuti thyroid shwanu ndiyo perfused nhengo mumuviri womunhu.

Thyrotoxic goiter - chirwere kuti pamwe hypertrophy kweprostate rinenge uyewo zvakawedzera secretion kuti thyroid mahormone. zvakawandisa kwavo anowedzera metabolic chinja mumuviri, zvichitungamirira ayo kuparadzwa. Kupfuura kutambura huta uye seredechno-vascular hurongwa.

Maererano nenhamba, zvikuru kubatwa nechirwere ichi vakadzi vane makore 20 kusvika 50 makore. Thyrotoxic goiter nevanhu Zvinogonekawo, asi ndoda kakawanda akanyorwa.

Chii chinokonzera chirwere?

Chii chinokonzera Graves 'chirwere? The zvinokonzera chirwere, zvinosuruvarisa haasi aizvinzwisisa. Zvinonzi chete anozivikanwa kuti hosha iri autoimmune zvakasikwa. Nokuti mumwe chikonzero kana mumwe munhu zvirwere anotanga kubudisa chaizvo maantigen kuti kurwisa pachake masero ayo ari thyroid shwanu.

The mashandiro kuti panowanikwa zvakafanana Kukundikana nhengo akadzidza zvakakwana. Zvisinei, masayendisiti vaikwanisa kuziva zvakawanda ngozi zvinokonzera kuti chidzoke chirwere:

• Pane majini kubatwa (kana uri mumhuri, mune vanhu kutambura nezvirwere thyroid, mukana wokuti kukura goiter kupfuura).
• Zvinhu Risk zvinosanganisira hormone disruptions, kusanganisira nokuvhiringidzirwa kushanda hypothalamic-pituitary hurongwa.
• Kusingadzoreki kushandiswa ayodhini kugadzirira anotsigirwa zvakawedzera kwetunhu thyroid mahormone.
• The chirwere chinogona kukonzerwa simba kugara mupfungwa, kunotevera.
• zvinokonzera njodzi zvinosanganisira chirwere cheshuga.
• Heavy, mazhinji zvirwere deplete dziviriro yezvirwere mumuviri, izvo zvinogona kuvhiringa zvarakanga inoshanda.
• Maererano nenhamba, thyrotoxic goiter kaviri vangangoora chirwere muna vanosvuta.

Zvinosuruvarisa, kwete nyaya dzose, chiremba anokwanisa kuona chikonzero thyrotoxic goiter.

Thyrotoxic goiter: kupatsanura

Kune akawanda mugadziriro kupatsanura pakati chirwere. Zvichienderana kwokuomerwa emit:

• munyoro goiter - pathological nepfungwa mune dzimwe kwemakemikari anobudiswa nhengo chinoshayikwa, cardiac arrhythmias hazvina kuitika, varwere chokunyunyuta pamusoro zviratidzo neurotic hunhu;
• avhareji kwokuomerwa chirwere chimiro, zvinonzi achiperekedzwa tachycardia, palpitations, uye kukurumidza uremu (kusvika makirogiramu 10 pamwedzi);
• zvakakomba chimiro, izvo pamwe neboka guru kurasikirwa uremu muviri, muviri kuneta, chadzo zvirwere zvomwoyo, chiropa uye neitsvo.

Zvichienderana hunhu thyroid maronda, kusunungurwa:

• diffuse goiter - maronda duku vakagovera noruvara pamusoro yose nyama dzomuviri;
• nodular goiter tireotoksicski - pane maronda akawanda guru, izvo aumba panzvimbo chisimbiso (nodules);
• yakavhenganiswa chimiro rinobatanidza zvose nodular uye diffuse thyroid maronda.

Mukuwedzera, nengoro uye vanonzi aberrant thyrotoxic goiter. Muchiitiko ichi chiri mubvunzo ectopic lesion rinenge thyroid, akaronga achitevedza mutsinga dzinofamba nemukaka tireoglossalnogo (kutsauka zvakadaro nokuda kutyorwa embryogenesis pezvakaitwa). Zvinokosha kutaura kuti pokukundwa aberrant zvinyama anoonekwa kuti ngozi zvikuru, sezvo kazhinji kunotungamirira kune akaipa kushanduka dzakabatana uye kukura kenza.

Diffuse goiter (tireotoksicski): mapikicha uye zviratidzo

Sezvingatarisirwa, pfungwa inokosha varwere vakawanda ndiro kunotoda mufananidzo chirwere. Saka chii zvinetso pamwe thyrotoxic goiter? Zviratidzo zviri chirwere angava akasiyana, nokuti kuwedzera padanho thyroid kemikari kunokanganisa basa zvinenge zvose nhengo uye hurongwa. Kunyange zvakadaro, varwere vakawanda chokunyunyuta pamusoro neurotic zvirwere uye matambudziko mwoyo.

Kutyorwa kumwoyo akataurwa tachycardia. Kunyange panguva zororo kwemwoyo unogona ngazviwedzerwe kusvika 120-130 anorova paminiti. Varwere vanoti dzimwe nguva vanonzwa yake kurova kwehana muchipfuva, dumbu, musoro uye kunyange maoko nemakumbo. Sezvo chirwere kunowedzera systolic kufurirwa, uye diastolic, Ukuwo, kunoderedza. Varwere yakataurawo kupfupika mweya, yakawedzera katsika nokuda nemabayo. Pasina mushonga, hyperthyroidism kungaita kuti zvikuru myocardial dystrophy.

Catabolic chirwere - mumwe nyonganyonga iyo rinoperekedza diffuse goiter (tireotoksicski). Zviratidzo nayo - ndiko, pakutanga kwezvose, zvikuru uremu pamusoro yaitwa yakawedzera kudya. Dzimwe nguva varwere uremu kubudikidza 10-15 makirogiramu muna 1-2 mwedzi. Uyezve, pane vakawanda simba muviri, ikawanda vangadikitira, thermoregulatory uye kutyora. Kunyange panguva yakaderera tembiricha varwere kazhinji chokunyunyuta pamusoro pfungwa kupisa. Manheru, zvichida inoratidza fivha kuti subfebrile tsika.

Thyrotoxic goiter uye ophthalmopathy pamwe, kureva, tsikidzi achishamisika zvinoonekera sezvo chirwere mberi. Nokuda kusiya rezasi uye kusimudza okumusoro kukotsira dzakavharika zvachose protrude eyeballs. Varwere yemhando thyrotoxicosis zviri nyore kuona - chiso chake zvinotora pamusoro kuratidzwa kugara nokutya uye kushamisika. Nokuti kuti namafungiro regai kuvhara chose, kuti munhu ari kutambura kubva kuoma iri conjunctiva uye kuramba manzwiro "jecha mumaziso." Kakawanda kuomesa iri chisingaperi conjunctivitis. Periocular zvinyama kukura zvishoma nezvishoma, periorbital edema kunoitika, iyo inotungamirira compression yeziso uye tsinga harinzwi kukwana kana kwakakwana kurasikirwa zvaakaratidzwa.

Zvakawandisa thyroid kemikari kunokanganisa kushanda tsinga. Varwere vanogona kutaurwa wakawedzera kushatirwa, kufunganya, utsinye, tearfulness, chinja kwemanzwiro, wevasungwa matambudziko, mune pfupi, dzimwe kusagadzikana mupfungwa. Zviratidzo chirwere zvinosanganisira kuora mwoyo, hope nyonganyonga. In munyoro Muzviitiko, vanhu vane tremor rakanaka minwe. Sezvo chirwere zvinoderedza uwandu tsandanyama, asi nekuti murwere zvakaoma kufamba nokushingaira.

Tikafunga thyrotoxic goiter nezvimwe zvinoita nekukasika:

• sezvo chirwere mberi mune varwere, vasanyanye pfupa arambe achirema nokuda leaching calcium phosphorus;
• chakakomba marudzi chirwere vari pamwe kukura adrenal insufficiency kuti nemaziso richiratidzwa ruvara rweganda;
• harirambidzi kutyora zvomudumbu ezvinhu, kusanganisira dumbu marwadzo, kurutsa, kusagadzikana cheya, uye zvikuru zviitiko - hunokachidza steatosis uye cirrhosis;
• mukono erectile dysfunction, uye gynecomastia anogona kuvaka hormone zvirwere;
• zvinobvira kuchinja nehadzi dzokubereka nadzo, kusanganisira ovarian dysfunction, kumwedzi hadzina kufambiswa zvakanaka, kuvandudzwa fibrocystic zamu chirwere;
• kuti zviratidzo chirwere zvinosanganisira Vitiligo, uye achiipa ganda munharaunda dzinongoitika muzvirugu, bvudzi kurasikirwa, kwakaderera zvipikiri;
• Kuwedzera thyroid saizi Zvinogonekawo, asi kwete - Varwere vazhinji vachava zvikuru hyperthyroidism chaiye yakawanda thyroid; zvisinei, kuwedzera kukura prostate, pakuonekwa chaiko "chirimwa" muna 20-30% nyaya, izvo zvingaita kuti compression pamusoro trachea, kuti kwaita yokumwe muviri manzwiro ari huro.

Chii yematambudziko zvinogona kukonzera zvirwere? thyrotoxic dambudziko

Sezvaunogona kuona, kana akasiya untreated, chirwere ichi chinobata anenge zvose nenhengo dzawo, zvichiita kuti pave mwoyo nokukundikana, cirrhosis chiropa, zvirwere zviri adrenal mabasa.

Kunyange zvakadaro, pane chimwe kuomesa ngozi anogona kukonzerwa diffuse muchetura goiter. Thyrotoxic dambudziko - imwe ezvinhu chakasimba izvo kazhinji ikabuda isiri kurapa kana pashure kuvhiyiwa.

The tanga Zviratidzo dambudziko iri nefivha (tembiricha muviri dzimwe nguva rinobuda zvikuru kusvika 40 madhigirii), wakawedzera vangadikitira, manzwiro lability. Apo neapo nechepakati tsinga zvinetso zvakawanda raidudzwa - kufunganya nounyoro kunotsiviwa utsinye uye zvikuru zvokudarikidza.

Migumisiro thyrotoxic dambudziko zvinosanganisira nokukurumidza kuchiita congestive mwoyo kukundikana, kweropa kuondomoka, pulmonary edema, pakoma. Inenge 30-40% nokushivirira rufu dambudziko rinoguma. Saka zvakakosha nguva rokuongorora thyrotoxic goiter. Zviratidzo nayo - zviri chikonzero kutsvaka zano dzokurapa pakarepo.

Modern nzira nechirwere

Chete pashure kunyatsoongorora, chiremba anogona kuita chirwere. Uyezve, tinofanira kuva nyore uye differential chirwere pamusoro thyrotoxic goiters.

Kutaura zvazviri, kunyange pashure kwokunze kuongororwa mukoti anogona chifungidziro pamberi hyperthyroidism. Kubva musi uyu, murwere waakaudzwa anoongororwazve. Ultrassom ongororo inoratidza diffuse akawedzera thyroid shwanu uye kuchinja kwayo echogenicity.

Differential chirwere nyore goiters uye thyrotoxic hazvo kunosanganisira muedzo kwevari thyroid hormone thyroid anotokonya pituitary kemikari ropa. Waya uye Immuno assays kubvumira kuziva pamberi dzakananga antibodies mu thyroglobulin ropa, thyroid peroxidase uye TSH receptors (izvo kunoratidza kuvapo autoimmune muitiro).

Inodzidzisa kudzidza ndiko thyroid scintigraphy, izvo zvinoita kuti zvakarurama kuziva vhoriyamu uye muviri chimiro, kuvapo imwe nodular, uye huwandu dzichipfekeka nyama iyo, chokwadi, synthesized mahormone.

mishonga

Zvakadini kana murwere chirwere thyrotoxic goiter? Treatment kunobva pavaipfuura chirwere, nenyonganiso varipo, ukuru thyrotoxicosis regiravhiti.

Kana isu kutaura zvinodhaka kurapa, kungasanganisira kushandisa zvinodhaka antithyroid, kunyanya "Merkazolil", "tirozol", "metizol" uye "propitsil". mishonga aya matsime dzinotsanagura kwetunhu mahormone ari thyroid shwanu munyama.

Uyezve, pakatanga samolecular ayodhini ive muviri kana munyu ayo maererano nheyo kunaka kubatana kutigumbura kweShanduro pituitary mahormone inotokonya basa thyroid shwanu. Zvechokwadi, kurapa kwakadaro kunofanira kuitwa chete pasi pokudzora chiremba.

Sezvo hyperthyroidism achiperekedzwa kusagadzikana kumwoyo, akarumbidza varwere kugamuchira Beta-blockers, izvo kuderedza kwemwoyo, yakaderera kwemwoyo, myocardial kuvandudza zvokudya uye normalize BP. Zvichienderana Kuwanikwa zvimwe zviratidzo, murwere anogona kupiwa sedatives uye hypnotics, tsandanyama relaxants, anticonvulsants uye antipsychotics.

At pangozi yokuita thyrotoxic dambudziko mukurapa zvaiitwa raitongwa mahormone, kureva steroids kuti kutadzisa nokukurumidza kukura adrenal insufficiency.

Nzira dzokurapa

The oparesheni akapiwa varwere uyo chirwere mberi nokukurumidza kana rave chirwere pave paya matanho, uye zvinodhaka kurapa havapi mhinduro. The chiratidzo kunorapwa ndiko kuwedzera simba iri thyroid.

Sezvingatarisirwa, kwakakwana kubviswa thyroid shwanu zvisingaiti, nokuti kushaya thyroid mahormone kuti kunotoreva zvachose kuchinja mumuviri. Ndokusaka vanachiremba zvishomanana resection kwemuviri, apo kuramba duku nzvimbo glandular tishu. Saka, mahormone achiri synthesized, asi muna zviduku nhamba.

Zviitiko dzokororo pashure kuvhiya zvinobvira. Nokuti mukuru chibatiso vasati uye pashure kuvhiyiwa rinoitwa kuchinja kurapa, uye dzimwe nguva kurapwa pamwe radioactive ayodhini.

Treatment pamwe radioactive ayodhini uye mamiriro ayo

Ver chirwere zvinogoneka achishandisa radioactive ayodhini. Chokwadi kuti kutanga radioactive fuma muviri zvikuru nokukurumidza yokuita zvinoitwa munyama pamusoro thyroid shwanu uye emitting Beta mwaranzi, kuparadza nhengo dzichipfekeka masero. Munzvimbo yavo inoumbwa connective zvinyama, havagoni kubereka mahormone.

Uyu kumbonyanya hasha kurapwa zvaiitwa, izvo zvingaita kuti migumisiro zvakadai hypothyroidism, chisingaperi chiropa, rikwanise kuzvimba thyroid shwanu. Ndokusaka zvichinzi ushandiswe chete muzviitiko. Zvairatidza kuti kurapa kwakadaro zvinosanganisira kwazvo siyana chirwere, kusemburwa pashure pokuvhiyiwa, uyewo inefficiency yokurapwa.

The fungidziro varwere

Diffuse thyrotoxic goiter - nechirwere ngozi chaizvo. Kana untreated, chirwere ichi zvinotungamirira zvishoma nezvishoma Kuparadzwa muviri, zvinetso zvepfungwa, zvemwoyo kukundikana uye anoshivirira rufu.

Ukuwo, vanhu vakasarudza yawapiwa, aanenge zvikuru zvakanaka. Achibatsirwa mishonga haigoni kudzorera chakaipa nokushanda uye dzinongoitika thyroid mahormone. Sezvo nhamba kudzidza, yapera mishonga iripo murwere cardiomegaly zvishoma regresses, uye sinus mutinhimira anodzorerwa. Sezvingatarisirwa, Zvinokurudzirwa kudzivisa kushandisa zvinodhaka uye zvokudya zvine yakakwirira mishonga kuti ayodhini.

Panyaya kuvhiya kurapwa, pashure pokuvhiyiwa, vanhu kazhinji kuva hypothyroidism zvinoda vamwe yezvokurapa kururamiswa.

Pane nzira muzvidzivirire?

Zvinosuruvarisa nhasi, vanhu vakawanda vari nemamiriro chirwere kuti "thyrotoxic goiter." Nhoroondo chirwere, zvinokonzera uye zvichiita matambudziko, inoshanda kurapwa - zvinokosha nguva mumwe murwere. Ukuwo, zviri pachena kuti chirwere nyore zvikuru kudzivirira pane ipapo kubata nemigumisiro chirwere.

Zvinosuruvarisa chaizvo ekudzivirira nzira havapo. ari Kana uine nemagene kubatwa, izvozvo varumbidzwa kanenge kaviri pagore kuti ashanyire hofisi endocrinologist wacho. Kwokutanga chirwere kunokwanisa kuonekwa, nyore zvichava kugadzirisa murwere ezvinhu.

nguva zvikuru kugamuchira kurapwa chero zvirwere zvinotapuriranwa. Uye, chokwadi, kuva nemararamiro ane utano, kusanganisira kutadza kugara mupfungwa, kurovedza muviri, zvakanaka zvokudya, pesvedzero inobatsira ezvinhu kwete chete thyroid, asi zvose hurongwa muviri.