chithokomiro cha anthu

Chithokomiro ndi chaching'ono, koma ndi gawo lalikulu la dongosolo la endocrine la thupi. "Iye amayatsidwa" m'mabuku azachipatala okhala ndi mayina osiyanasiyana andakatulo: amatchedwa "mfumukazi ya mahomoni" komanso "mbuye wa thupi." Chifukwa chiyani?

Chowonadi ndi chakuti chithokomiro chimapanga mahomoni omwe amawongolera njira zazikulu zama metabolic m'thupi la munthu, amawongolera kupanga mphamvu komanso kupereka mpweya ku minofu.

- Mahomoni a chithokomiro amakhudza kugwira ntchito kwa ziwalo zonse ndi machitidwe, - akufotokoza Endocrinologist Elena Kulikova. - Pamene ntchito ya chithokomiro imasintha, kulemera kwa thupi, mphamvu ndi nthawi zambiri za kugunda kwa mtima, kupuma kwa mpweya ndi ntchito ya m'mimba kusintha. Liwiro la kuganiza ndi mkhalidwe wamaganizo wa munthu zimadalira ntchito ya chithokomiro. Ndipo ngakhale kutha kukhala ndi ana, mimba ndi kubadwa kwa mwana wathanzi zimadaliranso kwambiri mlingo wa mahomoni a chithokomiro.

Mukawona kusintha kwa maonekedwe ndi khalidwe la khungu, kutchulidwa kutupa kwa zikope, mukuda nkhawa ndi tsitsi losasunthika komanso lophwanyika, kutayika tsitsi, ndizotheka kuti izi ndi chifukwa cha mavuto a chithokomiro.

Chofunika kudziwa za chithokomiro chamunthu

Kodi chithokomiro chamunthu chili kuti?

Chithokomiro cha chithokomiro chili m'chigawo chapakati pamakona atatu a khosi, omwe amamangidwa kuchokera pamwamba ndi pansi pa nsagwada yapansi, kuchokera pansi ndi notch ya jugular ya sternum, m'mbali mwa m'mphepete mwa kumanja ndi kumanja. kumanzere sternocleidomastoid minofu¹.

Kutsamira dzanja pakhosi, mumatha kumva chichereŵechereŵe cha chithokomiro (chomwe chimatchedwa apulo wa Adamu) - mawonekedwe owoneka bwino kapena olimba. Ikamezedwa, imatsetsereka. Pansi pake pali chithokomiro chokha - nthawi zambiri chimamveka ngati "kukula" kofewa pa trachea.².

Kodi chithokomiro chimawoneka bwanji ndipo chimagwira ntchito bwanji?

Maonekedwe a chithokomiro nthawi zambiri amafanizidwa ndi gulugufe. Mitsempha yake yakumanja ndi yakumanzere imalumikizidwa ndi kasumbu, ndipo mu 30% ya milandu palinso lobe ya piramidi yomwe imachokera kumtunda.³.

Chithokomiro chimakhala ndi zinthu zomwe zimafanana ndi ma vesicles m'mawonekedwe - follicle. Pali pafupifupi 30 miliyoni a iwo². Follicle iliyonse imadzazidwa ndi chinthu chonga gel chotchedwa colloid. Kungoti lili ndi mahomoni opangidwa ndi maselo. Ma follicles onse amagawidwa ndi zidutswa 20-30: magulu oterewa amatchedwa thyreons.

Chithokomiro chimayang'aniridwa ndi njira zitatu.

1. Njira yoyamba ndi hypothalamic-pituitary system, yomwe ili mu ubongo. Kusinthana kwa chidziwitso pakati pa chithokomiro, hypothalamus ndi pituitary gland kumachitika mothandizidwa ndi mahomoni olimbikitsa chithokomiro (TSH) ndi thyreoliberin (TRH).
2. Dongosolo lapakati la mitsempha limayang'anira njira yachiwiri yoyendetsera. Chitsanzo chabwino ndi kuchuluka kwa mahomoni a chithokomiro panthawi yamavuto.
3. Lachitatu limagwirira malamulo ndi zili inorganic ayodini m'chilengedwe (makamaka madzi ndi chakudya). Ndi kudya kosakwanira kwa ayodini m'thupi, kuchuluka kwa mahomoni a chithokomiro kumachepa ndipo ma pathologies osiyanasiyana a chithokomiro amayamba.

Chifukwa chiyani chithokomiro chimapweteka mwa anthu

Sikuti aliyense angathe kuzindikira chizindikiro kuchokera ku chithokomiro. Nthawi zambiri, munthu amasokoneza ululu m'derali ndi zizindikiro za osteochondrosis kapena akuganiza kuti ali ndi chimfine pakhosi.

Mwa njira, munthu samamva ululu nthawi zonse. Kawirikawiri, ululu ndi chizindikiro cha matenda a chithokomiro (kutupa), ndi hypothyroidism ndi hyperthyroidism, komanso mapangidwe a chithokomiro, monga lamulo, sichimapweteka.

Komanso, munthu sangamvetsere zizindikiro za thupi kwa nthawi yaitali ndipo sangaganize kuti ali ndi matenda. Choncho, nkofunika kudziwa zizindikiro za matenda a chithokomiro. Izi zikuphatikizapo: kuchepa kwa ntchito, kukwiya kowonjezereka, kuvutika kumeza, kusokonezeka kwa tulo, nkhawa (mpaka paranoia), kutaya thupi ndi chilakolako chabwino, etc. Matenda osiyanasiyana ali ndi zizindikiro zawo.

Chimodzi mwa zifukwa zomwe zimayambitsa matenda a chithokomiro ndi kusowa kwa ayodini m'zakudya.

"Kuchepa kwa ayodini kumachitika m'madera ambiri a dziko lathu: kuyambira wofatsa mpaka wovuta kwambiri," akutero Elena Kulikova. - Kufunika kowonjezera mankhwala okhala ndi ayodini kapena zakudya zomwe zili ndi ayodini ndizofunikira makamaka kwa ana, amayi apakati komanso oyamwitsa. Pa nthawi yake kumwa ayodini zakudya waukulu kupewa kupewa chithokomiro matenda ana ndi akulu.

Zina mwa zomwe zimayambitsa matenda a chithokomiro zingakhale: mavairasi ndi mabakiteriya, autoimmune nkhanza, oncology. Mbiri yabwino pazochitika zamavuto a chithokomiro ndi kupsinjika kwanthawi yayitali, kusowa kwa ayodini, komanso zachilengedwe zosasangalatsa.

Matenda a chithokomiro ndi matenda omwe amapezeka kwambiri mu dongosolo la endocrine. Amakhala nthawi 10-17 zambiri mwa akazi kuposa amuna.⁵.

Matenda onse a chithokomiro amagawidwa m'magulu atatu kutengera kuchuluka kwa mahomoni a chithokomiro:

1. Thyrotoxicosis ndi vuto lomwe limadziwika ndi kuchuluka kwa mahomoni a chithokomiro. Matenda ofala kwambiri omwe amatsagana ndi thyrotoxicosis syndrome ndi matenda a Graves (mpaka 80% ya milandu ku Russia).⁶), kufalitsa chotupa chakupha kapena chotupa chakupha cha nodular.

   Kuwonjezeka kwa mlingo wa mahomoni a chithokomiro kungayembekezeredwe ndi kuwonjezereka kwa matenda aakulu komanso kuchitika kwa pachimake ndi subacute thyroiditis.

2. Hypothyroidism. Zogwirizana ndi kuchepa kwakukulu kwa mahomoni a chithokomiro. Nthawi zambiri, hypothyroidism imayamba motsutsana ndi maziko a autoimmune thyroiditis (kutupa kwa chithokomiro) ndipo mwina pambuyo pakuchotsa (kuchotsa gawo) la chithokomiro.
3. Matenda a chithokomiro omwe amapezeka popanda vuto la mahomoni (euthyroid goiter, zotupa, thyroiditis).

Tiyeni tipende matenda omwe amapezeka kwambiri.

Matenda osokoneza bongo

Maziko a matendawa ndi kusowa kwamphamvu kwa mahomoni a chithokomiro, kapena kuchepa kwa mphamvu zawo pamagulu a thupi.⁷.

Choyambirira cha hypothyroidism nthawi zambiri chimayamba motsutsana ndi maziko a autoimmune thyroiditis. Zizindikiro zimatha kukhala zosiyanasiyana, ndipo nthawi zambiri ngakhale dokotala samazindikira msanga hypothyroidism. Gulu lachiwopsezo limaphatikizapo anthu omwe achitidwa opaleshoni ya chithokomiro, odwala matenda a shuga ndi matenda a Addison, osuta kwambiri. Amayi ayenera kusamala makamaka akamabereka.

Sizingakhale zosayenera kufufuzidwa kwa hypothyroidism ngati, popanda chifukwa china, kulemera kunayamba kukula, kutopa, kugona, nkhawa yosadziwika ndi kuvutika maganizo kunawonekera. Komanso, hypothyroidism imatha kuwonetsedwa ndi kuchepa kwa kukumbukira ndi chidwi, kutupa kwa nkhope ndi miyendo, komanso tsitsi. Mwa amuna, matendawa amatha kutsagana ndi kuchepa kwa libido ndi potency, mwa akazi - kuphwanya msambo. Kuperewera kwa magazi m'thupi ndi chizindikiro china chodziwika bwino cha hypothyroidism.

Matenda a Graves (kufalitsa toxic goiter)

Matendawa akachitika, chitetezo cha mthupi chimatulutsa ma antibodies omwe "amalimbikitsa" chithokomiro kugwira ntchito molimbika kuposa momwe ziyenera kukhalira. Chotsatira chake, kuchuluka kwa mahomoni a chithokomiro kumawonekera m'thupi, zomwe zimakhudza ziwalo zambiri ndi machitidwe, makamaka machitidwe amanjenje ndi amtima.

Zizindikiro zoyamba za matenda a Graves ndi: palpitations, thukuta, kuwonda motsutsana ndi maziko a chilakolako chowonjezeka, kufooka kwa minofu, kukwiya komanso kukwiya.⁸. Nthawi zambiri, chithokomiro chimakula ndikuwoneka. Nthawi zambiri, matenda a Graves amatsagana ndi endocrine ophthalmopathy, yomwe imawonetsedwa ndi exophthalmos (kutupa kwamaso) ndi kutupa kwa zikope.

"Kupezeka kwa matenda a maso nthawi zambiri kumakhala chizindikiro cha matenda oopsa a goiter," akutero katswiri wathu. - Ndikofunikira kukumbukira kuti matenda a Graves ndi matenda omwe amayambanso. Nthawi zambiri, zimabwereranso, zomwe zimakupangitsani kuganiza zosankha njira yochizira.

Kufalikira ndi nodular euthyroid goiter

Euthyroid goiter imatchedwanso kuti si poizoni. Mu chikhalidwe ichi, pali kuwonjezeka kwa kukula kwa chithokomiro popanda kusokoneza ntchito yake. Kukula kwa vutoli kumatha kukhala kosiyana: goiter nthawi zina imakhala yomveka, ndipo nthawi zina imatha kuwonedwa ndi maso.

Pali zifukwa zambiri zomwe zimayambitsa matendawa, koma ambiri mwa iwo ndi kusowa kwa ayodini, zomwe ndizofunikira pakupanga mahomoni a chithokomiro. Kuti awonjezere kupanga kwa mahomoni, chithokomiro chimayamba kukula.

Ndi goiter yofalikira, chitsulo chimawonjezeka mofanana, ndipo ndi goiter ya nodular, mapangidwe osiyana a volumetric kapena node amawonekera mmenemo. Atha kukhala amodzi kapena angapo. Palinso mitundu yosakanikirana - yofalikira-nodular ya matendawa. Mu 95% ya anthu, nodules ndi abwino. Komabe, ma pathology awa amafunikira kuwunika mosamala kuti asaphatikizepo khansa ya chithokomiro.

Autoimmune thyroiditis

Matenda otupa a chithokomiro a autoimmune etiology amatha kuyambitsa hypothyroidism. Autoimmune thyroiditis imatha kuzindikirika mwangozi osati limodzi ndi kukanika kwa chithokomiro.

Zomwe zimayambitsa kukula kwa matendawa ndi izi: cholowa, zachilengedwe zosasangalatsa, kuwonongeka kwa chitetezo chamthupi.

"Matendawa akamakula, chithokomiro chimakhala ndi kusintha kwa sclerotic ndipo pang'onopang'ono chimachepetsa ntchito yake," anatero katswiri wa endocrinologist Elena Kulikova. - Njira ya matendawa imatha kuchedwa komanso kufulumizitsa. Simungathe kudziwiratu kuti chithokomiro chidzataya bwanji ntchito yake. Kuti musaphonye mphindi ino ndikuyamba kulandira chithandizo munthawi yake, tikukulangizani kuti mupereke magazi a TSH osachepera kamodzi pachaka.

Khansa ya Chithokomiro

Khansara ya chithokomiro nthawi zambiri imasiyanitsidwa kwambiri. Izi zikutanthauza kuti kukula ndi chitukuko cha chotupa ndi pang'onopang'ono. Komabe, palinso aukali mitundu ya matenda, kotero muyenera kukhala osamala kwambiri ndi nthawi yake ultrasound wa chithokomiro England ndi, ngati n`koyenera, kuchita bwino singano aspiration biopsy.

Malinga ndi chiyambi, pali papillary, follicular ndi medullary chithokomiro khansa. Nthawi zambiri, mitundu yosakhala yaukali ya khansa ya papillary ndi follicular imachitika. Ndi chithandizo chanthawi yake, moyo wabwino wa wodwalayo suvutika. Zikatero, njira zochepetsera chithandizo cha opaleshoni ndizokwanira. Komabe, ngati njirayo ikugwira ntchito kapena isanadziwike m'nthawi yake, pamafunika opaleshoni yoopsa.

Kodi chithokomiro chamunthu chimachizidwa bwanji?

Matenda obwera chifukwa cha kusowa kwa mahomoni a chithokomiro malinga ndi “golide wokhazikika” akusonyeza kuti alandira chithandizo china. Nthawi zambiri ntchito levothyroxine sodium⁹. Chizindikiro cha kukhazikitsidwa kwa L-thyroxine ndi hypothyroidism yokha. Nthawi zina, kusankhidwa kwake kumakhala kosayenera ndipo kungakhale koopsa.

Mankhwala a Thyrostatic amagwiritsidwa ntchito pochiza matenda angapo a chithokomiro okhudzana ndi kugwira ntchito kwake mopitirira muyeso.

Njira zochiritsira zowonjezereka zimaphatikizapo chithandizo cha radioiodine ndi njira zothandizira opaleshoni. Kuti mumvetse njira yochiritsira yomwe ili yoyenera kwa inu, muyenera kuonana ndi dokotala.

Thandizo losintha

Mankhwala amtunduwu amaperekedwa ngati ntchito ya chithokomiro imachepetsedwa, ndipo m'malo mwake zonse kapena mbali zake ndizofunikira. Ntchito yosinthira mahomoni ndikusintha kuchuluka kwa mahomoni a chithokomiro.

Mankhwala osankhidwa ndi L-thyroxine. Ndikofunikira kwambiri kusankha mlingo wokwanira wa munthu ndi kumwa mankhwalawa moyenera: mosamalitsa pamimba yopanda kanthu, m'mawa, mphindi 30 musanadye, ndi madzi. Ngati malangizowo akuphwanyidwa, ubwino ukhoza kuipiraipira.

Mahomoni achibadwa a chithokomiro ndi ofunika kwambiri panthawi yomwe ali ndi pakati. L-thyroxine amaperekedwa kwa amayi apakati ngati kuli kofunikira, ndizotetezeka kwathunthu kwa mayi ndi mwana wosabadwayo.

Chithandizo cha Thyrostatic

Amagwiritsidwa ntchito pochiza thyrotoxicosis. Pankhaniyi, kukonzekera kwa thiourea (thiamazole, propylthiouracil) kumagwiritsidwa ntchito. Amadziunjikira mu chithokomiro ndikuletsa kaphatikizidwe ka mahomoni a chithokomiro. Chithandizo cha Thyrostatic chimaperekedwa kwa zaka 1-1,5, kapena chimagwiritsidwa ntchito ngati gawo lokonzekera musanachite opaleshoni.

Mukatenga thyreostatics, nthawi zina, zotsatira za chiwindi ndi circulatory zimatheka. Choncho, pakuwunika kowongolera, ndikofunikira kuyesa magazi osati kuchuluka kwa mahomoni a chithokomiro, komanso kuyezetsa magazi kwachipatala ndi magawo a chiwindi.

Kutengera maziko a thyreostatic mankhwala, matupi awo sagwirizana totupa pakhungu ndizotheka. Ndikofunikira kwambiri kuyang'anira mlingo ndi momwe amamwa mankhwalawa.

Njira za opaleshoni

Kufunika ndi kukula kwa opaleshoni zimadalira mtundu wa matenda a chithokomiro. Ndi goiter ya poizoni, chithokomiro chimasonyezedwa (kuchotsedwa kwathunthu kwa chithokomiro). Kwa zotupa zosiyanasiyana, mwina thyroidectomy kapena hemithyroidectomy (kuchotsa pang'ono). Kuchuluka kwa opaleshoni kumatsimikiziridwa ndi dokotala-endocrinologist kapena katswiri wa endocrinologist.

Opaleshoniyo imatha kuchitidwa momasuka (zachikale) kapena zosokoneza pang'ono (endoscopic). Njira za Endoscopic (popanda kudulidwa kwakukulu) zili ndi ubwino wosatsutsika pa maopaleshoni otsegula: kuwonongeka kochepa kwa minofu, nthawi yochepa yokonzanso, pafupifupi zipsera zosaoneka pambuyo pa opaleshoni.

Opaleshoni mankhwala a chithokomiro matenda ali ake okhwima zikuonetsa. Pali zinthu zingapo (mwachitsanzo, ma colloid node) omwe safuna chithandizo cha opaleshoni ndipo amayang'aniridwa mwamphamvu.

Chithandizo cha radioiodine

Chithandizo ndi radioactive ayodini ndi njira ina ya kwambiri mankhwala osiyanasiyana poizoni goiter. Amagwiritsidwa ntchito ngati matendawa amabwerera nthawi zonse, ndipo chithandizo cha thyreostatic sichinapereke zotsatira. Thandizo la radioiodine ndilofunika kwa otupa ang'onoang'ono kuti asachite opaleshoni. 

Madokotala amakhulupirira kuti chithandizo cha ayodini wa radioactive sichimakhudza chiopsezo chokhala ndi khansa ya chithokomiro¹⁰. Contraindications: mimba, mkaka wa m`mawere, endocrine ophthalmopathy.

Momwe mungasungire chithokomiro chanu chathanzi kunyumba

Chinthu chofunika kwambiri kuti chithokomiro chizigwira ntchito bwino ndi ayodini. Zomwe zimafunikira tsiku lililonse zimatengera zaka: mpaka zaka 5 - 90 mcg, mpaka zaka 12 - 120 mcg, kuyambira zaka 12 - 150 mcg, kwa amayi apakati ndi oyamwitsa - 250 mcg.¹¹.

Sikuti nthawi zonse gawo la tsiku ndi tsiku la ayodini limapezeka m'zakudya, choncho madokotala nthawi zambiri amalembera mankhwala okhala ndi ayodini. Komabe, munthu sayenera kukhala achangu kwambiri pakukonzekera ayodini. Nthawi zina, mlingo wa tsiku ndi tsiku ukhoza kupezedwa pogwiritsa ntchito iodized kapena mchere wamchere muzakudya.

Matenda a chithokomiro amatha kuyambitsidwa ndi kupsinjika maganizo, kugwira ntchito mopitirira muyeso, matenda a mavairasi ndi mabakiteriya, matenda aakulu a thirakiti lapamwamba la kupuma. Ngati mukufuna kuti chithokomiro chanu chimve bwino ndikugwira ntchito mosalephera, muyenera kulimbikitsa chitetezo cha mthupi, kukhala ndi moyo wathanzi, kupewa nkhawa komanso kugona mokwanira.

Tsoka, zinthu zina (mwachitsanzo, genetic predisposition) sizingakhudzidwe. Choncho, ngati mukudziwa kuti muli ndi mbiri ya matenda a chithokomiro, yang'anani mkhalidwe wake ndi ultrasound pachaka ndi kuyezetsa magazi kwa TSH.

Mafunso ndi mayankho otchuka

Katswiri wathu, katswiri wa endocrinologist Elena Kulikova, amayankha mafunso okhudza momwe chithokomiro chimagwirira ntchito.

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