Thyrotoxicosis bụ ọrịa a na-ahụ maka ịmịpụta oke nke homonụ thyroid. Ruo ugbu a, njikọta usoro a na ụkọ insulin dị ụkọ. Dabere na ọnụ ọgụgụ, site na 2 ruo 6% nke ndị ọrịa na-arịa ọrịa shuga na-arịa ọrịa thyrotoxic.
Ọtụtụ nnyocha egosila na ọrịa shuga na-apụta na 7.4% nke ndị ọrịa nwere thyrotoxicosis, ma mụbaa ọrụ thyroid na naanị 1% nke ndị nwere insulin.
Dịka ị siri hụ, ọrịa shuga nwere ike ibido ngwa ngwa karịa thyrotoxicosis ma ọ bụ gaa n'ihu megide nzụlite ya, nke dị ụkọ. Ọzọkwa, ọrịa abụọ ahụ nwere ike ịmalite na ahụ onye ọrịa n'otu oge.
Otutu ndi nyocha ihe a choputara na ihe otutu eji ara acho ihe n’enwe insulin. N'ime ndị mmadụ na-arịa ọrịa nke thyroid gland, a chọpụtara ụdị shuga ụdị usoro. N'ime ha:
- 10% nwere ọrịa shuga mellitus;
- na 17% ọ malitere na latent ụdị;
- na 31%, a na-enyocha enyocha nnabata nke glucose.
Ọ bụ ihe e ji mara na ọgwụgwọ ịwa ahụ nke thyrotoxic goiter ga-emetụta metabolism nke carbohydrate n'ụzọ dị mma ma nwee ike itinye aka na nhazi ya.
Ọ bụrụ na nke a emeghị, mgbe ahụ na nke a anyị nwere ike ikwu na thyrotoxicosis mepụtara ọtụtụ oge karịa ọrịa shuga.
Ọ bụrụ na a kọwara ọrịa mkpụrụedemede thyroidic gluelluria na hyperglycemia naanị tupu ọrụ ahụ, mgbe ahụ, ndị ọrịa nwere thyrotoxic goiter pụtara na nsogbu nwere insulin mgbe ọwachara akwara thyroid agaghị akwụsị inwe mmetụta nke ọrịa shuga.
Ebumnuche maka mmepe nke pathology
Mgbe mgbanwe dị iche iche na usoro ahụ ji alụso ọrịa ọgụ ebilite megide ọrịa shuga mellitus, akụkụ a nwere ike ịkọwa usoro a site na echiche nke immunology. Agbanyeghị, a mụbeghị pathogenesis na etiology nke thyrotoxicosis nke ọma.
Ogologo oge, ekwenyere na isi ihe kpatara ọnọdụ na mmepe nke ma ọ bụ nsi (ọrịa nke basedova) bụ ọrịa thyrotoxicosis, bụ nke ihe kpatara ụbụrụ na-akpata.
Na mgbakwunye na nrụgide na mmetụta na-emerụ ahụ ya, a na-ewe iwe nke thyrotoxic goiter:
- mkpụrụ ndụ ihe nketa;
- emeputa homonụ mmekọahụ nke ezughi oke;
- ọrịa ndị pụrụ iche na-efe efe (ụkwara nta, flu).
Na mgbakwunye, ọrịa ahụ na-atụle, na mgbakwunye na nke na-agbasa goiter, enwere ike ịhụ ya na iodine n'ime ahụ, thyrotoxic adenoma, trophoblastic neoplasms na-emepụta chorionic gonadotropin, polynodous na-egbu egbu goiter, mụbara ihe nzuzo nke TSH (homonụ na-akpali akpali thyroid), subacute na fibroids thyroid, .
Nkewa di iche-iche kewaputara thyrotoxic goiter dika ihe aruputara oria ahu. N'okwu a, a na-ahụba ọrịa lymphocytic nke gland na ọgụ nke sistem. Usoro a na-egosiputa n'ọdịdị dị n'ọbara ọbara nke ụfọdụ onwe na-anabata ndị na-anabata TSH na T-lymphocytes.
A nabatara ya na inye ihe na-egbu egbu bụ ihe mepụtara polygenic multifactorial pathology. Ọtụtụ mgbe ọ na-etolite n'okpuru ọtụtụ ihe metụtara gburugburu ebe obibi. Ọnọdụ ndị a nwere ike ịbụ ọnọdụ nrụgide, ọrịa na ọgwụ.
Usoro nke ịgbalite sistemu na - alụso ọrịa ọgụ na - apụta na nzụlite mmepụta nke ọgwụ B-lymphocytic na - anabata ndị na - anabata mkpụrụ akụ. Ha na-e mimomi arụmọrụ nke TSH eke, nke na-eduga n'ịhazi ntọhapụ nke homonụ thyroid n'ime n'ọbara na ngosipụta nke goiter na-egbu egbu.
Ihe nzuzo nke ọgwụ ndị na-akpali akpali nke na-emetụta akwara thyroid na-akpata goiter.
N'ime akwụkwọ ahụike nwere ọtụtụ nkọwa dị iche iche maka usoro ọdịda nke metabolism metabolism n'ihe metụtara thyrotoxicosis. Ya mere, ụfọdụ ndị dọkịta kwenyere na thyroxine na-eme ka mmiri ọgwụ insulin dịkwuo elu ma na-eme ka ọzịza nke carbohydrates dịkwuo elu.
Site na ịba ọcha n'anya nke ogologo oge, ngwa nke mmadụ na-ebelata ike, mgbanwe mgbanwe nke ọrịa na - ebute shuga dị elu na ketoacidosis mgbe niile.
Dabere na ndị dọkịta ndị ọzọ, mmepe nke thyrotoxicosis na nsogbu insulin na-emetụta mmepụta oke nke homonụ steroid na arụ ọrụ ezughị ezu nke usoro ọmịiko-adrenal.
Ọ bụ ihe kwesịrị ịrịba ama na ụdị usoro ahụ a na-ahụ nke ọma mgbe ọrịa shuga na-agbakọ.
Njirimara nke thyrotoxicosis
Ejikọtara usoro ejikọtara ọnụ nke mgbanwe akwara na akwara thyroid site na ihe akaebe na-egosi na otu n'ime ihe dị tupu usoro a:
- ọzịza
- oria
- nchekasị uche.
Ọzọkwa, n'afọ ndị na-adịbeghị anya, a marala eziokwu na thyrotoxicosis na ọrịa shuga mellitus bụ otu ọrịa pathogenesis - autoimmunization. Achọpụtara na ọgwụ nje HLAB8 nwere otu ugboro na - apụta n'etiti ndị ọrịa shuga na - enweghị insulinathic na - arịa ọrịa idiopathic ma na-agbasa ihe na-egbu egbu.
Ọ bụrụ na a na-ejikọ thyrotoxicosis na ọrịa shuga, mgbe ahụ ọrịa abụọ ahụ na-aka njọ n'otu oge. Ọkpụkpụ nke nguzogide ọgwụ insulin na enweghi afọ ojuju.
Iji kwụọ nsogbu maka ọ̀tụ̀tụ̀ shuga dị n'ọbara ya na ọgwụ a jikọtara ọnụ, a na-achọ iji insulin eme ihe nke ukwuu karị n'ihi mmụba nke mmiri ọgwụ na-akpata ịba ụba.
Onye ọrịa a pụrụ iche nwere nsogbu nke ketoacidosis, nna ochie ma ọ bụ ọrịa shuga. N'okwu a, ubara insulin kwa ụbọchị kwesiri ịbawanye 25 ma ọ bụ ọbụna 100%. Ọzọkwa, mmadụ kwesịrị ị attentiona ntị n'eziokwu ahụ bụ na na decompensation nke ọrịa shuga n'ihi mgbakwunye nke thyrotoxicosis, mmepe nke "akwara afọ" ma ọ bụ vomiting nke ụdị "kọfị kọfị" ga-ekwe omume. N'ọnọdụ dị otú ahụ, dọkịta nwere ike imehie ihe ma depụta ọgwụ laparotomy.
Achoputara na oria shuga na-agbari oke oge obula na-enye aka nmalite na mmepe nke nsogbu nsogbu nke thyrotoxic. Mgbe ejikọtara na coma na-arịa ọrịa shuga, enwere nnukwu ihe ize ndụ na ndụ onye ọrịa, n'ihi na njirimara nke ọrịa ndị a nwere nnukwu nsogbu. Site na foto a, nchọpụta ọrịa siri ike.
Yabụ, ịmalite, ọ dị mkpa iji wepu onye ọrịa ahụ n'ọgba aghara, n'ihi na ọgwụgwọ coma na-arịa ọrịa shuga agaghị ewetara ebumnuche eburu n'uche, ọ bụrụgodi na-eji insulin homonụ nke ukwuu.
Site na 8 ruo 22% nke ndị ọrịa nwere ọnya na-ezute ga-ata ahụhụ site na njigide akara nke thyrotoxicosis.
Ọ bụrụ na thyrotoxicosis adịghị agbakọ, mgbe ahụ na nke a, enwere ike ịhụ glucosuria na hyperglycemia mgbe ụfọdụ. Ha nwere ike ibute nsogbu na ịchọpụta ọrịa shuga.
N'ọnọdụ ndị a, ekwesịrị ịchọpụta nchọpụta ọdịiche nke thyrotoxicosis na ọrịa shuga mellitus site na nyochaa oge wedata ọkwa shuga n'okpuru ọnọdụ nke glucose.
Kedu ihe ọghọm nke thyrotoxicosis na-arịa ọrịa shuga?
Ndị dọkịta lebara anya na ndị ọrịa nwere ọrịa shuga na-arịa obere thyrotoxicosis. Ọ bụrụ na-amatabeghị ma nabata ọrịa shuga thyrogenic, yabụ nke a dị oke mkpa
- na-eduzi ịwa ahụ;
- isonye na oria concoitant.
Mmepe nke akpịrị sitere na ketoacidosis mgbe a rụchara ọrịrị thyroid nwere ike ime ka ohere nke ndị ọrịa nwere ọrịa shuga na-arịa ọrịa na-adịghị ala ala ma ọ bụ nke amaghị.
Eterchọpụta ọbara shuga n’afọ na-enweghị ihe ọ bụla iji nyocha ya nke onye ọrịa nwere thyrotoxic goiter bụ iwu n’okpuru ọnọdụ ọ bụla.
Ọ dịghị ihe dị ize ndụ mgbe nchọpụta nke thyrotoxicosis na ndị ọrịa mamịrị emeghị. Ndị dọkịta kwesịrị ịmụrụ anya:
- Ibelata oke ibu;
- oke iwe;
- ịatingụbiga mmanya ókè;
- ịba ụba nke ọrịa shuga ugboro ugboro dabere na nri yana usoro nke ọgwụ iji belata shuga.
Site na oge ngbanwe nke thyrotoxicosis bilitere, mgbaàmà ndị a na-arịa ọrịa shuga ga-amalite ịjụ oyi. N'ọnọdụ a, ihe ịrịba ama nke ụkọ insulin ga-amalite ịbawanye ngwa ngwa na onye ọrịa ahụ nwere ike daba adaba. Ọzọkwa, ọ bụrụ na usoro mkpali na-adịgide karịa izu ise, ihe mgbaàmà nke thyrotoxicosis ga-amalite imekpa onye ọrịa ahụ ihe karịa. Ọkwa ọbara mgbali ga-aghọ nke akwụghị chịm, na-enwe mmụba. Ahụ ike ga-aghọ arrhythmic na kpụ ọkụ n'ọnụ.
Mgbe ị na-enyocha ọbara maka ọdịnaya nke thyroxine, ayodiin na catecholamine dị na ndị dị otú ahụ nwere ọrịa jikọtara ọnụ, a ga-eme ka ọ pụta na na mmalite nke mmepe nke usoro nje, ịta ahụ nke thyroxine belatara. Ọ bụrụ na usoro na-efe efe ahụ dị ogologo oge, mgbe ahụ, a na-eme ka mmiri ọgwụ ahụ sikwuo ike site na mbelata nke triiodothyronine na protein nwere njikọ. N'otu oge ahụ, nchịkọta nke norepinephrine na adrenaline na-abawanye nke ọma.
Doctorsfọdụ ndị dọkịta kwenyere na ịdị ike na ogologo oge nke thyrotoxicosis ga-adabere n'ịdị njọ nke nsogbu nke endocrine pancreatic ngwa. Agbanyeghị, ndị dọkịta ndị ọzọ na-arụ ụka na ndị ọrịa nwere nnukwu thyrotoxicosis nwere ike ịnwe ụdị ọrịa shuga dị nro. Site na thyrotoxicosis dị nro, ụkọ insulin ga-amalite.
Ọgwụgwọ nke thyrotoxicosis
Site na ngwakọta nke thyrotoxic goiter na ọrịa shuga, nke na-arọ ibe gị, a na-egosi ntinye ịwa ahụ na gland thyroid n'agbanyeghị ogo nke pathology.
Ọnọdụ nke mbụ maka iwelata ihe egwu dị n’ọrụ ga-akwagide nkwụghachi maka ọrịa shuga yana idozi ọrụ thyroid. Suchdị data ahụ ga-egosi ụgwọ:
- mbelata nke mgbanye glucose na 8.9 mmol / l;
- nhazi nke metabolism nke electrolyte na CBS;
- mkpochapu nke ketonuria na glucosuria.
Ọ dịkwa mkpa iji belata ngụkọta metabolism dị n’ahụ n’ime ihe ruru 10%, mee ka ahụ gị ghara ịdị gara gara, kwụsị inwe ọrụ ya, ihi ụra n’ezie, mee ka onye ọrịa bukwuo ibu. Ọ bụrụ na emezuru ọnọdụ ndị a, mgbe ahụ onye ọrịa ahụ adịla njikere maka ịwa ahụ na gland thyroid.
N'ihi mmebi nke ọrụ nkịtị nke imeju (protein, antitoxic), mgbanwe na microelement na macroelement mejupụtara ọbara, ihe gbasara obi, akwara umeji, ịba ụba ugboro ugboro nke ọrịa shuga, ọbara mgbali elu na mgbagwoju anya nke thyrotoxicosis, ịkwadebe maka ịwa ahụ nwere ike igbu oge maka oge 8 ruo izu iri na abụọ.
Ekwadoro ịoụ ọgwụ ga - eme ka akparamagwa ndị ga - eme atụmatụ ibido afọ onye ọrịa, ogo nke ihe ịrịba ama nke ọrịa ahụ, ogo ọnụọgụ ọnya na ogo ịbawanye na gland thyroid. A na-ejikarị ya maka ebumnuche ndị a:
- ndị na - egbochi beta;
- ogige ayodiin;
- carbonate lithium;
- thyreostatics.
Na palpation na mpụga, a ga-achọpụta mbelata nke nha na ogo nke gland. N'oge ịwa ahụ, akụkụ ahụ na-agba obere nke ukwuu.
Agbanyeghị, ayodiin enweghi ike iji ya ogologo oge. Mgbe ihe dị ka izu abụọ gasị, njiri nke mgbochi nke mmepụta homonụ ga-akwụsị.
Maka ọgwụgwọ nke thyrotoxic goiter, a na-eji lithium carbonate na olu nke 900 ruo 1200 mg kwa ụbọchị. Akụrụngwa na-enyere aka mee ka akpụkpọ ahụ nke gland dịkwuo ala, ma belata mmetụta na-akpali akpali nke TSH na ọgwụ mgbochi mkpali. Na mgbakwunye, ntinye nke homonụ nke T na T4 n’ime ọbara ọbara na-ebelata.
Ọ bụrụ na onye ọrịa ahụ anabataghị thyreostatics na ụdị thyrotoxicosis dị nro, mgbe ahụ a na-eme ọgwụgwọ ahụ ruo ọnwa 2-3. Ọ bụ n'oge a ka mmetụta mgbochi nke lithium carbonate na arụ ọrụ nke akwara thyroid kpamkpam na-apụ n'anya.
N'ọnọdụ ụfọdụ, oge ọgwụgwọ ga-agbago ruo afọ 1.5. Amachibidoro ịdebere ndị ọrịa nwere thyrotoxic goiter nkwadebe, ma ọ bụrụhaala na a na-enweta ọgwụ euthyroidism na thyreostatics n'ihi nnukwu ihe ọghọm nke mmalite nlọghachị.
