Stehlwag cov tsos mob yog ib qho ntawm cov tsos mob ntawm hyperthyroidism. Tus kab mob no cuam tshuam nrog kev nce hauv hormonal kev ua haujlwm ntawm lub qog. Nrog rau cov thyroid lossis endocrine ophthalmopathy (EOP), uas yog, "qhov muag" cov tsos mob ntawm diffuse toxic goiter (DTG), qhov muag pom tshwm sim hauv daim duab kho mob: Graefe, Moebius, Stelvag, Krauss, Kocher, Delrymple, Jellinek, tsawg dua Rosenbach, Botkin. Ophthalmic ntshawv siab tshwm sim hauv 20-91.4% ntawm cov neeg mob. Cov duab intensifier tuaj yeem yog lub teeb, nruab nrab thiab hnyav hauv degrees.
Grefe's symptom
Nws tau qhia nyob rau hauv qhov tseeb tias thaum saib hauv qab, daim tawv muag sab sauv rov qab, thiab ib daim hlab ntawm sclera pom. Qhov tshwm sim no tshwm sim vim hais tias lub suab ntawm cov leeg uas tswj daim tawv muag tau nce, nyob rau hauv kev cuam tshuam ntawm ntau tshaj T3 thiab T4 hauv cov ntshav.
Los ntawm txoj kev, cov tsos mob no tsis tas mus li. Nws kuj tseem tuaj yeem tshwm sim hauv cov neeg noj qab haus huv uas muaj myopia (zes pom).
Mobius symptom
tshwm sim vim tsis muaj zog ntawm cov leeg ntawm qhov muag. Nyob rau tib lub sijhawm, kev sib koom ua ke tsis muaj zog, thiab tus neeg poob lub peev xwm los kho nws qhov muag ntawm cov khoom nyob ze. Nws tshwm sim hauv cov neeg noj qab haus huv.
Stellwag Syndrome
Stelvaga cov tsos mob yog qhov tsis tshua pom kev. Vim wrinkling (retraction) ntawm daim tawv muag sab sauv thiab protrusion ntawm lub qhov muag, lub tswv yim ntawm ib tug nce nyob rau hauv lub palpebral fissure yog tsim. Cov tsos mob ntawm Stelwag, uas feem ntau tshwm sim nrog hyperthyroidism thiab suav tias yog ib qho ntawm nws qhov tshwm sim, tsis tshwm sim hauv txhua tus neeg mob. Tsis tas li ntawd, cov tsos mob tseem tuaj yeem tshwm sim hauv qee cov kab mob hauv lub hlwb - Parkinson's disease, postencephalitic parkinsonism, akinetic-rigid syndrome (extrapyramidal phenomenon of parkinsonism), Tswb's palsy. Cov lus piav qhia ntawm daim paib no tau tsim los ntawm tus kws kho qhov muag ntawm Austria, Karl Stelwag.
Cov tsos mob ntawm Stelwag yog dab tsi? Qhov no yog qhov tsis tshua pom kev (tsawg dua 3 zaug hauv ib feeb), uas yog suav tias yog ib qho cim ntawm kev txo qis ntawm lub pob txha. Tus neeg mob lub ntsej muag zoo li tsis muaj zog, khov.
Vim li cas cov tsos mob no tshwm sim
Kev txhais cov tsos mob ntawm qhov muag yog qhov nyuaj vim tias lub tshuab tsis nkag siab tag nrho. Nws tau hais tias nrog pathologies ntawm cov thyroid caj pas nyob rau hauv lub orbit, o ntawm cov leeg thiab cov nqaij mos tshwm sim. Lawv thawb lub pob muag mus rau pem hauv ntej thiab ua rau muaj ntau yam tsos mob ntawm qhov muag - ib qho laj thawj ntxiv.
Tam sim no, nws tau raug pov thawj tias exophthalmos yog tshwm sim los ntawm cov kab mob pathological m. orbitalis (müllerian leeg). Yog li ntawd, kev loj hlob ntawm retrobulbar fatty ntaub so ntswg,expansion ntawm orbital leeg thiab cov hlab ntsha tsis ua lub luag haujlwm. Qhov no yog pov thawj los ntawm qhov tsis muaj kev hloov pauv hauv cov nyiaj.
Thib ob, qhov kev lees paub tseem ceeb ntawm qhov kev xav no yog tias exophthalmos tuaj yeem tshwm sim hauv ob peb teev. Qhov no yog vim irritation ntawm lub ncauj tsev menyuam sympathetic paj hlwb. Nws ua rau ib tug ntse txo m.orbitalis. Muaj ib daim npog qhov muag tom qab thiab, zoo li nws tau, thawb nws mus tom ntej.
Ntxiv rau, cov hlab ntsha thiab cov hlab ntsha lymphatic dhau los ntawm cov leeg no, thiab thaum cov leeg nqaij dheev sib cog lus, lawv raug nyem, thiab cov lus teb yog o ntawm daim tawv muag thiab qhov chaw retrobulbar. Ntawm no yog ib qho kev piav qhia ntxiv ntawm qhov pathogenesis. Puffy ob lub qhov muag nrog thyrotoxicosis yuav tsis tshwm sim, qhov no kuj tshwm sim.
Ncua ntsais muag (Stelwag cov tsos mob), qhib dav ntawm palpebral fissures (Delrymple cov tsos mob), thiab qhov tshwj xeeb ci ntawm lub qhov muag yog vim muaj cov leeg nqaij ntawm pob txha pob txha ntawm daim tawv muag. Thiab, thaum kawg, nyob rau hauv hyperthyroidism, ntxiv rau autoimmune o ntawm lub qhov muag, cov kev ua ntawm lub sympathetic-adrenal system yog nce. Nws, nyob rau hauv lem, ntxiv dag zog rau lub suab ntawm cov nqaij ntshiv uas nqa lub sab sauv daim tawv muag. Tab sis tag nrho cov txheej txheem ntawm cov kab mob neurohormonal cuam tshuam nrog cov tsos mob ntawm qhov muag tsis tau nthuav tawm tag nrho hnub no.
Puas yog lawv lub ntsej muag yuav tsum
Tsis yog txhua qhov muag pom ntawm DTG tuaj yeem tshwm sim hauv ib tus neeg mob. Ntau dua li lwm tus:
- Graefe, Ekrot, Kocher, Dalrymple - nrog rau lawv, kev ua haujlwm ntawm daim tawv muag sab sauv yog qhov tsis zoo.
- Jaffe thiab Geoffroy cov tsos mob, Rosenbach cov tsos mob, Stellwag cov tsos mob cuam tshuam nrog neurogenicyam.
- Moebius, Wilder tsos mob vim qhov muag tsis pom kev.
Tab sis qhov no tsis tau txhais hais tias qhov muag kos npe yuav tsum tau rau goiter. Tej zaum lawv yuav tsis tuaj tag nrho. Yog li ntawd, nws yog qhov tsis ncaj ncees lawm los txiav txim siab lawv ua qhov tshwm sim ntawm qhov hnyav ntawm DTG. Hauv thyrotoxicosis hnyav, lawv yuav tsis tshwm sim.
Kev kho mob
Vim li cas thiaj yuav tsum kho qhov muag tsos mob? Qhov tseeb yog tias lawv tsis tsuas yog hloov cov tsos mob ntawm tus neeg mob (qhov phem dua), tab sis kuj cuam tshuam tsis pom kev, ua rau nws txo qis, conjunctivitis, subluxation ntawm lub qhov muag, mob qhov muag thiab tsis xis nyob. Kev kho mob zoo rau qhov tseeb cov tsos mob no tsis tau tsim hnub no.
Kev kho mob ntawm Stelwag cov tsos mob thiab lwm yam kev tshwm sim qhov muag muab cov txiaj ntsig tsuas yog nyob rau theem nquag ntawm goiter. Thaum cov txheej txheem inflammatory tshwm sim, qee zaum nws yog ib qho tsim nyog los siv kev cuam tshuam kev phais.
Kev kho qhov muag cov tsos mob feem ntau yog pathogenetic thaum tshem tawm. Hauv lwm lo lus, nws yog kev tiv thaiv qhov muag. Nws tuaj yeem yog kev kho mob, txhawb nqa lub cev thiab kev phais, txawm tias nyob rau hauv daim ntawv ntawm hluav taws xob. Kev npaj tsim kua muag yog qhia rau txhua tus neeg mob ("Hilo-comod", "Vizomitin") los yog moisturizing gels ("Oftagel", "Korneregel").
Tab sis qhov tseem ceeb tshaj plaws yog kev kho mob goiter nws tus kheej. Mild EOP feem ntau tsis tas yuav kho. Hauv cov ntawv nruab nrab thiab hnyav, glucocorticoid steroids (Prednisolone, Metipred) thiab kev kho hluav taws xob tau siv.
"Prednisolone" tau muab tshuaj rau lub sijhawm ntev thiab siv tshuaj ntau. Raws li qhov xwm txheej zoo duakoob tshuaj maj mam txo. Qhov txiaj ntsig zoo dua yog siv cov tshuaj parenterally, mus rau hauv cov hlab ntsha. Nws yog nqa tawm mus tas li. Irradiation ntawm lub orbits tsuas yog siv los ua ib qho ntxiv rau cov tshuaj. Kev tiv thaiv ntawm exophthalmos kuj yog nyob rau hauv kev kho mob raws sij hawm ntawm thyrotoxicosis.
