Cov thyroid caj pas yog lub cev loj tshaj plaws ntawm cov kab mob endocrine. Nws nyob ntawm lub caj dab ntawm ob sab ntawm lub trachea sab sauv thiab zoo li npauj npaim. Thyroid follicles nquag ua cov tshuaj hormones triiodothyronine (T 3) thiab tetraiodothyronine (T 4 lossis thyroxine). Txij li cov thyroid caj pas hauv Latin suab zoo li " thyroid caj pas ", cov tshuaj hormones uas nws synthesizes hu ua thyroid hormones. Lawv khi rau cov protein kom tsim thyroglobulin, thiab nyob rau hauv daim ntawv no tuaj yeem khaws cia rau hauv lub hauv paus ntawm lub caj pas rau ob peb lub hlis. Raws li qhov xav tau, thyroglobulin tawg, cov tshuaj hormones raug tso tawm. Tom qab ntawd lawv nkag mus rau hauv cov hlab ntsha thiab muab faib thoob plaws hauv lub cev los ntawm cov khoom thauj tshwj xeeb, thiab tom qab ntawd nkag mus rau hauv cov ntaub so ntswg ntawm peb lub cev.
Dej, zeb thiab cov thyroid hormones
Lawv hais tias cov thyroid caj pas "kho dej rau lub zeb ntawm peb lub neej." Qhov no yogtxhais tau hais tias ib txwm cov thyroid hormones muab ib tug neeg muaj kev ua si, lub siab zoo, thiab cov me nyuam - kev loj hlob thiab kev loj hlob. Yog hais tias cov thyroid caj pas tsis ua hauj lwm zoo - "dej me ntsis dej", ces "mills tig maj mam", uas yog, tus neeg yuav inhibited, apathetic, thiab cov me nyuam tsis loj hlob, lawv lub hlwb kev loj hlob qeeb. Qhov no yuav piav qhia txog science li cas?
Lub ntsiab biochemical nyhuv ntawm cov thyroid hormones yog ua kom cov protein synthesis. Cov thyroid hormones nquag nkag mus rau hauv cov hlwb, cuam tshuam nrog cell DNA, hloov cov haujlwm ntawm qee qhov ntawm cov genome. Yog li ntawd, cov synthesis ntawm cov enzymes proteins thiab receptor proteins yog txhim kho. Ob leeg thiab lwm tus tswj cov metabolism hauv feem ntau.
Tyroid Performance Norm
Feem ntau, cov ntshav raug coj mus kawm qib ntawm cov thyroid hormones yog tias xav tias muaj kab mob ntawm lub qog no.
Cov theem ib txwm ntawm cov tshuaj hormones thiab lwm yam ntsuas ntawm cov thyroid caj pas muaj nyob rau hauv Table 1.
| Table 1. Ib txwm muaj cov thyroid hormones hauv cov poj niam | ||
| TTG | µIU/ml | 0, 4-4, 0 |
| T3 gen | nmol/L | 1, 2-2, 7 |
| T3 sv | pmol/L | 2, 3-6, 4 |
| T4gen | nmol/L | 55-156 |
| T4 s | pmol/L | 10, 3-24, 6 |
| Tyroglobulin Y | ng/ml | ≦56 |
| YThyroxine khi globulin | nmol/L | 259-575, 6 |
| Cov tshuaj tiv thaiv rau tereoglobulin | µIU/ml | ≦65 |
| Anti-thyroid peroxidase antibodies | ≦35 | |
| Antibodies to TSH receptor | IU/L | ≦1, 8 tsis zoo |
| ≧2, 0 zoo | ||
Y Thyroglobulin, tshuaj tiv thaiv rau thyroglobulin
Kev tsim cov thyroid hormones tshwm sim hauv cov hlwb ntawm cov thyroid caj pas - thyrocytes. Rau kev sib txuas ntawm cov tshuaj hormones, cov amino acid tyrosine thiab cov kab mob iodine xav tau. Tyrosine yog ib feem ntawm thyroglobulin molecule. Ob lub iodine atoms thiab ib pawg phenolic txuas nrog tyrosine. Qhov sib xyaw ua ke yog hu ua thyronin. Ib qho ntxiv iodine tuaj yeem koom nrog kev tsim ntawm triiodothyronine, lossis cov tshuaj hormone T 3, thiab ib qho ntxiv iodine tuaj yeem ntxiv rau nws nrog kev tsim ntawm tetraiodothyronine (tetra txhais tau tias 4), lossis Cov tshuaj hormone T4 , tseem hu ua thyroxine.
Cov tshuaj hormones tshwm sim yog khaws cia hauv cov qog hlwb ua ib feem ntawm thyroglobulin. Raws li qhov tsim nyog, lub complex ntawm cov tshuaj hormones thiab thyroglobulin raug rhuav tshem, cov tshuaj hormones nkag mus rau hauv cov hlab ntsha los ua lawv txoj haujlwm. Ua ke nrog lawv, me me ntawm iodine thiab thyroglobulin nkag mus rau hauv cov hlab ntsha. Nws yog ib qho tseem ceeb kom paub txog kev nkag siab txog kev txhim kho cov kab mob autoimmune. Yav dhau los, nws tau ntseeg tias thyroglobulin nkag mus rau hauv cov hlab ntsha nkaus xwb nrog cov thyroid pathology, thiab yog li ua rau tsim cov tshuaj tiv thaiv rau nws tus kheej. Tam sim no nws tau tsim tias thyroglobulin yog ib txwm nyob hauv cov ntshav.
Anti-thyroid peroxidase antibodies
Raws li twb tau hais lawm, cov thyroid hormones yog tsim los ntawm tyrosine thiab iodine. Lub hauv paus ntawm iodine yog zaub mov, tshwj xeeb tshaj yog cov nqaij nruab deg. Iodine nkag nrog cov zaub mov yog inorganic, absorbed nyob rau hauv cov hnyuv, nkag mus rau hauv cov hlab ntsha, los ntawm qhov uas nws yog ntes los ntawm cov thyroid caj pas. Txhawm rau kom cov iodine ua kom nquag plias thiab tuaj yeem ua ke rau hauv cov organic molecules, nws yuav tsum tau oxidized. Nws yog oxidized los ntawm hydrogen peroxide nrog kev koom tes ntawm enzyme iodide peroxidase, uas tseem hu ua thyroid peroxidase. Yog tsis muaj cov enzymes no, cov tshuaj hormones yuav tsis raug synthesis, txawm tias iodine nkag mus rau hauv lub cev raws li qhov tsim nyog.
Dawb thiab khi T4 thyroxin-binding globulin
Nquag, hauv cov poj niam, cov thyroid hormones T 4 hauv cov ntshav yog 99.95% khi. Hormones khi rau cov kab mob tshwj xeeb cov proteins. Qhov no tiv thaiv cov tshuaj hormone los ntawm kev puas tsuaj thiab tsim nws cov cia. Hauv 80% ntawm cov neeg mob, cov protein no yog thyroxin-binding globulin. Muaj ib qho tsis tseem ceeb ntawm thyroxin hauv daim ntawv dawb hauv cov ntshav ntshav, tab sis nws yog thyroxine dawb uas muaj kev ua haujlwm.
Free and bound T3
Hauv cov ntshav, 99.5% ntawm cov tshuaj hormone T 3 yog nyob rau hauv daim ntawv khi, 90% ntawm nws koom nrog thyroxin-binding hormone. Ntawm tag nrho cov nyiaj ntawm T 3hauv cov ntshav, tsuas yog 15% yog synthesized nyob rau hauv cov follicles ntawm cov thyroid caj pas, tus so ntawm cov tshuaj hormones yog tau nyob rau hauv lub siab thaum ib tug iodine raug cais tawm. los ntawm T4. Raws li tau pom los ntawm Table 1, hauv cov ntshavT3 tsawg dua T4, tab sis nws lub cev ua haujlwm yog 4 npaug ntau dua. Tsis tas li ntawd, cov kev tshawb fawb tau pom tias nws yog T 3 uas ua haujlwm hormonal hauv hlwb (lawv hnov mob nrog cov receptors nuclear, yog li cuam tshuam rau DNA ntawm lub cell). Qhov no tau lees paub tias qhov tseeb cov thyroid hormone ib txwm yog T 3, thiab T4 yog prohormone.
TTG
Cov thyroid hormones ua haujlwm tseem ceeb hauv lub cev - lawv tswj cov synthesis ntawm cov protein nyob hauv txhua lub hlwb ntawm lub cev, yog li lawv cov kev tsim khoom tau tswj hwm ntau theem:
- tawv tawv ntawm lub paj hlwb hemispheres;
- hypothalamus via efferent qab haus huv;
- hypothalamus ntawm pituitary caj pas;
- nyob ntawm seb muaj pes tsawg iodine hauv lub cev.
Tam sim no txoj hauv kev tseem ceeb los tswj cov synthesis ntawm cov tshuaj hormones yog qhov thib peb ntawm cov npe. Nyob rau hauv lub hypothalamus, lub teeb liab yog tsim uas cuam tshuam rau lub caj pas pituitary thiab txhawb kev tsim cov thyroid-stimulating hormone (uas yog, qhia rau cov thyroid caj pas) nyob rau hauv nws - TSH. Nws activates lub synthesis ntawm thyroglobulin nyob rau hauv cov thyroid caj pas, uas yog ib tug precursor ntawm cov thyroid hormones. Thaum cov tshuaj hormones txaus txaus, tsim ntawm TSH yog suppressed, thyroid hormones ib txwm tsis ua synthesized (lus teb). Nrog kev pab los ntawm cov txheej txheem nyuaj, kev tswj hwm zoo ntawm cov thyroid caj pas yog ua tiav, ua raws li cov kev xav tau ntawm tag nrho cov kab mob.
Hloov cov ntsiab lus ntawm TSH hauv cov ntshav - thawj qhov kev hu ua haujlwm tsis zoocov thyroid caj pas. Yog tias qib TSH hauv cov poj niam yog qhov qub, ces cov thyroid hormones tej zaum yuav nyob rau hauv kev txiav txim ib yam nkaus.
Kev cev xeeb tub thiab cov thyroid caj pas
Lub luag haujlwm tseem ceeb ntawm cov thyroid hormone ntau lawm yog TSH. Thaum cev xeeb tub, cov placenta tsim chorionic gonadotropin, uas kuj ua rau cov thyroid hormones tsim. Yog li, hauv cov poj niam cev xeeb tub, tus nqi ntawm cov thyroid hormones hauv cov ntshav nce. Chorionic gonadotropin pib synthesis 6 teev tom qab fertilization, nws muaj nyob rau hauv cov ntshav inhibits lub synthesis ntawm TSH. Nyob ib ncig ntawm lub hli 4, qhov xwm txheej rov zoo li qub. Yog li ntawd, cov qib TSH nce hauv cov ntshav hloov pauv thaum cev xeeb tub.
Estrogens kuj cuam tshuam rau kev sib txuas ntawm cov thyroid hormones. Thaum cev xeeb tub, muaj ntau ntawm lawv, thiab cov thyroid caj pas secretes cov tshuaj hormones ntau dua. Tom qab ntawd cov txheej txheem ntawm deactivation ntawm cov tshuaj hormones hauv cov ntshav los ntawm thyroxin-binding globulin yog qhib, nws cov synthesis nyob rau hauv lub siab nce, uas yuav tshwm sim nyob rau hauv cov kev tshwm sim ntawm kev tsom xam.
Lwm yam hauv kev ua kom lub caj pas nyob rau hauv ib nrab ntawm cev xeeb tub yog qhov txo qis hauv cov ntsiab lus ntawm iodine hauv cov ntshav vim nws hloov mus rau fetoplacental complex. Ntxiv rau, iodine hauv cov poj niam cev xeeb tub tau tawm ntau heev hauv cov zis.
Txhua yam ntawm no ua rau muaj kev ua haujlwm siab ntawm lub qog. Hauv cov ntshav, nce qib ntawm tag nrho T3 thiab tag nrho T4, dawb T3 thiab T 4 yuav zoo.
| Table 2. Ib txwm muaj cov thyroid hormones hauv cov poj niam cev xeeb tub | ||
| TTG | µIU/ml | 0, 2-3, 5 |
| T4 gen | nmol/L |
I trimester 100-209 |
|
II, III trimester 117-236 |
||
| T4 s | pmol/L |
I trimester 10, 3-24, 6 |
|
II, III trimester 8, 2-24, 7 |
||
Kev txhais cov txiaj ntsig ntawm cov thyroid test
txhawm rau ntsuas kev ua haujlwm ntawm cov thyroid caj pas, chav kuaj (kev txiav txim siab cov ntsiab lus ntawm cov tshuaj hormones hauv cov ntshav) thiab ntsuas ntsuas (ultrasound) kev tshawb fawb yog siv.
Lub xeev ntawm lub cev, uas tsis muaj cov tsos mob ntawm qhov txawv txav hauv cov thyroid caj pas, hu ua euthyroidism. Ib qho mob uas muaj cov tsos mob ntawm kev ua haujlwm ntau dhau ntawm lub qog (hyperfunction) hu ua hyperthyroidism; Kev ua haujlwm tsis txaus ntawm lub qog (hypofunction) - hypothyroidism.
Cov qauv hauv kev tshuaj xyuas cov thyroid hormones hauv cov poj niam muaj tsawg dua li cov txiv neej, vim nws yog cov poj niam uas muaj ntau yam pathologies ntawm cov thyroid caj pas.
| Table 3. Cov kev hloov pauv hauv cov ntshav tsis nyob hauv cov thyroid pathologies | |||||
| T3 st | T4 s | TTG | AT-TG | at-TPO | |
| Primary hypothyroidism. | qis lossis ib txwm | qis lossis ib txwm | High | ||
| Hypothyroidism theem nrab. | qis | qis | qis | ||
| YPrimary hyperthyroidism. | High | High | qis | ||
| Autoimmune thyroiditis. Cov thyroid caj pas yog mob. | Tau muaj qhov nce thiab txo qis hauv cov tshuaj hormone | High | High | ||
Table 4 qhia cov kab mob thiab ntau yam mob ntawm lub cev, uas yog cov yam ntxwv ntawm kev hloov pauv ntawm cov thyroid caj pas.
| Table 4. Kev kuaj mob ntau yam raws li kev kuaj ntshav | ||
| Txuag | ||
|
T4 gen |
YThyrotoxic goiter; xeeb tub, postpartum thyroid dysfunction; cov qog ua qog ntawm cov thyroid caj pas, o ntawm caj pas; pathology ntawm daim siab thiab ob lub raum, rog; tshuaj - thyroid hormones, iodine-muaj, estrogens, insulin, tshuaj tiv thaiv qhov ncauj; kab mob HIV, AIDS. |
YHypothyroidism; tshuaj - tshuaj antithyroid, iodides, glucocorticoids, tshuaj tsis-steroidal tshuaj tiv thaiv kab mob, tshuaj tiv thaiv kab mob, tshuaj tiv thaiv kab mob, hypolipidemic, anticonvulsant, tshuaj tiv thaiv kab mob, lithium ntsev, furosemide; qhov tsis txaus iodine hauv lub cev. |
|
T4 sv |
Tshuaj lom goiter; thyroiditis; qog nqaij hlav tom qab yug me nyuam, nephroticsyndrome, rog rog; tshuaj - tshuaj tiv thaiv qhov ncauj, tshuaj estrogens, thyroid tshuaj, TSH; nrawm mus kuaj ntshav rau kev kuaj ntshav. |
Primary hypothyroidism, uas tshwm sim nws tus kheej li: autoimmune thyroiditis, endemic goiter, hlav hauv cov thyroid caj pas, tshem tawm ib feem lossis tag nrho cov qog; secondary hypothyroidism; tertiary hypothyroidism vim lub hlwb raug mob lossis o hauv hypothalamus; tsis muaj protein ntau thiab iodine kom tsawg; tshuaj - anabolic steroids, anticonvulsants, lithium npaj, tshuaj tiv thaiv qhov ncauj, overdose ntawm thyreostatics; kev sib cuag, phais, ua kom poob phaus hauv cov poj niam rog. |
| T3gen and sv |
YThyrotoxic goiter; kab mob ntawm lub caj pas, qee cov qog ntawm lub caj pas, cais T 3- toxicosis, cuam tshuam TSH synthesis, tiv thaiv cov thyroid hormones; caj pas tom qab yug me nyuam, lub raum thiab lub siab pathology, hemodialysis, hnyav nce; noj tshuaj - estrogens, levothyroxine, tshuaj tiv thaiv qhov ncauj. |
YHypothyroidism; mob hnyav, mob hlwb; noj tsis txaus protein; noj tshuaj - tshuaj antithyroid, glucocorticoids, beta-blockers, nonsteroidal anti-inflammatory tshuaj, lipid-txo cov tshuaj, qhov ncauj contraceptives, radiopaque agents. |
| TTG |
YHypothyroidism; xeeb tub; mob qog nqaij hlav; tiv thaiv cov thyroid hormones, cov hluas hypothyroidism, decompensated adrenal insufficiency, mob hnyav thiab mob hlwb, tshem tawm ntawm lub gallbladder, ua kom lub cev tseem ceeb, hemodialysis, lead lom; noj tshuaj - tshuaj tiv thaiv kab mob, neuroleptics, beta-blockers, iodides, morphine, prednisolone, radiopaque agents. |
YToxic goiter, thyrotoxicosis; ntshav tsis txaus rau lub caj pas pituitary; raug mob, tshaib plab, ntxhov siab, kev nyuaj siab, mob hlwb hnyav; noj tshuaj - T3 thiab T4, somatostatin, corticosteroids, anabolic steroids, cytostatics, beta-agonists, kho hyperprolactinemia. |
Nrog kev pab ntawm cov ntaub ntawv no, koj tuaj yeem txiav txim siab koj tus kheej cov txiaj ntsig, tab sis nws yog qhov zoo dua yog hu rau tus kws tshaj lij.
