Diffuse toxic goiter yog ib qho kab mob autoaggressive, uas yog tus cwj pwm los ntawm kev tsim cov thyroid hormones thiab nce qhov loj ntawm lub caj pas vim yog kev loj hlob ntawm tes sai. Hauv lwm txoj kev, tus kab mob no hu ua hyperthyroidism, lossis kab mob ntawm Graves, Graves, Perry, Flayani. Feem ntau, cov kab mob no tau kuaj pom hauv cov poj niam.
Etiology thiab pathogenesis
caj ces predisposition ua lub luag haujlwm tseem ceeb hauv kev loj hlob ntawm hyperthyroidism. Feem ntau tus kab mob kis tau los ntawm tiam neeg. Cov laj thawj hauv qab no provoke qhov tshwm sim ntawm pathology:
- xov xwm ntxhov siab;
- mob kis kab mob;
- mob caj pas;
- lwm cov kab mob ntawm endocrine system - hypoparathyroidism, Addison tus kab mob, ntshav qab zib mellitus.
Heredity tau lees paub los ntawm qhov tseeb tias ib nrab ntawm tus neeg mob cov txheeb ze muaj ntshavantithyroid antibodies, thiab hauv 15% cov kab mob no tau txheeb xyuas thiab paub tseeb. Nws yog ib qho tseem ceeb uas tsis yog tus kab mob nws tus kheej yog kis tau los ntawm caj ces, tab sis tsuas yog ib qho predisposition rau nws. Yog li, lub luag haujlwm tseem ceeb hauv cov txheej txheem pathogenesis ntawm diffuse toxic goiter yog muab rau cov caj ces predisposition, nrog rau cov provoking yam, vim hais tias cov ntaub ntawv embedded nyob rau hauv cov noob yog tsim. Vim yog lub cev tsis ua haujlwm ntawm lub cev, kev hloov pauv tshwm sim hauv T-lymphocytes, thiab lawv, ua haujlwm ntawm cov qog nqaij hlav, pom nws cov antigens txawv teb chaws. Tsis tas li ntawd, T-killers muaj peev xwm ua rau nws tus kheej ua rau lub cev puas tsuaj, ua rau muaj kev cuam tshuam rau cov thyroid caj pas. T-lymphocytes los ntawm B-hlwb, uas tsim cov tshuaj tiv thaiv antithyroid, tuaj yeem ua rau muaj kev cuam tshuam ncaj qha rau ntawm cov qog nqaij hlav. Cov tom kawg txhawb lub cev los ntawm kev sib txuas ntawm cov thyroid-stimulating hormone receptors rau thyrocytes, piv txwv li, cov hlwb ntawm cov thyroid caj pas. Nrog rau kev txhim kho ntawm diffuse toxic goiter, kev ua haujlwm ntawm lub hauv paus tswj hwm ntawm lub cev tiv thaiv kab mob (T-lymphocytes) yog qhov tsis zoo.
Kev faib tawm txawv
Tus kws kho mob txiav txim siab qhov loj ntawm cov thyroid caj pas siv palpation thiab kuaj pom ntawm tus neeg mob. Raws li WHO kev faib tawm, txij li xyoo 1994, cov qib hauv qab no tau raug cais:
- 0 - goiter tsis pom qhov muag thiab tsis tuaj yeem palpated;
- 1 - goiter palpable, tab sis visually, thaum lub caj dab nyob rau hauv ib tug natural position, nws tsis pom;
- 2 - goiter tuaj yeem pom tau yooj yim pom qhov muag thiab palpation.
Raws li lwm qhov kev faib tawm (raws li Nikolaev), muaj cov qib zoo li no ntawm diffuse toxic goiter:
- 0 - tsis palpable thiab tsis muaj caj pas txiav txim siab;
- Kuv - palpation tuaj yeem txiav txim siab lub isthmus ntawm cov thyroid caj pas, nws pom qhov muag pom;
- II - lateral lobes tuaj yeem kuaj pom los ntawm palpation, thaum nqos nws pom tau yooj yim pom cov goiter;
- III - pom lub caj dab tuab pom;
- IV - lub caj pas loj, vim qhov no, deformation ntawm lub caj dab yog pom tau;
- V - cov thyroid caj pas ncav cuag qhov loj tshwj xeeb.
Ntxiv rau, ob peb qib tuaj yeem paub qhov txawv raws li qhov hnyav ntawm tus kab mob:
- Easy. Cov cim qhia ntawm pathology yog tshwm sim los ntawm kev nce siab hauv lub siab, tsis nco qab, insomnia, tearfulness. Feem ntau, kev ua haujlwm qis tau pom. Ua ntej ntawm tag nrho cov, cov hlab plawv system raug kev txom nyem. Tus naj npawb ntawm lub plawv dhia ib feeb nce mus rau ib puas. Tus neeg pib poob phaus.
- Average. Cov tsos mob ntawm diffuse toxic goiter, piav nrog ib tug me me degree, yog aggravated. Tremor koom nrog cov kab mob uas twb muaj lawm. Kev poob phaus txuas ntxiv txawm tias qab los noj mov zoo heev. Tus neeg muaj kev tawm hws hnyav, tsis muaj zog. Cov quav muaj teeb meem, qhov mob tshwm sim hauv plab, uas tsis muaj qhov chaw pom tseeb.
- Hav. Kev ua haujlwm ntawm lub cev tseem ceeb thiab lub cev tsis ua haujlwm. Psychoses yog ua tau. Tus neeg mob muaj lub cev tag nrho.
Lwm qhov kev faib tawm yog paub, raws li cov kab mob sib txawv:
- Subclinical - cov tsos mob raug tshem tawm, qhov kev kuaj mob yog tsim los ntawm cov txiaj ntsig ntawm kev tshawb fawbntshav rau cov tshuaj hormonal.
- Manifest - muaj lub chaw kho mob hais. Cov thyroid-stimulating hormone nyob rau hauv cov ntshav tsis tau txiav txim siab, qhov concentration ntawm cov thyroid hormones yog overestimated.
- Nyuaj - mob hlwb ntxiv. Kev ua haujlwm ntawm cov hlab plawv thiab lwm yam tseem ceeb yog cuam tshuam. Tus neeg raug kuaj pom tias muaj qhov hnyav hnyav.
Lab diagnostic method
Siv chav kuaj thiab ntsuas cov txheej txheem los kuaj xyuas "diffuse toxic goiter". Kev kuaj ntshav kom txiav txim siab dawb T3 (triiodothyronine) thiab T4 (thyroxine), nrog rau TSH (thyrotropin) yog qhov ntsuas tseem ceeb. Ib tug siab concentration ntawm thawj ob cov tshuaj hormones thiab ib tug tsawg npaum li cas ntawm cov tom kawg yog cov yam ntxwv ntawm no pathology. Tsis tas li ntawd, kev ntsuam xyuas cov tshuaj tiv thaiv rau thyroglobulin thiab thyroid peroxidase tau sau tseg. Raws li kev tshawb fawb ntxiv tau ua tiav:
- Scintigraphy, lossis radioisotope kawm txog cov thyroid caj pas, uas kawm txog cov haujlwm thiab cov qauv ntawm cov thyroid caj pas.
- Ultrasound, uas qhia txog cov qauv ntawm lub cev.
- MRI raug tshuaj los kuaj mob ophthalmopathy uas muaj nyob hauv tus kabmob no.
Ntxiv rau, thaum kuaj pom cov kab mob toxic goiter (ICD-10 muab code E05.0 rau nws), lub luag haujlwm ntawm ob lub raum, siab thiab lwm yam kabmob uas tsim nyog rau kev teem caij kho kom txaus yog txiav txim siab.
Ua rau thiab cov tsos mob ntawm tus mob
Hormonal imbalance pab txhawb kev loj hlob ntawm tus kab mob thaum lub sij hawmcev xeeb tub, pub niam mis, cev xeeb tub los yog menopause. Ntawm cov laj thawj tseem ceeb provocateurs yog:
- mob hlwb raug mob;
- kev puas hlwb;
- genetic predisposition;
- ib puag ncig phem;
- autoimmune teb ntawm lub cev;
- ib puag ncig phem;
- kab mob kis kab mob.
Qhov laj thawj tseem ceeb ntawm cov kab mob toxic goiter yog suav tias yog kev ua txhaum ntawm kev tiv thaiv kab mob. Cov tsos mob ntawm pathology lossis daim duab kho mob classic yog qhov muag pom, goiter thiab palpitations. Ntawm ib feem ntawm lub cev thiab lub cev tseem ceeb rau lub neej ib txwm muaj, cov cim qhia ntawm pathology tshwm sim:
- nrawm metabolism;
- huab cua kub tsis haum;
- qab qab heev, tab sis muaj qhov poob qis;
- mob plab;
- kab mob;
- tshee ntawm lub cev thiab ceg ceg;
- faus;
- kev qaug zog;
- insomnia;
- lub cev o;
- arrhythmia;
- lub plawv tsis ua hauj lwm;
- tachycardia;
- plab o;
- hyperactivity ntawm lub cev muaj zog reflexes;
- kub nce;
- qhov ncauj candidiasis;
- tawm hws ntau dhau;
- cov nails brittle.
Tus txiv neej muaj erectile kawg, lub mis loj. Cov tsos mob ntawm diffuse toxic goiter nyob rau hauv cov poj niam yog infertility, kev coj khaub ncaws tsis ua hauj lwm thiab mob hnyav nyob rau hauv lub plab mog,fibrocystic mastopathy. Nyob rau ib feem ntawm lub cev ntawm lub zeem muag, muaj kev nce hauv intraocular siab, conjunctivitis, kev xav ntawm cov xuab zeb nyob rau hauv lub qhov muag, kaw tsis tiav ntawm daim tawv muag, tsis tshua muaj blinking, lagging ntawm daim tawv muag qis ntawm lub qhov muag.
Teebmeem thiab kev kho lawv
Kev tsim cov tshuaj hormonal ntau dhau los ntawm cov thyroid caj pas muaj kev cuam tshuam tsis zoo rau tag nrho cov kabmob thiab cov kab ke ntawm tus neeg lub cev. Cov teeb meem ntawm diffuse toxic goiter suav nrog:
- Thyrotoxic ntsoog yog qhov tshwm sim tshwj xeeb ntawm tus kab mob, uas ua rau muaj kev hem thawj rau lub neej. Hmoov zoo, niaj hnub no tus kab mob no tsis tshua muaj vim yog cov txheej txheem tshiab ntawm kev kuaj thiab kho cov neeg mob. Txoj kev loj hlob ntawm kev kub ntxhov tsis tau nkag siab tag nrho, tab sis muaj ntau qhov kev xav. Raws li ib qho ntawm lawv, nws tshwm sim vim qhov nce ntawm cov dawb triiodothyronine thiab thyroxine. Ntawm qhov tod tes, vim yog qhov nce siab ntawm lub cev rau adrenaline, norepinephrine, dopamine. Tus provocateur ntawm tus kab mob yog kev nyuaj siab los yog ib tug kab mob. Cov tsos mob ntawm thyrotoxicosis yog nce. Kev kub ntxhov loj zuj zus tuaj. Tus neeg siv lub luag haujlwm yuam kev, qhov hu ua Qav posture, kev hais lus raug cuam tshuam, dermis yuav ntub thiab kub rau qhov kov, lub plawv dhia nce ib feeb mus rau 130 neeg ntaus. Kev kho mob ceev ceev suav nrog detoxification ntawm lub cev, kev qhia txog beta-blockers, cov tshuaj hormones, thyreostatics. Txhawm rau txo qis kev ntxhov siab psychomotor, cov tshuaj ntawm pawg barbiturate, opioid analgesics yog siv. Cov kev ntsuas ceev ceev yuav tsum tau tsom rauKev them nyiaj rau qhov tsis txaus ntawm adrenal cortex, neutralization ntawm cov thyroid hormonal tshuaj, txo kev ua haujlwm ntawm sympathoadrenal system, tshem tawm cov kab mob metabolic.
- YEndocrine ophthalmopathy. Qhov ua rau ntawm cov thyroid teeb meem no kuj muaj feem xyuam, tab sis nws nyob rau hauv ib qho autoimmune nres ntawm lub qhov muag cov ntaub so ntswg thiab cov nqaij ntshiv tom qab lub qhov muag. Yog li, qhov chaw ntawm kev puas tsuaj yog tib yam li nyob rau hauv cov ntaub ntawv ntawm diffuse toxic goiter. Nyob rau tib lub sij hawm, lub qhov muag protrude muaj zog rau pem hauv ntej, lawv kuj hu ua bulging. Daim duab kho mob tsim nyob rau theem. Thaum xub thawj, cov kev hloov pauv cuam tshuam rau ib lub qhov muag, nrog rau kev vam meej ntxiv, lwm qhov tseem cuam tshuam. Tom qab qee lub sijhawm, exophthalmos tshwm sim. Hauv qhov mob hnyav, cov hlab ntsha optic raug kev txom nyem, uas yog kev hem thawj rau kev pom. Kev kho nyuaj yog qhia. Nrog kev kho tsis raws sijhawm lossis tsis raug, cov txheej txheem pathological yuav hloov tsis tau.
- Pretibial myxedema. Qhov teeb meem no tsis tshua muaj. Nws yog manifested los ntawm khaus, liab, o thiab thickening ntawm cov ntaub so ntswg dermis ntawm lub anterior nto ntawm sab ceg. Raws li kev kho mob, cov tshuaj hormonal rau kev siv tshuaj pleev ib ce.
Tsis tas li ntawd, kev nce qib ntawm hyperthyroidism tuaj yeem ua rau cov txiaj ntsig hauv qab no:
- atrial fibrillation;
- pulmonary edema;
- psychosis;
- lub plawv tsis ua hauj lwm;
- osteoporosis;
- tshuaj lom kab mob siab;
- adrenal insufficiency;
- myopathy;
- mob ntshav qab zib;
- blood clotting disorder.
Cov zaub mov txawv tshuaj
Kev kho cov kab mob toxic goiter nrog kev kho pej xeem yog pom zoo nyob rau thawj theem ntawm tus kab mob. Cov zaub mov hauv qab no ua ib qho ntxiv rau kev kho mob tseem ceeb:
- Ripe chokeberry berries yog tov nrog zib mu los yog qab zib nyob rau hauv ib tug ratio ntawm 1: 1, insisted nyob rau hauv ib qhov chaw txias rau xya hnub. Noj txhua hnub ntawm lub plab khoob 40 grams, uas yog sib npaug rau ob tablespoons tsis muaj swb.
- Ib hiav txwv ntsev yog siv rau cov thyroid caj pas rau 55 hnub, ntawm 27 zaug cov txheej txheem ua txhua hnub, tom qab ntawd txhua hnub.
- Cov nplooj nplooj me me sau ib lub lauj kaub peb-liter, ntxiv dej, muab tso rau hauv hluav taws thiab evaporate kom txog thaum cov av zoo li jelly tau txais. Cov txiaj ntsig sib xyaw yog smeared ntawm goiter rau plaub lub hlis ua ntej yuav mus pw.
- Txhua yav tsaus ntuj, ib qho iodine mesh yog siv rau thaj tsam goiter. Yog tias pom cov kab mob iodine thaum sawv ntxov, cov txheej txheem raug tso tseg.
- Npaj ib lub tincture ntawm walnut partitions, uas yuav tsum tau haus ob teev ua ntej sawv, 15 ml rau ib hlis, ces so 30 hnub. Yog tsim nyog, mus kawm ntxiv.
Diffuse toxic goiter: cov lus qhia kho mob
Nov yog ib daim ntawv tshwj xeeb uas tau muab tso rau ib ntus thiab tsim los rau cov kws kho mob. Cov txheej txheem kho mob muaj cov ntaub ntawv tshiab tshaj plaws, ua pov thawj hauv kev xyaum ntawm cov teeb meem hauv qab no:
- diagnostics;
- kev kho;
- rehab;
- kev tiv thaiv.
Daim ntawv no txhais cov algorithm ntawm kev ua hauv kev tswj tus neeg mob. Tus kws kho mob muaj cai xaiv txoj kev kuaj mob thiab kev kho mob, nyob ntawm seb tus yam ntxwv ntawm tus kheej, nws poj niam txiv neej, hnub nyoog, nrog rau cov chav kawm ntawm pathology. Tam sim no, hauv cov tshuaj siv tau, cov kev kho mob tau piav qhia hauv cov txheej txheem kho mob tau siv. Diffuse toxic goiter yog pom zoo kom kho nyob rau hauv peb txoj kev:
- ncig;
- phais;
- Yradioactive iodine.
Rau txhua hom, qib ntawm cov pov thawj tau muab thiab cov lus qhia, uas tau teev cov ncauj lus kom ntxaws txog kev kho mob thiab kev kuaj xyuas tsim nyog. Tsis tas li ntawd, cov kev mob tshwm sim thiab cov teeb meem tshwm sim los ntawm kev kho mob tau piav qhia. Ib ntu tshwj xeeb tau hais qhia hauv daim ntawv, uas qhia txog cov kev cai uas yuav tsum tau ua rau tus kws kho mob, lawv cov kev ua tiav cuam tshuam rau qhov tshwm sim ntawm tus kab mob, tshwj xeeb tshaj yog diffuse toxic goiter.
kev kho mob
Tsim los tshem tawm qhov tshwm sim ntawm tus kab mob. Kev siv cov ntsiav tshuaj ntau npaum cov ntaub ntawv tso cai rau koj kom ua tiav cov txiaj ntsig tom qab ib hlis txij li pib kho. Txawm li cas los xij, tom qab tus neeg tsis noj lawv, rov qab tshwm sim. Ob peb pawg tshuaj siv los kho:
- Y Thyrostatics - "Propicil", "Merkazolil". Lawv thaiv kev ua haujlwm ntawm lub caj pas, vim li ntawd, kev sib xyaw ntawm cov tshuaj hormonal txo qis. Kev kho mob ntawm diffuse toxic goiter nrog cov tshuaj no pab normalize cov thyroid caj pas. Tsis tas li ntawd, cov tshuaj "Eutiroks" raug sau los tiv thaiv qhov tshwm sim ntawm cov tshuajhypothyroidism. Txhawm rau tswj hwm cov haujlwm ntawm lub caj pas, monotherapy yog ua los ntawm kev siv tshuaj me me ntawm thyreostatics.
- Beta-blockers thiab glucocorticoids tau sau tseg raws li kev kho mob tshwm sim thaum muaj cov kab mob sib xws (tachycardia, kub siab, palpitations, ophthalmopathy, osteoporosis) uas nrog cov kab mob hauv qab.
Cov neeg mob tau txais kev kho tshuaj rau ib xyoos thiab ib nrab.
kho mob phais
Txoj kev no suav hais tias ua tau zoo, tab sis yog fraught nrog ntau yam teeb meem. Qhov taw qhia rau hom kev kho no yog:
- kab mob nruab nrab thiab hnyav;
- tsis tshwm sim los ntawm lwm yam kev kho mob;
- Ythyrotoxic adenoma;
- nodal thiab retrosternal forms;
- relapses;
- compression ntawm txoj hlab pas thiab trachea los ntawm goiter;
- meej;
- thawj lub hlis thib ob ntawm cev xeeb tub;
- muaj teeb meem hauv daim ntawv ntawm atrial fibrillation.
Contraindication rau kev phais:
- diffuse toxic goiter nyuaj los ntawm kev puas siab puas ntsws;
- mob hnyav concomitant pathology ntawm ob lub raum, ntsws thiab lub plawv.
Ua ntej kev phais, cov neeg mob tau muab tshuaj "Mercazolil" txhawm rau ua kom cov thyroid hormones normalize, txo cov tsos mob lom thiab tiv thaiv kom tsis txhob muaj thyrotoxicosis tom qab phais. Thaum lub sijhawm ua haujlwm, cov thyroid caj pas raug tshem tawm yuav luag tag nrho. Tsuas yog thaj chaw uas cov qog nqaij hlav parathyroid nyob xwb.
Kev siv hluav taws xob iodine
Thaum kho cov kab mob toxic goiter nrog txoj kev no, ib qho isotope ntawm radioactive iodine I-131 yog txhaj rau hauv tus neeg mob lub cev, uas cuam tshuam rau lub caj pas nrog gamma thiab beta rays, ua rau nws cov hlwb puas. Yog li ntawd, cov synthesis ntawm cov tshuaj hormonal raug txo. Kev kho mob yog nqa tawm nyob rau hauv qhov chaw nyob ruaj khov. Thaum kho, nws raug nquahu kom txwv cov khoom noj uas muaj iodine.
Qhia rau qhov kev kho no:
- laus;
- mob hnyav lossis intolerance rau kev saib xyuas kev kho mob;
- tsis kam tus neeg mob los ntawm kev ua haujlwm;
- tsis tuaj yeem ntawm kev cuam tshuam kev phais;
- kev txhim kho ntawm postoperative thyrotoxicosis.
Kev txwv tsis pub siv cov tshuaj iodine yog:
- xeeb tub;
- pub mis niam;
- retrosternal goiter;
- meej;
- kab mob ntshav, raum.
Yuav ua li cas diffuse toxic goiter kho tau?
Kev kuaj mob thaum tsis kho yog qhov tsis zoo. Tus neeg mob tsim cov teeb meem loj, tus kab mob loj tuaj. Nrog rau normalization ntawm cov thyroid caj pas, qhov kev tshwm sim zoo. Nyob rau hauv cov ntaub ntawv ntawm kev kho mob ntawm tus kab mob, muaj ib tug siab tshwm sim ntawm tsim ntawm hypothyroidism, nyob rau hauv uas cov txheej txheem metabolic qeeb hauv lub cev ntawm tus neeg. Yog vim li cas rau qhov tshwm sim no nyob rau hauv qhov tsis txaus ntawm cov tshuaj hormonal (triiodothyronine thiab thyroxine). Cov neeg mob raug qhia kom tsis suav cov zaub mov thiab tshuaj uas muaj cov ntsiab lus siab ntawm iodine, nrog rau txo qis.txo qhov raug tshav ntuj ncaj qha.
ntsuas kev tiv thaiv suav nrog:
- Txhim kho thiab ntxiv dag zog rau lub cev, uas suav nrog kev ua kom tawv nqaij, taug kev tsis tu ncua, ua gymnastic ce.
- Ua raws li kev noj haus. suav nrog hauv koj cov zaub mov noj uas muaj tsiaj txhu thiab zaub protein, zaub nyoos thiab txiv hmab txiv ntoo.
- Kev tsis suav nrog kev ntxhov siab, vim nws ua lub luag haujlwm tseem ceeb hauv kev txhim kho pathology. Qee zaum, tus kws kho mob yuav pom zoo kom noj tshuaj sedatives.
- kev kho mob raws sijhawm ntawm tus kab mob.
Tsis muaj kev tiv thaiv tshwj xeeb ntawm cov kab mob toxic goiter. Txhawm rau tiv thaiv kab mob, kev soj ntsuam los ntawm tus kws kho mob endocrinologist hauv polyclinic ntawm qhov chaw nyob yog qhia.
