CHAIT ntawm cov thyroid caj pas - nws yog dab tsi thiab txaus ntshai npaum li cas yog tus kab mob no? Qhov tseeb, tus kab mob no suav hais tias muaj ntau heev, thiab yuav luag txhua tus tuaj yeem cuam tshuam.
Chronic autoimmune thyroiditis ntawm cov thyroid caj pas (CHAT) yog ib qho kab mob uas tshwm sim los ntawm kev hloov pauv autoimmune. Lub cev, ua rau qee cov txheej txheem, pib tsim cov tshuaj tiv thaiv rau cov thyroid hlwb, uas maj mam ua rau lawv puas tsuaj. Tawm tsam keeb kwm yav dhau los ntawm tus mob no, kev tsim cov thyroid hormones hauv cov kab mob endocrine qeeb, ua rau cov thyroid hypothyroidism tsis tu ncua.
CHAIT ntawm thyroid caj pas - nws yog dab tsi
Tus neeg noj qab haus huv tsim kev tiv thaiv kab mob rau cov kab mob thiab cov kab mob, txawm li cas los xij, vim muaj ntau yam kev ua haujlwm tsis zoo, cov tshuaj tiv thaiv autoimmune tshwm sim. Cov laj thawj tshwj xeeb rau kev txhim kho ntawm cov txheej txheem no tseem yog qhov tsis paub, tab sis cov kws kho mob tau txheeb xyuas qhov kev sib raug zoo ntawm cov kab mob no nrog cov caj ces predisposition. Cov neeg uas muaj keeb kwm ntawm tsev neeg muaj kab mob endocrine muaj kev pheej hmoo ntau dua ntawm kev tsim cov thyroid CAI.
Vim li cas thiaj tshwm?
Cov hauv qab no muaj peev xwm ua rau muaj tus kabmob no:
- kab mob khaub thuas thiab khaub thuas;
- caries;
- Kuv muaj mob, mob siab rau tonsillitis;
- kev puas tsuaj ib puag ncig;
- kev kho mob ntev iodine;
- mob ntshav qab zib mellitus;
- radioiodine therapy;
- raug hluav taws xob;
- teeb meem kab mob ntev;
- kev nyuaj siab heev.
Risk pawg
Muaj ntau yam ua rau muaj kev hloov pauv hauv cov thyroid caj pas zoo li CAI.
- Hormonal tsis ua haujlwm. Qhov no yog vim li cas feem ntau. Hauv qhov no, diffuse hloov pauv hauv cov thyroid caj pas hauv CAI tshwm sim raws li hom kev nce ntxiv. Ntxiv mus, cov txheej txheem no tuaj yeem hloov pauv tsis sib xws thiab tsis sib xws hauv lub cev lossis nws cov ntaub so ntswg.
- Iodine deficiency. Qhov no tseem cuam tshuam qhov tshwm sim ntawm pathology. Qhov no feem ntau tshwm sim hauv qee thaj chaw ntawm qhov chaw nyob, tshwj xeeb tshaj yog nyob rau hauv cov cheeb tsam endemic. Cov neeg nyob hauv cov chaw no muaj kev pheej hmoo ntau ntxiv.
- Kev ua haujlwm tsis zoo ntawm cov kab mob autoimmune. Cov kab mob tshwm sim hauv cov hlwb ntawm cov thyroid caj pas. Cov txheej txheem no yog nrog los ntawm kev sib txawv hauv kev ua haujlwm ntawm lub cev tiv thaiv kab mob. Nyob rau hauv xws li ib tug teeb meem, nws tsis ua hauj lwm kom raug, perceives lub cev raws li txawv teb chaws. Hauv qhov no, cov tshuaj tiv thaiv yog tsim nyob rau hauv lub cev uas tawm tsam cov thyroid caj pas. Yog tias lub cev tiv thaiv kab mob ua haujlwm zoo, qhov no tsis tuaj yeem tshwm sim.
- khoom noj tsis zoo. Tawm tsam keeb kwm yav dhau los tas li tsis muaj zaub mov tsim nyoglub cev iodine ntim maj mam hloov. Yog tias ib tug neeg noj qee yam zaub mov ntev, qhov txawv txav ntawm cov thyroid caj pas tau raug sau tseg. Lawv ua rau cov hormonal hlwb tsim los ntawm qhov tshwm sim. Kev noj ntau dhau ntawm pob kws, taum pauv, taum, turnips, cauliflower thiab zaub qhwv dawb tuaj yeem pab txhawb txoj kev loj hlob ntawm pathology.
CHAIT ntawm cov thyroid caj pas feem ntau kuaj pom hauv cov poj niam hnub nyoog 40-50 xyoo. Raws li rau cov txiv neej, lawv raug rau cov kab mob no txog 10 zaus tsawg dua. Qhov tshwm sim no tau piav qhia los ntawm kev cuam tshuam ntawm cov tshuaj estrogen ntawm poj niam lub cev thiab kev mob ntawm X chromosome. HAIT suav txog li 30% ntawm tag nrho cov kab mob ntawm cov kab mob endocrine.
daim duab kho mob
CHAIT ntawm cov thyroid caj pas yog ib yam kab mob uas tuaj yeem ua rau tsis pom zoo rau lub sijhawm ntev. Maj mam, raws li tus kab mob tshwm sim, qhov ntim ntawm lub cev puas tsuaj tuaj yeem nce ntxiv, uas yog nrog los ntawm kev sib zog ntawm txoj hlab pas, cov hlab ntsha, trachea thiab paj hlwb receptors.
Lub cim tseem ceeb ntawm cov thyroid HAIT nyob rau theem no yog qhov tsis txaus siab uas muaj cov khoom txawv teb chaws hauv caj pas. Nws ua nyuaj rau tus neeg nqos, qhov mob hauv lub caj dab tuaj yeem pom nrog lub taub hau tam sim ntawd. Kev hnov mob tsis txaus siab ua rau lub sijhawm thaum lub sijhawm palpation. Tsis tas li ntawd, cov neeg uas muaj tus kab mob no feem ntau yws yws ntawm kev qaug zog, mob pob qij txha thiab cov leeg, thiab qaug zog sai heev.
Thaum pib ntawm CAITI ntawm cov thyroid caj pasthyrotoxicosis tshwm sim, uas yog tus cwj pwm los ntawm kev nce hauv qhov ntim ntawm cov thyroid hormones hauv lub cev. Cov mob no tshwm sim tawm tsam keeb kwm ntawm kev tso tawm T4 thiab T3 reserves los ntawm cov thyroid follicles puas.
Cov tsos mob ntawm thyrotoxicosis hauv CAI feem ntau yog cov xwm txheej hauv qab no:
- poob qab los;
- poob ceeb thawj;
- ntuav thiab xeev siab;
- ntshav siab;
- ntsej muag o;
- daj ntawm daim tawv nqaij;
- tawm hws ntau dhau;
- tachycardia;
- qhov muag pom.
Txoj kev ntws
Nrog CAI, thyrotoxicosis muaj ib ntus cim, thiab dhau sijhawm, hypothyroidism thiab euthyroid pathology tshwm sim. Ib qho tshwm sim zoo sib xws tshwm sim tawm tsam keeb kwm ntawm kev tuag ntawm thaj chaw loj ntawm cov thyroid caj pas - cov txheej txheem tuaj yeem siv 5-15 xyoo. Cov cim qhia ntawm T4 thiab T3 tsis muaj peev xwm tau tshaj tawm nyob rau hauv kev cuam tshuam ntawm cov teeb meem tsis zoo: kev ua haujlwm ntau dhau, kev ntxhov siab, lub sijhawm ua rau mob hnyav heev.
Thaum CAI cov tsos mob ntawm cov thyroid yog raws li hauv qab no:
- ntshav siab;
- arrhythmia;
- kev nyuaj siab, chim siab;
- ntsej muag o;
- tshee ceg lossis caj npab;
- rau tes, plaub hau poob ntau dhau;
- yuag yuag yuag yuag yuag yuag.
-
Kev faib tawm
Vim qhov peculiarities ntawm daim duab kho mob, autoimmune pathology yog conditionallymuab faib ua ob peb hom:
- Nrog latent CAIthe ntawm cov thyroid caj pas, tsis muaj cov tsos mob tshwm sim. Lub cev nws tus kheej yog qhov loj me lossis loj me ntsis, kev ua haujlwm tsis cuam tshuam.
- Hom hypertrophic ntawm CAITI ntawm cov thyroid caj pas yog nrog los ntawm kev hloov pauv uas npog lub cev puas, lossis tsim cov pob hauv nws cov ntaub so ntswg. Kev sib xyaw ntawm nodular thiab diffuse goiter yog qhov zoo heev. Nrog rau daim ntawv hypertrophic ntawm HAIT, kev ua haujlwm ntawm cov thyroid caj pas, raws li txoj cai, tsis raug kev txom nyem. Tsis tshua muaj heev, thyrotoxicosis tau kuaj pom nyob rau theem pib, uas nws thiaj li ntws mus rau hauv hypothyroidism.
- Atrophic ntau yam ntawm CAITS tsis ua rau qhov loj ntawm cov thyroid caj pas. Daim duab kho mob yog tus cwj pwm los ntawm cov tsos mob ntawm hypothyroidism. Qhov ntau yam no suav hais tias yog hom kab mob hnyav tshaj plaws, feem ntau kuaj pom hauv cov neeg laus thiab cov ntxhais hluas tom qab kho radioiodine.
Phases of HAIT
Kev txhim kho ntawm cov kab mob no tuaj yeem muab faib ua ob peb theem nrog cov tsos mob xws li:
- Euthyroid theem - qhov kev ua haujlwm ntawm cov thyroid caj pas tseem nyob, tus neeg tau xyaum tsis muaj cov tsos mob ntawm tus kab mob, lub xeev ntawm kev noj qab haus huv tseem zoo ib yam.
- theem subclinical yog tus cwj pwm los ntawm kev nce hauv cov thyroid-stimulating hormones los ntawm lub caj pas pituitary. Lawv, nyob rau hauv lem, pab mus nce zus tau tej cov T4 thiab T3, vim hais tias tus nqi ntawm thyroxine nce mus txog ib txwm theem.
- theem thyrotoxic yog tus cwj pwm los ntawm cov tsos mob ntawm thyrotoxicosis. Nyob rau hauv cov hlab ntshantau cov thyroid follicles puas lawm, uas txuas ntxiv tsim cov tshuaj hormones. Nyob rau tib lub sijhawm, lub cev tiv thaiv kab mob pib tsim cov tshuaj tiv thaiv kab mob ntau ntxiv, uas ua rau CAI hnyav dua.
- theem hypothyroid tshwm sim tawm tsam keeb kwm ntawm T4 thiab T3 tsis txaus. Muaj kev hloov pauv hauv cov thyroid caj pas raws li hom HAIT, nws cov haujlwm ua haujlwm qeeb, thaj tsam ntawm cov qog nqaij hlav qis. Cov theem no tuaj yeem kav ntev tshaj li ib xyoos, tom qab ntawd cov haujlwm ntawm lub cev cuam tshuam stabilizes. Txawm hais tias qee kis tus mob no tuaj yeem nyob mus ib txhis.
CHAIT muaj peev xwm ntws los ntawm ib daim ntawv mus rau lwm qhov lossis pom nws tus kheej tsuas yog cov cim qhia ntawm hypothyroidism thiab thyrotoxicosis. Qhov hnyav ntawm cov tsos mob ntawm pathology yog txiav txim los ntawm lub hnub nyoog ntawm tus neeg mob thiab lub xub ntiag ntawm concomitant ailments.
Diagnosis of HAIT
Ua ntej tshaj plaws, tus neeg mob tau kuaj thiab nug los ntawm tus kws kho mob endocrinologist, tom qab ntawd nws palpates cov thyroid caj pas thiab sau tag nrho cov keeb kwm tsim nyog. Thaum lub sij hawm txoj kev tshawb no, ib tug nce nyob rau hauv lub ntim ntawm lub cev, nws compaction, tsim ntawm nodes, mob nyob rau hauv lub caj dab sab yuav raug kuaj pom.
Nrog kev pab los ntawm kev kuaj sim rau qhov concentration ntawm cov thyroid hormones, nws muaj peev xwm txiav txim siab theem ntawm CAITI. Nrog thyrotoxicosis, theem ntawm T4 thiab T3 yuav nce ntau zaus, thiab TSH tseem nyob rau hauv ib txwm muaj. Cov theem hypothyroid pib nrog qhov txo qis ntawm thyroxine, nrog rau kev nce lossis ib txwm ntawm cov thyroid-stimulating hormone.
ELISA kev ntsuam xyuas tso cai rau kuaj cov tshuaj tiv thaiv rau thyroproxidase, colloidalantigens, thyroglobulin, thyroid cov ntaub so ntswg. Cov txiaj ntsig ntawm cov ntshav suav ua tiav qhia tau tias muaj cov lymphocytes ntau ntxiv thiab txo qis ntawm leukocytes.
Qhia meej txog kev kuaj mob
Ultrasound yog ua los txiav txim seb tus mob thiab qhov loj ntawm cov thyroid caj pas. Yog hais tias muaj cov ntsaws ruaj ruaj nyob rau hauv nws, ib tug fine-needle aspiration biopsy yog ua, uas yuav tsum tau mus kawm cov ntaub so ntswg ntawm node thiab kuaj qog hlwb.
Kev kuaj mob tuaj yeem lees paub los ntawm kev kuaj xyuas cov tshuaj tiv thaiv ATPO, cov tsos mob ntawm hypothyroidism, thiab thyroid hypoechogenicity.
Ntxiv rau, kev kuaj mob sib txawv ntawm autoimmune pathology ntawm Riedel's goiter, nodular goiter, kab mob qog noj ntshav thiab de Quervain's thyroiditis yog xav tau.
Kev Kho CAITS ntawm cov thyroid caj pas
Kev kho tshwj xeeb yog xav tau tsuas yog nyob rau theem thyrotoxic thiab hypothyroid theem ntawm tus kab mob. Tseeb tiag, nyob rau hauv lub subclinical thiab euthyroid theem, cov thyroid caj pas tseem zoo li qub, tus neeg tsis hnov qhov tsis xis nyob.
Nrog rau kev nce siab ntawm cov thyroid hormones, tus neeg mob tsis tau tshuaj thyreostatics, uas inhibit qhov ntau lawm ntawm T4 thiab T3, txij li thawj qhov ua rau ntawm qhov teeb meem yog twv yuav raug hu tsis yog hyperfunction ntawm cov thyroid caj pas. Hypothyroidism yog kho nrog thyroxine analogues. Cov tshuaj kws tshaj lij tshaj plaws yog "L-thyroxine" thiab "Levothyroxine". Kev kho tshuaj hormone yog nqa tawm tshwj xeeb hauv kev saib xyuas ntawm tus kws endocrinologist. Nws yog ib qho tseem ceeb heev uas yuav tau soj ntsuam cov ntshav rau qib tshuaj hormones. Qhov ntau npaum li cas yog xaiv raws liNyob ntawm tus kheej, nyob ntawm lub hnub nyoog ntawm tus neeg mob, nws qhov hnyav, kev noj qab nyob zoo, nrog rau qhov muaj qhov tsis xws luag hauv cov hlab plawv.
Txoj Kev Kho Mob
Txhawm rau txo cov tshuaj tiv thaiv kab mob, cov kws kho mob feem ntau sau cov tshuaj adaptogens thiab tshuaj tiv thaiv kab mob. Cov tshuaj uas tsis yog-steroidal anti-inflammatory xws li Nise, Diclofenac thiab Nurofen tuaj yeem txo qhov mob thiab txo qhov mob. Yog tias HAIT txuas ntxiv nrog rau cov thyroiditis subacute, glucocorticoids tau siv - Dexamethasone thiab Prednisolone. Yog tias qhov kev ua ntawm lwm yam kabmob thiab lub cev raug cuam tshuam, kev kho mob tau ua tiav.
Yog tias cov thyroid caj pas loj hlob sai heev, ua rau lub siab nyob ze, nyob txawv txav, lossis muaj ntau qhov loj heev, tus neeg mob tau teem sijhawm rau kev phais, uas yuav tshem tawm ib feem lossis ua tiav ntawm lub cev puas tsuaj.
xov xwm ntxiv
CHAIT ntawm cov thyroid caj pas feem ntau yog tus cwj pwm los ntawm kev kawm nce qib. Muab hais tias kev txhawb nqa kev kho mob tau ua tiav raws sijhawm, qhov sib npaug hormonal tau rov qab los thiab tag nrho cov lus qhia ntawm tus kws kho mob endocrinologist tau ua raws, kwv yees li 85% ntawm tag nrho cov xwm txheej muaj peev xwm ua tiav qhov txiaj ntsig zoo thiab lub sijhawm ntev ntawm kev tshem tawm.
Lub peev xwm ua haujlwm ntawm cov neeg uas raug mob los ntawm subclinical hom CAI tau khaws cia tsawg kawg 20 xyoo tom qab pib tus kabmob. Yog tias tus neeg mob tsis tau txais kev kho mob txaus, muajIb daim ntawv tsis tu ncua ntawm hypothyroidism, muaj kev sib txawv hauv kev ua haujlwm ntawm cov hlab plawv thiab cov hnyuv, ntshav qab zib mellitus tshwm.
