Manda matenda akuluakulu

Chithokomiro ndi chiwalo chaching'ono cha dongosolo la endocrine lomwe lili pansi pa khungu kutsogolo kwa khosi. Ntchito yake yayikulu ndikutulutsa mahomoni a chithokomiro omwe amayang'anira kagayidwe kazakudya (kutulutsa mphamvu pazofunikira zama cell ndi minofu). Ngati, pazifukwa zosiyanasiyana, gland imayamba kugwira ntchito mwachangu kuposa nthawi zonse, izi zitha kuyambitsa matenda a Graves mwa akulu.

Dzinali lakhalapo kuyambira masiku a mankhwala a Soviet ndipo tsopano limatengedwa kuti ndi lachikale. M'mabuku apadziko lonse lapansi ndi malangizo azachipatala, dzina la hyperthyroidism kapena Graves Disease limagwiritsidwa ntchito. Mayina ena omwe amagwiritsidwa ntchito m'maiko osiyanasiyana ndi awa:

• exophthalmic goiter;
• Graves 'hyperthyroidism;
• Matenda a Parry;
• toxic diffuse goiter.

Kuphatikiza apo, palinso kugawanika kwamkati kwa matenda a Graves, kutengera kuchuluka kwa zizindikiro zina:

• dermopathy (pamene khungu limakhudzidwa makamaka);
• osteopathy (zovuta za chigoba);
• ophthalmopathy (makamaka zizindikiro za maso).

Kodi matenda a Basedow ndi chiyani?

Matenda a Graves kapena Graves 'thyroiditis ndi matenda omwe amakhudza chithokomiro, komanso khungu ndi maso.

Chithokomiro ndi chiwalo chomwe ndi gawo la endocrine system, ma network a endocrine glands ndi minyewa yomwe imatulutsa mahomoni omwe amawongolera njira zama mankhwala (metabolism).

Mahomoni amakhudza ntchito zofunika kwambiri za thupi, komanso amawongolera kugunda kwa mtima, kutentha kwa thupi ndi kuthamanga kwa magazi. Mahomoni amatulutsidwa mwachindunji m’magazi, kumene amapita kumadera osiyanasiyana a thupi.

Matenda a Graves amadziwika ndi kukula kwachilendo kwa chithokomiro cha chithokomiro (chotchedwa goiter) ndi kuwonjezeka kwa hormone ya chithokomiro (hyperthyroidism). Mahomoni a chithokomiro amakhudzidwa ndi machitidwe osiyanasiyana a thupi ndipo, chifukwa chake, zizindikiro zenizeni ndi zizindikiro za matenda a Graves zimatha kusiyana kwambiri pakati pa anthu osiyana zaka ndi zaka. Zizindikiro zodziwika bwino ndi kuonda mwangozi, kusalolera kutentha mosadziwika bwino ndi kutuluka thukuta kwambiri, kufooka kwa minofu, kutopa, ndi kutuluka kwa diso. Matenda a Graves mwachibadwa ndi matenda a autoimmune.

Zithunzi zisanachitike komanso pambuyo pa matenda a Graves

Zomwe zimayambitsa matenda a Basedow mwa akuluakulu

Matenda a Graves amaonedwa kuti ndi matenda a autoimmune, koma zinthu zina, kuphatikizapo majini, chilengedwe, kapena chilengedwe, zingathandize kuti chitukuko chake chikhalepo. Kusokonezeka kwa autoimmune kumachitika pamene chitetezo chamthupi chimaukira molakwika minofu yathanzi.

Chitetezo cha mthupi chimapanga mapuloteni apadera otchedwa ma antibodies. Ma antibodies amenewa amakhudzidwa ndi zinthu zakunja (monga mabakiteriya, mavairasi, poizoni) m'thupi, zomwe zimapangitsa kuti ziwonongeke. Ma antibodies amatha kupha tizilombo tating'onoting'ono kapena kuyaka kuti tiziphwanyidwa mosavuta ndi maselo oyera a magazi. Ma antibodies enieni amapangidwa potengera zida kapena zinthu zina zomwe zimathandizira kupanga ma antibodies. Iwo amatchedwa ma antigen.

M'matenda a Graves, chitetezo chamthupi chimapanga antibody yosadziwika bwino yotchedwa thyroid-stimulating immunoglobulin. Antibody iyi imatsanzira momwe timadzi tambiri timene timatulutsa chithokomiro (chomwe chimatulutsidwa ndi gland ya pituitary). Tizilombo toyambitsa matenda timene timatulutsa timadzi timeneti timakhala pamwamba pa maselo a chithokomiro ndipo timachititsa kuti maselowa atulutse timadzi ta m’chithokomiro, zomwe zimachititsa kuti magazi azichuluka kwambiri. Pali hyperactivity wa chithokomiro, ake kumatheka, ntchito kwambiri. Mu Graves 'ophthalmopathy, ma antibodies awa amathanso kukhudza maselo ozungulira diso.

Anthu okhudzidwa akhoza kukhala ndi majini olakwika kapena chibadwa ku Graves' disease. Munthu yemwe ali ndi chibadwa cha matenda amanyamula jini (kapena majini) a matendawa, koma matendawo sangadziwonetsere ngati jini silinayambe kapena "kutsegulidwa" pazochitika zina, mwachitsanzo, chifukwa cha kusintha kwachangu kwa chilengedwe. (chotchedwa multifactorial cholowa).

Ma jini osiyanasiyana azindikirika omwe amalumikizidwa ndi matenda a Graves, kuphatikiza awa:

• kufooketsa kapena kusintha kuyankha kwa chitetezo chamthupi (immunomodulators),
• zomwe zimagwirizana mwachindunji ndi ntchito ya chithokomiro, monga thyroglobulin (Tg) kapena majini a chithokomiro cholimbikitsa hormone receptor (TSHR).

Gene Tg imapanga thyroglobulin, puloteni yomwe imapezeka m'minyewa ya chithokomiro yokha ndipo imathandizira kupanga mahomoni ake.

Gene TSHR imapanga mapuloteni omwe ndi cholandirira ndipo amamangiriza ku mahomoni olimbikitsa a chithokomiro. Maziko enieni a kugwirizana kwa majini ndi chilengedwe zomwe zimayambitsa matenda a Graves sizikumveka bwino.

Zowonjezera ma genetic, zomwe zimadziwika kuti modifier gene, zitha kukhala ndi gawo pakukula kapena kufotokozera kwa matendawa. Zinthu zachilengedwe zomwe zingayambitse kukula kwa hyperthyroidism zimaphatikizapo kupsinjika maganizo kwambiri kapena thupi, matenda, kapena mimba. Anthu omwe amasuta amakhala pachiwopsezo chachikulu chotenga matenda a Graves ndi ophthalmopathy. Anthu omwe ali ndi matenda ena omwe amayamba chifukwa cha kulephera kwa chitetezo chamthupi, monga matenda a shuga 1 kapena nyamakazi ya nyamakazi, ali pachiwopsezo chachikulu chotenga matenda a Graves.

Ndani ali ndi mwayi wotenga matenda a Graves?

Matenda a Graves amakhudza amayi nthawi zambiri kuposa amuna, pa chiwerengero cha 10: 1. Matendawa nthawi zambiri amayamba m'zaka zapakati ndi zochitika zambiri zapakati pa zaka zapakati pa 40 ndi 60, koma zimathanso kukhudza ana, achinyamata, ndi okalamba. Matenda a Graves amapezeka pafupifupi padziko lonse lapansi. Akuti 2-3% ya anthu amadwala matendawa. Mwa njira, matenda a Graves ndi omwe amayambitsa hyperthyroidism.

Mavuto ena azaumoyo ndi mbiri ya banja ndizofunikanso. Anthu omwe ali ndi matenda a Graves nthawi zambiri amakhala ndi mbiri ya achibale ena omwe ali ndi vuto la chithokomiro kapena matenda a autoimmune. Achibale ena atha kukhala ndi hyperthyroidism kapena chithokomiro chosagwira ntchito bwino, ena amatha kukhala ndi matenda ena a autoimmune, kuphatikiza imvi tsitsi lisanakwane (kuyambira m'zaka za m'ma 20). Mwachitsanzo, wodwala akhoza kugwirizanitsa mavuto a chitetezo cha mthupi m'banjamo, kuphatikizapo matenda a shuga a ana, kuchepa kwa magazi (chifukwa cha kuchepa kwa vitamini B12), kapena zigamba zoyera pakhungu (vitiligo).

Ndikofunika kuchotsa zifukwa zina za hyperthyroidism. Amaphatikizapo poizoni nodular kapena multinodular goiter, yomwe imadziwika ndi nodules imodzi kapena zingapo kapena zokhala mu chithokomiro zomwe zimakula pang'onopang'ono ndikuwonjezera ntchito zawo kuti chiwerengero cha mahomoni a chithokomiro m'magazi chiwonjezeke.

Komanso, anthu amatha kukhala ndi zizindikiro za hyperthyroidism kwakanthawi ngati ali ndi vuto lotchedwa thyroiditis. Matendawa amayamba chifukwa cha vuto la chitetezo chamthupi kapena matenda obwera chifukwa cha ma virus omwe amachititsa kuti chithokomiro chizitulutsa timadzi tambiri tosungidwa. Mitundu ya chithokomiro cha chithokomiro imaphatikizapo subacute, mwakachetechete, opatsirana, opatsirana pogwiritsa ntchito ma radiation, ndi postpartum thyroiditis.

Nthawi zambiri, mitundu ina ya khansa ya chithokomiro ndi zotupa zina, monga TSH-producing pituitary adenomas, zingayambitse zizindikiro zofanana ndi zomwe zimawonekera ku Graves' disease. Nthawi zambiri, zizindikiro za hyperthyroidism zimatha kuyamba chifukwa chomwa mapiritsi ambiri a chithokomiro.

Zizindikiro za matenda a Basedow mwa akuluakulu

Zizindikiro zomwe zimagwirizanitsidwa ndi matenda a Basedow nthawi zambiri zimawonekera pang'onopang'ono, nthawi zina ngakhale mosazindikira kwa munthuyo (akhoza kukhala oyamba kuwona achibale). Zimatenga milungu kapena miyezi kuti zikule. Zizindikiro zingaphatikizepo kusintha kwa khalidwe monga mantha aakulu, kukwiya, nkhawa, kusakhazikika, ndi kugona movutikira (kusowa tulo). Zizindikiro zowonjezera zimaphatikizapo kuwonda mwangozi (popanda kutsatira zakudya zokhwima ndi kusintha kwa zakudya), kufooka kwa minofu, kusalolera kutentha kwachilendo, kutuluka thukuta, kuthamanga, kuthamanga kwa mtima (tachycardia), ndi kutopa.

Matenda a Graves nthawi zambiri amakhudzana ndi matenda omwe amakhudza maso, omwe nthawi zambiri amatchedwa ophthalmopathy. Mtundu wofatsa wa ophthalmopathy umapezeka mwa anthu ambiri omwe ali ndi hyperthyroidism panthawi ina ya matendawa, odwala osachepera 10% ali ndi chidwi chachikulu cha maso chomwe chimafuna chithandizo chogwira ntchito. Zizindikiro za maso zimatha kuyamba, nthawi yomweyo, kapena pambuyo pa chitukuko cha hyperthyroidism. Kawirikawiri, anthu omwe ali ndi zizindikiro za maso sakhala ndi hyperthyroidism. Nthawi zina, kuwonongeka kwa maso kumatha kuwoneka koyamba kapena kuipiraipira pambuyo pa chithandizo cha hyperthyroidism.

Madandaulo a ophthalmopathy amasiyanasiyana kwambiri. Kwa anthu ena, amatha kukhala osasinthika kwa zaka zambiri, pomwe kwa ena, vutoli limatha kukhala bwino pakangopita miyezi ingapo. Kusintha kungathenso kutsata ndondomekoyi: kuwonongeka kwakukulu (kuwonjezereka), ndiyeno kusintha kwakukulu (kukhululukidwa). Mwa anthu ambiri, matendawa ndi ofatsa ndipo sapita patsogolo.

Zizindikiro zodziwika bwino za diso ndi kutupa kwa minyewa yozungulira diso, zomwe zimapangitsa kuti ituluke munjira, zomwe zimatchedwa proptosis (kutupa kwamaso). Odwala angazindikirenso kuuma kwakukulu kwa maso, kutupa kwa zikope ndi kutsekedwa kosakwanira, kuphulika kwa zikope, kutupa, kufiira, kupweteka ndi kukwiya kwa maso. Anthu ena amafotokoza mmene mchenga ulili m’maso mwawo. Nthawi zambiri, kusawona bwino kapena kuwirikiza kawiri, kumva kuwala, kapena kusawona bwino kumatha kuchitika.

Nthawi zambiri, anthu omwe ali ndi matenda a Graves amakhala ndi zotupa pakhungu zomwe zimatchedwa pretibial dermopathy kapena myxedema. Matendawa amadziwika ndi maonekedwe a khungu lolimba, lofiira kutsogolo kwa miyendo. Nthawi zambiri zimakhala zochepa kumapazi, koma nthawi zina zimatha kuchitika pamapazi. Nthawi zambiri, kutupa ngati gel osakaniza m'manja ndi kutupa zala ndi zala (acropachia) zimachitika.

Zizindikiro zina zomwe zimagwirizanitsidwa ndi matenda a Graves ndi:

• mtima;
• kunjenjemera pang'ono (kunjenjemera) kwa manja ndi / kapena zala;
• kutayika tsitsi;
• misomali yosweka;
• kuwonjezeka kwa reflexes (hyperreflexia);
• kuwonjezeka kwa njala ndi kuwonjezeka kwa matumbo.

Azimayi omwe ali ndi matenda a Graves amatha kusintha nthawi yawo yosamba. Amuna amatha kukhala ndi vuto la erectile dysfunction (kusowa mphamvu).

Nthawi zina, matenda a Graves amatha kupita patsogolo, zomwe zimapangitsa kuti mtima ukhale wochepa kwambiri kapena kupatulira kwachilendo ndi kufooka kwa mafupa (osteoporosis), kuwapangitsa kukhala ophwanyika ndi kuchititsa fractures chifukwa cha zoopsa zazing'ono kapena kuyenda movutikira.

Chithandizo cha matenda a Basedow mwa akulu

Kuzindikira ndi kuchiza matenda a Basedow kumawonekera m'ma protocol apadziko lonse lapansi komanso malangizo azachipatala adziko lonse. Dongosolo la mayeso limapangidwa motsatira zomwe akufuna ndipo imachitika pang'onopang'ono.

Diagnostics

Matenda a Graves 'matenda amapangidwa pamaziko a mbiri yakale ya wodwalayo ndi banja lake (kufufuza ngati achibale apamtima ali ndi vuto lofanana), kuunika kwachipatala mokwanira, kuzindikira zizindikiro za khalidwe, etc. Pambuyo pa zizindikiro zachipatala. zizindikirika, kuyezetsa ma laboratory ndi zida zowunikira zimaperekedwa.

Mayesero onse (magazi, mkodzo, biochemistry) ndi mayesero apadera monga kuyezetsa magazi komwe kuyeza kuchuluka kwa mahomoni a chithokomiro (T3 ndi T4) ndi mahomoni olimbikitsa chithokomiro (miyezo ya TSH). Kuti atsimikizire za matendawo, kuyezetsa magazi kungachitike kuti azindikire kukhalapo kwa ma antibodies enieni a thyrogloulin ndi thioperoxidase omwe amayambitsa matenda a Graves, koma nthawi zambiri izi sizofunikira.

Mankhwala amakono

Chithandizo cha matenda a Graves nthawi zambiri chimaphatikizapo imodzi mwa njira zitatu:

• antithyroid mankhwala (kuletsa ntchito ya chithokomiro pa synthesis wa mahomoni);
• kugwiritsa ntchito ayodini wa radioactive;
• alowererepo opaleshoni.

Njira yeniyeni yamankhwala yomwe ikulimbikitsidwa ingadalire zaka za wodwalayo komanso kukula kwa matendawa.

Malangizo azachipatala

Magawo onse a chithandizo amachitika motsatira malangizo a Clinical protocol

Chithandizo chochepa kwambiri cha matenda a Graves ndi kugwiritsa ntchito mankhwala omwe amachepetsa kutulutsa kwa mahomoni a chithokomiro (mankhwala oletsa chithokomiro). Amayamikiridwa makamaka pochiza amayi apakati, omwe ali ndi hyperthyroidism yofatsa, kapena odwala omwe amafunikira chithandizo chachangu cha hyperthyroidism. Mankhwala enieni amasankhidwa ndi dokotala, malinga ndi zaka za wodwalayo, chikhalidwe chake ndi zina zowonjezera.

Mankhwala otsimikizika a matenda a Graves ndi omwe amawononga chithokomiro, zomwe zimayambitsa hypothyroidism. Chithandizo chofala kwambiri cha matenda a Graves m'maiko ambiri. Iodine ndi mankhwala omwe amagwiritsidwa ntchito ndi chithokomiro kupanga (kaphatikizidwe) mahomoni a chithokomiro. Pafupifupi ayodini onse m’thupi la munthu amatengedwa ndi minyewa ya chithokomiro. Odwala amameza mankhwala okhala ndi ayodini wa radioactive, amene amadutsa m’mwazi n’kudziunjikira m’chithokomiro, kumene amawononga ndi kuwononga minofu ya chithokomiro. Izi zidzachepetsa chithokomiro ndikuchepetsa kuchulukitsa kwa mahomoni. Ngati mlingo wa timadzi ta m’chithokomiro watsika kwambiri, pangafunike chithandizo chamankhwala kuti chithokomiro chikhale chokwanira.

Njira ina yochiritsira kwambiri ndiyo opaleshoni yochotsa chithokomiro chonse kapena mbali ina ya chithokomiro. Njira yochizira matendawa nthawi zambiri imasungidwa kwa anthu omwe njira zina zamankhwala sizinapambane kapena zimatsutsana, kapena pamaso pa kukula kwa minofu ya gland mpaka kukula kwakukulu. Pambuyo pa opaleshoni, hypothyroidism nthawi zambiri imapezeka - izi ndi zotsatira zomwe zimafunidwa, zomwe zimakonzedwa ndi mlingo wokhazikika wa mahomoni kuchokera kunja.

Kuwonjezera pa machiritso atatu omwe tawatchula pamwambapa, mankhwala akhoza kuperekedwa omwe amalepheretsa mahomoni a chithokomiro omwe amayenda kale m'magazi (beta-blockers) kugwira ntchito yake. Beta blockers monga propranolol, atenolol, kapena metoprolol angagwiritsidwe ntchito. Mulingo wa mahomoni a chithokomiro ukakhazikika, chithandizo cha beta-blockers chimatha kuyimitsidwa.

Nthawi zambiri, kutsatiridwa kwa moyo wonse komanso kufufuza kwa ma laboratory ndikofunikira. Nthawi zina, chithandizo chosinthira mahomoni moyo wonse chingafunikire.

Matenda ocheperako a ophthalmopathy amatha kuthandizidwa ndi magalasi, mafuta odzola, misozi yopangira. Matenda owopsa kwambiri amatha kuthandizidwa ndi corticosteroids monga prednisone kuti achepetse kutupa m'matenda ozungulira maso.

Pazovuta kwambiri, opaleshoni ya orbital decompression ndi orbital radiation therapy ingafunikirenso. Pa opaleshoni ya orbital decompression, dokotala wa opaleshoni amachotsa fupa pakati pa socket (orbit) ndi ma sinuses. Izi zimathandiza kuti diso libwerere kumalo ake achilengedwe mu socket. Opaleshoniyi nthawi zambiri imasungidwa kwa anthu omwe ali pachiwopsezo cha kuwonongeka kwa masomphenya chifukwa cha kupsinjika kwa mitsempha ya optic kapena omwe njira zina zamankhwala sizinagwire ntchito.

Kupewa matenda a Basedow kwa akuluakulu kunyumba

Kuneneratu za chitukuko cha matendawa pasadakhale ndi kupewa ndizovuta. Koma pali njira zochepetsera kuopsa kwa zovuta komanso kupitilira kwa hyperthyroidism.

Ngati matenda a Graves apezeka, yesetsani kukhala ndi thanzi labwino m'maganizo ndi m'thupi.

Chakudya choyenera komanso kuchita masewera olimbitsa thupi zitha kusintha zina mwa zizindikiro panthawi ya chithandizo ndikukuthandizani kuti mukhale bwino. Mwachitsanzo, chifukwa chakuti chithokomiro chimayang'anira kagayidwe kazakudya, hyperthyroidism imatha kukhala yodzaza ndi kufooka pambuyo powongolera hyperthyroidism, ndipo kuchita masewera olimbitsa thupi kungathandize kuti mafupa azikhala osalimba komanso kulemera kwake.

Kuchepetsa kupsinjika Zitha kukhala zopindulitsa chifukwa zitha kuyambitsa kapena kukulitsa matenda a Graves. Nyimbo zosangalatsa, kusamba kotentha kapena kuyenda kudzakuthandizani kupumula ndikusintha maganizo anu.

Kukana zizolowezi zoipa - osasuta. Kusuta kumayambitsa matenda a Graves's ophthalmopathy. Ngati matendawa akhudza khungu lanu (dermopathy), gwiritsani ntchito mafuta odzola omwe ali ndi hydrocortisone kuti muchepetse kutupa ndi kufiira. Kuonjezera apo, kupanikizana kwa miyendo kungathandize.

Mafunso ndi mayankho otchuka

Mafunso okhudzana ndi matenda a Basedow, tidakambirana nawo dokotala wamkulu, endoscopist, mkulu wa bungwe ndi methodological ofesi Lidia Golubenko.