Cov tsos mob rau cov me nyuam tshiab uas mob Congenital hypothyroidism

Hauv tsab xov xwm no koj yuav kawm:

Kab mob Congenital hypothyroidism feem ntau pom tias yog menyuam yaus thiab nws qhov tshwm sim yog feem ntau tsis tuaj yeem. Txawm li cas los xij, ib qho kev xaiv raug tsim nyog koob tshuaj levothyroxine rau kev hloov kho hloov kiag li tshem tawm cov txiaj ntsig ntawm kev mob ntawm lub nruab nrog cev ntawm lub cev.

Cov Ua Rau Congenital Hypothyroidism

Lub ntsiab yog:

Qhov tsis / tsim ntawm qog ua cov thyroid caj pas vim caj ces,
Kev ntshawb rau hauv cov caj ces hauv biosynthesis cov thyroid hormones,
Kev tsis muaj lossis ntau tshaj ntawm iodine nyob rau hauv tus poj niam cev xeeb tub txoj kev noj zaub mov tuaj yeem ua rau hypothyroidism hauv tus menyuam yug tshiab,
Ntau dhau ntawm cov thio thiab isocyanates, nrog rau cov cyanogenic glycosides, hauv kev noj haus. Nws yog ib txwm coj los hu cov tshuaj no rau hauv kev kho mob ib puag ncig strumogenic thiab lawv muaj nyob hauv qhov zoo tib yam, Zaub pob zaub thiab zaub paj, canola, turnip, qos yaj ywm qab zib ... Daim ntawv tuaj yeem txuas ntxiv, tab sis qhov no tsis txhais hais tias txhua lub sijhawm thaum cev xeeb tub cov khoom no yuav tsum tau muab cais tawm ntawm kev noj haus. Nws tau tsis txaus kom haus rau lawv hauv qhov ntau ntau,
Tsis tshua muaj txiaj ntsig, kev siv rau iodine cev xeeb tub noj los ntawm tus poj niam cev xeeb tub. Txij li ntawm 10-12 lub lis piam, tus me nyuam cov thyroid caj pas twb tau khaws iodine ntau, suav nrog rau hauv xov tooj cua,
Cov tsis tshua muaj thiab tsawg kawg tau cog lus kho tus kab mob Congenital hypothyroidism yog txoj kev kho mob ntawm cov thyroid hormones txaus receptors. Hauv qhov no, muaj ntau TSH, thiab T3, thiab T4 hauv cov ntshav, tab sis tseem hypothyroidism tseem pom. Tsuas yog ob puas tsev neeg uas muaj hom mob Congenital hypothyroidism no tau piav qhia.

Congenital hypothyroidism, yog tsim hauv menyuam yaus, feem ntau hu ua cretinism. Tseeb, qhov tsis muaj cov thyroid hormones txaus ua rau kev loj hlob ntawm lub siab-kev xav ntawm ib tug neeg. Myxedema tau hais kom nyob rau hauv kev mob hypothyroidism loj heev, suav nrog rau cov kabmob thaum yug los, thaum tus yam ntxwv hypothyroid lossis myxedema edema txhim kho.

Kev kuaj mob

Cov tsos ntawm tus me nyuam yug tshiab yog li xeeb ceem hais tias tus kws paub txog neonatologist qhia txog kev kuaj mob ua ntej ntawm kev soj ntsuam yooj yim:

Lub loj ntawm cov me nyuam yug los yog saum toj ib txwm los yog nyob rau ntawm nws sab sauv,
Kev o ntawm taw, tes, lub ntsej muag yog pom. Qhov ua tau tawv nqaij ntawm tus menyuam tau sib txig sib luag thaum sib piv nrog lwm cov menyuam tshiab,
Thaum kov, ib qho kev tso siab qis ntawm lub cev tsis tau xav txog,
Ib tug menyuam yaus nrog mob ntsws hypothyroidism yog qhov ua haujlwm qeeb, quaj me ntsis, qhov nqus ntawm lub cev tsis muaj zog, uas feem ntau tsis meej pem nrog lub siab tsis zoo,
Txawm li cas los xij, thaum tus menyuam tab tom hnyav dua. Lub cev hnyav tsis nce vim yog rog, tab sis vim yog nce ntxiv edema. Nrog kev mob qog nqaij hlav ntshav siab rau ob tus menyuam mos, menyuam yaus, thiab neeg laus, cov tshuaj feem ntau tsis muaj teebmeem tab sis muaj peev xwm tsis zoo lub cev los khaws cov kua dej hauv cov rog uas muaj rog. Vim tias qhov no, edema nrog ib qho hypothyroidism yog li ntom, thiab cov tawv nqaij zoo li tuab.

Cov ntaub ntawv tshawb pom muaj pov thawj ntau dua tuaj yeem tau tsis pub dhau 4-5 hnub, vim tias ua ntej ntawd, cov niam txiv cov tshuaj hormones tuaj yeem pom nyob hauv cov ntshav ntawm tus menyuam yug tshiab. Muaj cov qauv ntsuas cov ntshav, ib tee ntshav tau siv rau lawv, uas nyob hauv cov menyuam tshiab yog coj los ntawm luj taws. Yog tias dhau ntawm TSH yog kuaj pom nyob hauv txoj kev no, ces kev kuaj mob raug teeb tsa.

Cov kauj ruam tom ntej yog los tsim kom muaj qhov ua rau ntawm tus mob Congenital hypothyroidism, txij li kev kho yog nyob ntawm nws ua ntau yam. Congenital hypothyroidism, yog tias nws yog "qhov tseem ceeb", yog koom nrog nrog kev muaj qog ua kua qog tsis txaus. Qhov no yog vim tias qhov teeb meem nyob hauv hypothalamus (ib feem ntawm lub hlwb, lub hauv nruab nrab lub paj hlwb), uas nyob hauv cov kabmob no tsis txhawb tus qog adrenal lossis cov thyroid caj pas. Hauv qhov no, nws yog qhov zoo dua los sau tshuaj rau tsis muaj cov thyroid hormones, tab sis TSH, thiab yeej nrog cov tshuaj hormones adrenal, uas tau sau ua ntej. Qhov zoo, congenital central hypothyroidism yog casuistically tsis tshua muaj.

Tsis tau txais kev kho mob Congenital hypothyroidism

Nws yuav zoo li txhua yam yog yooj yim: tus yam ntxwv ntawm tus menyuam, ntsuas thiab tuaj yeem kho tau. Tab sis ntau ntau dhau los yog subclinical cov ntaub ntawv ntawm kev mob ntshav ntawm lub ntsws (Congenital hypothyroidism), uas tsis yooj yim los tsim. Cov tsos mob no hauv cov menyuam tshiab, yog lawm, tab sis lawv muaj ntau yam tsis muaj zog, tsis ntes lub qhov muag thiab feem ntau mus tsis nco qab, thiab tus me nyuam tsis kho. Qhov feem ntau ua rau cov ntshav yug lub ntsws (Congenital hypothyroidism) yog qhov tsis txaus siab ntawm cov thyroid caj pas, thiab hauv qhov no, subclinical, hypothyroidism mob me.

Tus me nyuam loj hlob tsis muaj zog thiab phlegmatic, ntawm lub cev ntas, ntau zaus poob qab ntawm kev txhim kho. Qhov no tshwm sim los ntawm inhibition ntawm lub hlwb kev loj hlob. Kev txhim kho lub cev kuj tseem qeeb: fontanelles tom qab kaw, thawj cov hniav ntshis. Cem quav tawv tawv, ua kom o tuaj kuj yog yam ntxwv ntawm cov menyuam yaus. Edema txuas rau lub qhov ntswg txoj hlab ntaws, thiab feem ntau tus me nyuam ua pa ntawm qhov ncauj. Adenoid hom ntsej muag yog tsim nrog lub puab tsaig me me thiab lub qhov ncauj qhib tas li. Lub tswb pob ntseg tseem cuam tshuam, thiab lub rooj sib hais tsis zoo.

Cov tsos mob hauv cov laus feem ntau zoo ib yam, tab sis teeb meem lub plawv ntxiv: atherosclerosis tshwm sim thaum ntxov thiab tom qab CHD. Cov plaub hau poob tawm, rau tes tawg, ib tus neeg ntxim rau kev nyuaj siab, tab sis kev tua tus kheej muaj tsawg. Feem ntau, ntshav liab tau ntxiv rau hauv cov khoom siv no rau cov qauv ntshav ntawm lub ntsws (Congenital hypothyroidism). Yog li ntawd, ib tus neeg cov tawv nqaij yog yam ntxwv ntawm lub ntsej muag daj ntseg daj ua ntu vim muaj kev sib txuam ntawm cov ntshav khov nrog kev o.

Tsuas yog kuaj cov tshuaj hormones tuaj yeem qhia qhov kuaj pom tseeb. TSH yog nce ntau, thiab cov thyroid hormones yog txo. Yog tias koj ua ib qho ultrasound, koj tuaj yeem nrhiav qhov txo qis, qhov hloov ntawm lub cev ntawm cov thyroid caj pas hloov.

Cov tsos mob ntawm tus mob Congenital hypothyroidism tau tiav zoo los ntawm kev teem caij cov thyroid hormones, thiab kev kho yuav tsum pib tsis pub dhau 5-17 hnub tom qab yug tus neeg.

Raws li rau cov menyuam yaus nrog lig tsim subclinical hypothyroidism, lawv tus mob teb sai heev rau kev kho mob zoo. Cov kws kho menyuam yaus hu qhov tshwm sim no "tsim kev puas tsuaj loj rov qab." Kev nrawm nrawm ploj mus, tus me nyuam ua haujlwm, xav paub, loj hlob nthuav dav ntawm cov qib ib txwm muaj. Tag nrho cov no tshwm sim nyob rau hauv ib qho teeb meem ntawm hnub, txawm hais tias cov tshuaj hormones hauv kev kuaj ntshav tseem tsis tau zoo.

Qhov nyuaj ntawm kev kho cov menyuam yaus nrog cov thyroid hormones yog tias thaum lawv loj hlob, qhov xav tau rau lawv hloov thiab qhov koob tshuaj, raws li, tau xaiv dua. Raws li rau cov neeg laus, txoj kev kho mob feem ntau zoo ib yam li, cov koob tshuaj tsis tshua hloov pauv (cev xeeb tub, kev ntxhov siab loj, lub cev ntas, thiab lwm yam), thiab qhov tshwm sim tau kwv yees ntau dua. Xyoo dhau los, kev kho kab mob mus ntxiv, tus kws kho mob yuav tsum xaiv cov tshuaj uas txuas nrog cov tshuaj tua cov thyroid niaj hnub tas li, uas yog qhov tseem ceeb rau ib tus neeg thiab tsis txhob tso tseg.

Niaj hnub no, sodium levothyroxine yog qhov nrov tshaj plaws, tab sis kev sib xyaw (T3 + T4 lossis T3 + T4 + iodine) kuj muaj qee zaum sau tseg. Thawj koob tshuaj yog ib txwm muaj tsawg heev (50-150 μg / hnub rau cov neeg laus, 5-15 μg / kg rau ib tus menyuam mos thiab tsawg kawg 2 μg / kg rau ib tus menyuam), nws maj mam nce ntxiv rau tus kheej haum. Tus endocrinologist tsom mus rau theem ntawm TSH: yog tias nws nce, ces koob tshuaj yuav tsum tau nce, thiab yog tias nws txo qis, tom qab ntawd ib qho kev siv ntau tshaj. Yog tias tus neeg muaj hnub nyoog laus dua 55 xyoos, tom qab ntawd lawv nruj tswj hwm cov roj cholesterol thiab lub siab ua haujlwm, muaj cov yam ntxwv ntawm xaiv koob tshuaj (saib cov lus).

Hauv cov neeg laus, TSH raug kuaj rau 1-1, 3-1 thiab 6 lub hlis tom qab nws ib txwm hloov, tom qab ob peb xyoos, kev ntsuam xyuas tau rov ua txhua rau lub hlis, thiab tom qab ntawd yam tsawg kawg ib xyoos. Cov menyuam yaus teb rau kev kho mob nrog kev ua haujlwm ntawm TSH sai dua - twb nyob ntawm 2-3 lub lis piam. Yog tias TSH tsis nyob hauv kev txheeb xyuas tsawg kawg, ces xaiv koob yuav pib dua.

Congenital hypothyroidism feem ntau yuav tsum muaj kev txuas ntxiv, noj tshuaj mus ntev. Txawm li cas los xij, kev noj tshuaj kom yog ntawm cov thyroid hormones yog tus kws kho mob tau sau rau hauv txoj cai ntau npaum cuam tshuam rau lub sijhawm thiab lub neej nkaus xwb.

Kev nquag noj cov thyroid hormones txaus rau txoj kev noj tshuaj yog tso cai rau tus menyuam kom nws loj hlob zoo ib yam li nws cov phooj ywg.

Cov ntaub ntawv dav dav

Hypothyroidism hauv cov menyuam yaus yog cov kab mob pathological ua los ntawm kev ua tsis tiav lossis ib nrab ntawm cov thyroid hormones txaus: thyroxine (T4), triiodothyronine (T3) thiab thyrocalcitonin. Hauv thawj lub lis piam ntawm tus me nyuam hauv plab, tus niam cov thyroid cov tshuaj hormones ua rau lub cev xeeb tub, tab sis thaum 10-12 lub lis piam cov thyroid caj pas pib ua haujlwm hauv tus me nyuam hauv plab. Kev tsim cov thyroid hormones tshwm sim nyob rau hauv cov qog ntshav ntawm lub qog - cov qog cov thyroid, uas tuaj yeem ntes thiab khaws cov iodine dawb los ntawm cov ntshav ntshav. Cov thyroid cov tshuaj hormones ua lub luag haujlwm tseem ceeb tshaj plaws rau kev coj ua zoo ntawm tus menyuam, tshwj xeeb tshaj yog nyob hauv lub sijhawm ua ntej yug menyuam thiab thawj lub sijhawm ntawm lub sijhawm yug menyuam. Cov thyroid cov tshuaj hormones tswj cov txheej txheem ntawm embryogenesis: qhov sib txawv ntawm cov pob txha nqaij, kev tsim thiab ua haujlwm ntawm lub qog ntshav, ua pa thiab lub cev tsis muaj zog, kev loj hlob ntawm lub hlwb cov qauv, suav nrog lub cerebral cortex.

Kev tsis muaj cov thyroid hormones txaus hauv cov menyuam yaus ua rau muaj kev rau txim loj dua li cov neeg loj, thiab cov menyuam yaus hnub nyoog tsawg dua, kev pheej hmoo mus rau hypothyroidism yog rau nws kev noj qab haus huv thiab lub neej. Hypothyroidism hauv cov menyuam yaus ua rau muaj kev ncua ntawm kev loj hlob ntawm lub cev thiab lub hlwb (kev loj hlob, kev nkauj nraug, kev txawj ntse), qhov kev ua txhaum ntawm txhua hom ntawm cov metabolism hauv (cov protein, cov rog, carbohydrates, calcium) thiab cov txheej txheem thermoregulation.

Kev faib tawm ntawm hypothyroidism hauv cov menyuam yaus

Hypothyroidism rau menyuam yaus tuaj yeem yug los tau lossis tau los. Nrog rau cov mob qog ua ntshav (Congenital hypothyroidism), menyuam yug los es muaj cov thyroid tsis txaus. Zaus ntawm kev muaj ntshav siab ntsws thaum yug los, raws li kev pom kabmob hauv hlwb, yog kwv yees li 1 tus menyuam ntawm 4-5 txhiab tus menyuam yug tshiab (cov menyuam ntxhais yog 2 npaug ntau dua li cov tub hluas).

Raws li qhov mob hnyav ntawm kev ua kom pom, hypothyroidism hauv cov menyuam yaus tuaj yeem hloov pauv (hloov chaw), subclinical, tshwm sim. Ua raws li qib kev sib txuam hauv kev tsim cov thyroid hormones, thawj (thyrogenic), theem nrab (pituitary) thiab tertiary (hypothalamic) hypothyroidism hauv cov menyuam yaus tau raug cais.

Cov ua rau muaj tus kab mob hypothyroidism rau menyuam yaus

Hypothyroidism hauv cov menyuam yaus loj hlob nrog ntau yam kev tsis txaus siab hauv kev ua haujlwm ntawm lub hypothalamic-pituitary-thyroid system. Hauv 10-20% ntawm cov neeg mob, qhov ua rau muaj tus mob hypothyroidism rau cov menyuam yaus tuaj yeem yog cov kev mob caj ces thaum cov caj ces caj ces tau txais los ntawm menyuam los ntawm lawv niam lawv txiv, tab sis feem ntau tus kab mob no yog kev tsim.

Yeej, cov menyuam yaus muaj tus thawj hypothyroidism cuam tshuam nrog pathology ntawm cov thyroid caj pas nws tus kheej. Ib qho tshwm sim ntawm hypothyroidism hauv cov menyuam yaus yog cov thyroid malformations, tshwm sim los ntawm aplasia (tsis tuaj), hypoplasia (tab tom tsim kho), lossis dystopia (hloov chaw) ntawm cov khoom nruab nrog. Cov xwm txheej ib puag ncig tsis zoo (hluav taws xob, tsis muaj iodine hauv zaub mov), mob rau sab hauv, noj qee yam tshuaj (thyreostatics, tshuaj tua kab mob, bromides, ntsev ntsev), muaj cov kab mob ua rau lub cev cov thyroiditis, thiab cov leeg txuas mus ntxiv tuaj yeem ua rau me nyuam cov thyroid puas tsuaj. Hauv 10-15% ntawm cov neeg mob, hypothyroidism hauv cov menyuam yaus cuam tshuam nrog kev hnov lus tsis zoo ntawm cov thyroid hormones, lawv cov metabolism lossis kev puas tsuaj rau cov ntaub so ntswg tau txais lub luag haujlwm rau qhov rhiab ntawm cov ntaub so ntswg mus rau lawv cov kev ua.

Thib ob thiab tertiary hypothyroidism hauv cov menyuam yaus tuaj yeem vim qhov kev tsis txaus siab ntawm lub caj pas thiab / lossis hypothalamus lossis ua rau lub caj ces tsis zoo hauv lub synthesis ntawm TSH thiab thyroliberin, uas tswj cov kev zais ntawm cov thyroid hormones. Tau txais hypothyroidism hauv cov menyuam yaus tuaj yeem tshwm sim nrog kev puas tsuaj rau lub qog pituitary lossis lub qog vim cov qog lossis cov txheej txheem o, mob lossis phais, thiab kev ua tsis muaj peev xwm ntawm iodine tsawg.

Cov tsos mob ntawm hypothyroidism hauv cov menyuam yaus

Hypothyroidism hauv cov menyuam yug tshiab tau muaj kev kuaj mob me, uas suav lub sijhawm qeeb (40-42 lub lis piam), qhov hnyav ntawm tus menyuam (tshaj 3.5-4 kg), o ntawm lub ntsej muag, tawv muag, nplaig (macroglossia), ntiv tes thiab ntiv taw sib quas ntus thiab hnyav ua pa, qis, quaj tag nrho. Hauv cov menyuam mos liab nrog hypothyroidism, lub ntsej muag daj ntev ntev, kev kho mob lig ntawm txoj hlab pas, hlab caj pas, txhaws tsis muaj zog tuaj yeem nco txog.

Cov tsos mob ntawm hypothyroidism nce zuj zus thiab pom meej meej thaum tus me nyuam loj hlob, lawv tsis tshua pom tshwm thaum pub mis niam vim them nyiaj los ntawm leej niam cov thyroid hormones. Tam sim no thaum tseem yau nyob rau hauv cov menyuam yaus nrog hypothyroidism, cov cim ntawm kev ncua ntawm somatic thiab psychomotor txoj kev loj hlob tau pom: kev qaug zog, nkees nkees, mob ntshav siab, tsis muaj zog thiab lub cev tsis ua haujlwm, stunted kev loj hlob thiab hnyav, nce loj thiab qeeb ntawm lub fontanel, ncua teething, tsis muaj kev txawj ntse (khaws koj lub taub hau, tig rov qab , zaum, sawv ntsug).

Nrog hypothyroidism hauv cov menyuam yaus, bradypsychia tsim - kev tsis pom zoo rau lub ntiaj teb sab nraud nrog kev tsis txaus siab thiab lub suab: tus menyuam tsis taug kev, tsis tshaj tawm cov suab lus, tsis ua si ntawm nws tus kheej, ua rau tsis zoo. Muaj cov cim qhia txog kev puas tsuaj rau lub plawv mob, txo qis tiv thaiv kab mob, pallor thiab tawv nqaij qhuav, tawv nqaij plaub hau, lub cev kub tsis muaj zog, ua kom ntshav khov, tawv ncauj.

Qhov mob hnyav ntawm cov tsos mob ntawm lub ntsws Congenital hypothyroidism nyob rau hauv cov menyuam yaus yog nyob ntawm etiology thiab mob hnyav ntawm tus kab mob. Qhov phom sij txog qhov tsis txaus cov thyroid cov tshuaj hormones thaum ntxov ntawm kev tsim kho intrauterine yog qhov kev tsis txaus ntseeg ntawm kev txhim kho ntawm lub hauv nruab nrab cov hlab hlwb ntawm tus menyuam, ua rau dementia thiab cretinism nrog lub hlwb tsis zoo ntawm lub hlwb, pob txha tsis meej, dwarfism, lub cev tsis hnov lus, tsis hnov lus thiab hais lus (mus txog rau lag ntseg)

Nrog rau ib daim ntawv me, cov cim qhia ntawm hypothyroidism hauv cov menyuam yaus thaum lub sijhawm mob neonatal tuaj yeem lwv tawm thiab tshwm tuaj tom qab, thaum muaj hnub nyoog 2-6 xyoo, qee zaum thaum tseem tiav nkauj tiav nraug. Yog tias hypothyroidism tshwm sim hauv cov menyuam yaus hnub nyoog tshaj li 2 xyoos, nws tsis ua rau muaj mob puas hlwb loj. Hauv cov menyuam yaus thiab cov hluas thaum yau, mob hypothyroidism tuaj yeem ua ke nrog lub cev rog, rog, kev loj hlob tsis txaus thiab muaj neeg laus, tsis zoo siab, xav qeeb qeeb, thiab txo qis kev kawm ntawv.

Kev kho mob hypothyroidism hauv menyuam yaus

Kev kho kab mob siab ntsws thaum yug menyuam nyob rau hauv cov menyuam yuav tsum tau pib thaum ntxov ua ntej tom qab kuaj mob (tsis pub dhau 1-2 lub lis piam tom qab yug los) txhawm rau txhawm rau tiv thaiv kev mob hlwb tsis zoo ntawm tus menyuam lub hlwb.

Feem ntau ntawm kev mob qog nqaij hlav yug thiab tau txais hypothyroidism hauv cov menyuam yaus, kev hloov kho lub neej nrog lub cev cov thyroid hormone sib piv, sodium levothyroxine yog qhov tsim nyog. Cov tshuaj tau sau tseg rau hauv thawj zaug ntawm 10-15 μg / kg lub cev qhov hnyav ib hnub nyob rau hauv kev soj ntsuam tsis tu ncua ntawm tus menyuam qhov mob thiab biochemical tsis dhau los xaiv qhov zoo tshaj plaws ntawm cov tshuaj. Ib qho qhia ntxiv yog cov vitamins (A, B12), cov tshuaj nootropic (hopantenic acid, piracetam), zaub mov zoo, zaws, kho kev tawm dag zog.

Nrog rau subclinical daim ntawv ntawm hypothyroidism nyob rau hauv cov menyuam yaus, kev kho mob tej zaum yuav tsis tas yuav tsum tau, nyob rau hauv cov ntaub ntawv no tas li kev saib xyuas kev kho mob tau qhia. Nrog txoj kev loj hlob ntawm cretinism, ib qho kev kho mob ua tiav tsis tau, noj levothyroxine sodium me ntsis txhim kho cov chav kawm ntawm tus kab mob.

Kev kwv yees thiab kev tiv thaiv hypothyroidism hauv cov menyuam yaus

Kev ntsuas ntawm hypothyroidism hauv cov menyuam yaus nyob ntawm tus qauv ntawm tus kabmob, hnub nyoog ntawm tus menyuam, lub sijhawm ntawm kev pib kho, thiab txoj kev txhaj tshuaj levothyroxine kom raug. Raws li txoj cai, nrog kev kho mob ntawm lub sijhawm hypothyroidism hauv cov menyuam yaus, qhov xwm txheej tau them sai sai, thiab tom qab ntawd muaj kev ntsuas ntawm kev loj hlob ntawm lub cev thiab lub hlwb.

Qhov qhaj ntawv los yog pib lig ntawm kev kho mob hypothyroidism ua rau muaj kev hloov zoo rau lub cev thiab kev tsis taus ntawm cov menyuam yaus.

Cov menyuam yaus nrog hypothyroidism yuav tsum tau soj ntsuam tas li los ntawm tus kws kho mob menyuam yaus, tus kws kho mob menyuam yaus, tus kws kho mob hlwb nrog kev tshuaj xyuas cov thyroid xwm yeem.

Kev tiv thaiv ntawm hypothyroidism hauv cov menyuam yaus muaj kev noj tshuaj iodine txaus los ntawm tus poj niam cev xeeb tub nrog zaub mov noj lossis hauv cov tshuaj, tshwj xeeb tshaj yog nyob rau thaj tsam ntawm iodine tsis txaus, kev tshawb pom thaum ntxov cov thyroid hormone tsis txaus nyob rau cov niam thiab cov menyuam yug tshiab.

Kev mob nkeeg yog dab tsi?

Tus ua cov thyroid caj pas yog qhov khoom tseem ceeb tshaj plaws uas nkag mus rau hauv tib neeg endocrine system. Nws ua ntau txoj haujlwm tsim nyog rau kev tsim kho tag nrho ntawm tus menyuam. Lub hlwb tau txais tag nrho cov ntaub ntawv los ntawm sab nraud los ntawm kev nkag siab ntawm lub suab, ntxhiab tsw, lub teeb. Tib neeg lub cev ua haujlwm nrog kev pab los ntawm cov tshuaj hormones - cov tshuaj biochemical. Lub kaw lus neuroendocrine ua haujlwm nruab nrab ntawm lub hlwb thiab lub cev.

Lub plab hnyuv siab raum uas ua tiav tag nrho cov ntaub ntawv yog pituitary thiab hypothalamus. Lawv muab cov thyroid caj pas “lus txib” txog yam kev xav tau ntawm lub cev uas lub cev xav tau.

Nws yog qhov nyuaj rau xav txog yuav ua li cas ntau zog ib tug muab hlau ua. Qhov tseem ceeb muaj li nram no:

tswj tswj lub cev kub thiab metabolism,
synthesis cov vitamin A hauv lub siab,
kev koom tes hauv kev txhim kho kev txawj ntse,
cov roj (cholesterol) tsawg
txhawb kev loj hlob hauv cov menyuam yaus,
kev tswj ntawm cov metabolism hauv calcium, raws li cov rog, carbohydrates thiab cov nqaijrog.

Yog li, cov khoom siv no koom nrog txhawb kev loj hlob ntawm tus menyuam lub cev. Ntxiv mus, hauv kev tsim cov paj hlwb thiab pob txha caj dab, nws ua si ib txoj haujlwm loj. Cov hlau kom noj qab haus huv ua rau ob hom tshuaj hormones:

thyroxine (T4),
triiodothyronine (T3).

Tsuas yog xav txog dab tsi tshwm sim rau lub cev yog tias lub qog lub qog tau cuam tshuam. Qhov tseeb tiag, nrog kev kuaj mob ntawm tus kab mob ntshav siab (Congenital hypothyroidism) hauv kev yug menyuam tshiab, kev tsim cov tshuaj hormones saum toj no tsawg dua. Lawv qhov tsis txaus ntseeg cuam tshuam rau kev ua haujlwm ntawm txhua yam muaj sia. Kev tsis txaus ntawm cov tshuaj hormones tuaj yeem ua rau kev cuam tshuam ntawm lub hlwb thiab kev loj hlob ntawm tus menyuam, kev loj hlob tau qeeb. Tus me nyuam rog hnyav dua, nws muaj kev mob nkees ntev, lub zog txo qis, nws lub plawv dhia thiab ntshav siab cuam tshuam. Tsis tas li ntawd xwb, txoj hnyuv ua haujlwm kev ua haujlwm tsis zoo, lub pob txha tsis zoo tshwm sim.

Cov laj thawj tseem ceeb

Vim li cas tus kab mob Congenital Congenital hypothyroidism tshwm sim rau menyuam yaus? Muaj ntau ntau yam khoom siv provoking qhov tshwm sim ntawm tus kab mob. Ntawm lawv, cov kws kho mob paub qhov txawv loj:

Muaj keeb muaj feem. Tus kab mob hauv nqe lus nug yog cuam tshuam txog noob caj noob ces. Feem ntau, kev cuam tshuam cov thyroid tshwm sim txawm tias ua ntej yug menyuam - thaum yug menyuam. Xws li lub pathology cuam tshuam nrog kev hloov caj ces.
Malfunctions hauv kev tsim cov tshuaj hormones. Qhov no tshwm sim los ntawm qhov txo qis ntawm kev rhiab ntawm cov thyroid caj pas mus rau iodine. Qee zaum kev thauj mus los ntawm cov khoom tsim nyog uas tsim nyog rau kev sib txuas ntawm cov tshuaj hormones tuaj yeem cuam tshuam. Thiab qee zaum cov laj thawj nyob hauv kev ua txhaum ntawm iodine metabolism hauv lub cev.
Kev poob ntawm lub hypothalamus. Nov yog lub plawv khoom ntawm lub hlwb. Nws tswj hwm kev ua haujlwm ntawm lub qog ua haujlwm, nrog rau lwm cov qog endocrine. Txhab ntawm lub hypothalamus ua rau endocrine cuam tshuam loj heev.
Kev tsis hnov mob ua rau cov thyroid hormones txaus. Qhov tshwm sim no tuaj yeem tshwm sim los ntawm qhov tseeb tias tus poj niam cev xeeb tub, cev xeeb tub, noj tshuaj antithyroid.
Cov kab mob autoimmune.
Lub qog hlav qog.
Txo tiv thaiv kab mob.
Noj tshuaj ntau dhau nrog qee yam tshuaj (lithium npaj, corticosteroids, vitamin A, beta-blockers).
Tawg tiv thaiv hluav taws xob.
Kis mob ailments.
Iodine tsis muaj peev xwm.
Parasitic infestations.
Kev kho mob nrog hluav taws xob iodine.

Muaj ntau ntau yam ua rau muaj kev txhim kho ntawm tus kab mob kev ua haujlwm los ntawm lub neej thaum ub. Txawm li cas los xij, feem ntau, qhov ua kom muaj mob ntawm tus menyuam tseem tsis tau meej.

Lub ntsiab hom

Tus kab mob no yog pom los ntawm kev txo qis hauv kev tsim cov thyroid hormones, uas yog lub luag haujlwm rau cov metabolism hauv lub cev. Niaj hnub no, hypothyroidism yog ib tus mob ntau dhau los. Nws sib txawv hauv ntau hom, theem ntawm txoj kev loj hlob.

Qhov teeb meem loj tshaj plaws yog qhov ua tau rau lub caij nyoog asymptomatic ntev ntawm tus kab mob. Thiab qhov no ua rau ntau yam kev nyuaj, los ntawm qhov kev kho mob uas muaj ntau nyuab dua.

Tus kab mob Hypothyroidism tuaj yeem tshwm sim los ntawm ntau yam. Raws li kws tshaj lij, cov laj thawj nyob ntawm tus qauv mob. Niaj hnub no, lawv qhov txawv los ntawm ob:

Congenital hypothyroidism feem ntau sib kis thaum cev xeeb tub. Cov thyroid rhuav tshem tshwm sim. Tom qab yug tus menyuam tas, qhov zoo li no tuaj yeem ua rau tsis txaus ntseeg ntawm lub hauv nruab nrab cov hlab hlwb ntawm tus menyuam, poob qis hauv kev txhim kho kev xav, thiab kev tsim cov pob txha tsis zoo.

Txais hypothyroidism tuaj yeem tshwm sim nrog ib qho kev tsis muaj iodine tsawg, tom qab kev ua haujlwm tshem tawm (ib feem lossis ua tiav) cov thyroid caj pas. Qee zaum kev mob nkeeg provokes txawm tias koj tus kheej tiv thaiv kab mob, uas ua rau lub qog ua haujlwm tseem ceeb.

Kev faib tawm cov teeb meem pathological uas tshwm sim hauv cov thyroid caj pas, cov kws kho mob cais cov hom nram qab no:

thawj hypothyroidism
theem nrab
tertiary.

Lawv txhua tus nyias muaj nyias qhov laj thawj. Thawj hypothyroidism yog tus mob los ntawm yam uas cuam tshuam ncaj qha rau cov ua cov thyroid caj pas. Cov no suav nrog cov hauv qab no:

caj ces tsis xws luag
kab mob kev coj ntawm lub cev,
ntau cov txheej txheem o cuam tshuam ncaj qha rau cov thyroid caj pas,
iodine tsis muaj zog hauv lub cev.

Qhov tshwm sim ntawm daim ntawv thib ob ntawm tus kabmob yog cuam tshuam nrog kev puas tsuaj rau lub qog pituitary, hauv qhov ntawd nws nres ntawm TSH yam tshuaj. Lub hauv paus tseem ceeb hauv kev tshwm sim ntawm tus kab mob hauv qhov no yog:

yug los ua neeg ntawm lub caj pas pituitary,
hnyav thiab nquag los ntshav,
mob hlwb thiab kis tau tus mob,
hlav hauv lub caj pas pituitary.

Tertiary theem provokes teeb meem hauv kev ua haujlwm ntawm hypothalamus.

Cov cim thiab tsos mob ntawm tus kab mob

Feem ntau hauv thawj hnub ntawm tus menyuam lub neej, hypothyroidism tsis tshwm sim. Cov tsos mob ntawm tus kab mob tsuas yog tshwm sim tom qab ob peb hlis. Txog lub sijhawm no, ob leeg niam txiv thiab kws kho mob tau pom tias txoj kev loj hlob ntawm tus menyuam qeeb. Txawm li cas los xij, hauv qee tus menyuam mos, cov tsos mob ntawm lub ntsws Congenital hypothyroidism yuav tshwm sim hauv thawj lub limtiam ntawm lub neej.

Cov phiajcim muaj feem ntau muaj xws li:

Yug me nyuam hnyav (cov me nyuam muaj rog nyhav dua 3.5 kg).
Ib tus neeg hloov pauv nrog tag nrho cov txiaj ntsig tshwm sim (qhuav thiab tawv nqaij ntawm daim tawv nqaij, tus ntsia hlau ntev, tsis muaj lub roj).
Cov ntsej muag muag, di ncauj, tawv muag.
Tawv kav ntev.
Lub supraclavicular fossae muaj o tuaj rau hauv daim ntawv ntawm cov ntaub ntawv tuab.
Ib nrab-qhib qhov ncauj, tiaj tus nplaig.
Lub xub ntiag ntawm cov cim ntawm kev sib deev tsis txaus ntseeg.
Hnyav tawm thawj cov quav.
Lub suab quaj ntawm cov menyuam yaus, teeb qis (thaum quaj).
Hnyav kho tus pias ntaws ntawm cov hlab ntaws (feem ntau yog hernia).
Hauv daim duab peb sab ntawm thaj av hauv nasolabial ua cyanotic.

Yog hais tias kev kho mob tsis tau pib hauv thawj lub hlis ntawm lub neej, nws zoo li tus me nyuam yuav ua kom pom kev xav, lub cev, kev hais lus thiab kev xav hauv lub siab. Hauv tshuaj, tus mob no hu ua cretinism.

Nrog cov tshuaj kho tsis txaus thaum muaj hnub nyoog 3-4 hlis, lwm cov tsos mob tshwm sim. Lawv qhia tau tias hypothyroidism muaj kev kawm nce qib. Cov cim ntawm tus kabmob yog li nram no:

Tsis qab los noj mov.
Ua txhaum cov txheej txheem nqos.
Peeling tawv nqaij.
Cem quav.
Tsawg kub.
Nqaij hypotension.
Dryness thiab pallor ntawm daim tawv nqaij.
Txig plaub hau.

Thaum muaj hnub nyoog laus dua, tus kab mob twb muaj cov tsos mob li nram no:

Lag hauv kev xav, lub cev kev loj hlob.
Hloov cov ntsej muag muag.
Qhov pom ntawm cov hniav ploj.
Tsawg siab.
Tsawg tsawg mem tes.
Kev kho lub plawv.

Qhov Tseeb Ua rau txhawm rau Hypothyroidism

Kwv yees li ntawm 85% ntawm ntu kev yug tus mob hypothyroidism thaum ntxov mas nws tsis nco qab. Qhov ua rau feem ntau ntawm lawv yog dysgenesis ntawm lub qog ua haujlwm lub qog.

Kwv yees li 15% ntawm lub sijhawm ntawm kev mob qog nqaij hlav ntshav hauv lub cev yog vim muaj kev cuam tshuam ntawm cov niam cov tshuaj tiv thaiv rau cov thyroid caj pas los yog rau cov qub txeeg qub teg ntawm pathologies ntawm T4 synthesis.

Qee cov qauv ntawm kev mob qog ua ntshav hnub no muaj kev hloov caj ces uas ua rau muaj kev loj hlob ntawm tus kab mob.

Lub hauv paus tseem ceeb ntawm kev ua haujlwm ntawm Congenital hypothyroidism

Lub qog dysgenesis (tab tom tsim kho):

Congenital pathologies ntawm T4 synthesis:

Pendred's Syndrome.
Cov kab mob pathology ntawm cov thyroid peroxidase.
Pathology ntawm cov neeg siab phem sodium iodide.
Pathology ntawm thyroglobulin.
Cov kab mob pathology ntawm cov thyroid hormone deiodinase.

Congenital central hypothalamic-pituitary hypothyroidism.

Congenital hypothyroidism provoked los ntawm cov tshuaj tiv thaiv niam.

Yuav muaj dab tsi tshwm sim nrog hypothyroidism?

Kev xeeb tub hauv plab hauv plab, uas rau qee qhov vim li cas tus kab mob hlwb tsis tuaj yeem lossis tsis ua haujlwm, tshwm sim vim lub cev cov thyroid hormones txaus ntawm leej niam, nkag mus rau hauv lub cev.

Thaum menyuam yaus yug los, cov theem ntawm cov tshuaj hormones hauv nws cov ntshav poob qis zuj zus. Hauv kev muaj menyuam hauv plab, tshwj xeeb tshaj yog nyob rau lub sijhawm thaum ntxov, cov thyroid hormones yog qhov tsim nyog rau kev txhim kho kom zoo ntawm lub hauv nruab nrab lub paj hlwb ntawm tus menyuam.

Qhov no yog qhov tshwj xeeb tshaj yog rau cov txheej txheem ntawm myelination ntawm cov hlwb hlwb.

Nrog cov tsis muaj cov thyroid cov tshuaj hormones hauv lub sijhawm no, ib qho kev txhim kho ntawm cerebral cortex ntawm tus menyuam tau tsim, uas yog qhov tsis hloov pauv. Nws ua tau nws tus kheej hauv ntau qib ntawm lub hlwb ruamqauj ntawm tus menyuam nce mus rau cretinism.

Yog tias hloov pauv tau pib thaum lub sijhawm (thawj lub lim tiam ntawm lub neej), txoj kev txhim kho ntawm lub hauv nruab nrab ntawm lub paj hlwb yuav luag zoo li qub. Tib lub sijhawm ua ke nrog kev tsim cov teeb meem nyob rau hauv lub hauv nruab nrab cov hlab ntsha, nrog rau cov hlab ntsws ua haujlwm tsis tau them nyiaj nyob rau lub sijhawm, kev txhim kho ntawm lub cev pob txha thiab lwm yam sab hauv lub cev thiab lub cev tiv thaiv.

Feem ntau, kev soj ntsuam cov tsos mob ntawm lub ntsws Congenital hypothyroidism tsis yooj yim rau kev paub txog kev paub ntxov. Qhov mob Congenital hypothyroidism hauv tus menyuam mos yug tshiab tuaj yeem xav tias yog raws qhov ntsuas ntawm cov duab hauv chaw kuaj mob hauv tsuas yog 5% ntawm tus neeg mob xwb.

Cov tsos mob thaum ntxov ntawm Congenital hypothyroidism:

o hauv plab
Lub sijhawm ntev (ntau tshaj 7 hnub) hyperbilirubinemia,
suab tsawg
hnoos qeev
mob posterior fontanel,
hypotension
lub qog o
macroglossia.

Yog tias qhov kev ntsuas kho tsis tau ua raws sijhawm, tom qab 3-4 lub hlis cov tsos mob tshwm sim no:

teeb meem nqos
tsis qab los noj mov
flatulence
qhov hnyav tsis zoo nce
dryness thiab pallor ntawm daim tawv nqaij,
tshuaj txau ntshav
cov leeg hypotension.

Tom qab rau lub hlis ntawm lub neej, tus me nyuam qhia cov cim ntawm kev ncua ntawm lub cev, kev loj hlob ntawm psychomotor thiab kev loj hlob tsis sib xws: hypertelorism, dav lub qhov ntswg sab hnub ntswg, lub qhov kawg ntawm tag nrho cov fontanels (saib daim duab).

Cov ntaub ntawv yuav pab tau, dab tsi yog cov tsos mob thiab kev kho mob ntawm hypothyroidism hauv cov poj niam, vim hais tias muaj tus kab mob qog nqaij hlav tseem nyob nrog tus neeg mob rau lub neej.

Kho kab mob

Kev hloov pauv yuav tsum tau ua rau lub nrawm nrawm ntawm T4 hauv cov ntshav, thiab tom qab ntawd xaiv cov koob tshuaj L-T4 raws, uas ua kom muaj kev saib xyuas zoo ntawm kev saib xyuas zoo ntawm T4 thiab TSH.

Thawj qhov pom zoo koob ntawm L-T4 yog 10-15 mcg / kg lub cev hnyav ib hnub. Ntxiv mus, kev tshuaj xyuas thiab kev soj ntsuam tas li yuav tsum xaiv kom tau txais koob tshuaj L-T4 txaus.

Qhov ntsuas ntawm tus mob Congenital hypothyroidism

Cov kev ntsuas ntawm tus kab mob tsuas yog nyob ntawm lub sijhawm ua ntej pib ntawm L-T4 hloov txoj kev kho. Yog tias koj pib nws hauv thawj ob lub lim tiam ntawm tus menyuam mos lub neej, kev ua txhaum ntawm kev txhim kho lub cev thiab lub hlwb kev xav yuav luag ploj mus.

Yog hais tias lub sijhawm pib ntawm kev hloov kho tsis tiav, thiab nws tsis pib, qhov kev pheej hmoo ntawm kev loj hlob ntawm tus kab mob nce ntxiv, mus txog oligophrenia thiab nws cov ntawv hnyav.

Kev kho mob ntawm hypothyroidism yog qhov ua tau zoo nrog kev ua haujlwm hauv thyroid hormone. Cov tshuaj feem ntau tso siab rau hypothyroidism yog suav tias yog cov thyroid hormones txaus synthetically (artificially).

Tib qho mob rau kev hloov pauv nrog cov tshuaj no yog kev mus ntsib kws kho mob, uas yuav tsum xaiv cov tshuaj ntawm lub sijhawm thiab kho nws thaum kho.

Cov tsos mob ntawm hypothyroidism pib ploj, feem ntau hauv thawj lub lim tiam ntawm cov tshuaj. Lawv qhov kev ploj tag nrho tshwm sim nyob rau hauv ob peb hlis. Cov menyuam yaus hauv thawj xyoo ntawm lub neej thiab thaum laus dua tsuas yog xav tau kev kho mob. Cov neeg laus thiab cov neeg mob uas tsis muaj zog teb rov qab qeeb dua los ntawm kev siv tshuaj.

Yog tias hypothyroidism tshwm sim los ntawm qhov tsis muaj cov thyroid caj pas, Hashimoto's disease, lossis hluav taws xob kho, nws yog qhov yuav los kho nws lub neej ntev. Muaj tseeb, muaj qee kis thaum, nrog Hashimoto's thyroiditis, pancreatic muaj nuj nqi tau raug kho dua tshiab.
Yog tias lwm cov pathologies yog cov ua rau cov hypothyroidism, tom qab kev tshem tawm ntawm tus mob hauv qab, cov cim ntawm hypothyroidism kuj ploj.
Qhov ua rau hypothyroidism tuaj yeem yog qee yam tshuaj noj, tom qab tshem tawm ntawm qhov uas cov thyroid caj pas normalizes.
Mob Hypothyroidism hauv kev kho mob sai sai tej zaum yuav tsis tas muaj. Txawm li cas los xij, kom tsis txhob nco lub zuj zus ntawm tus kab mob, tus neeg mob xav tau kev saib xyuas kev kho mob tas li.

Cov ntaub ntawv muaj tseeb ntawm cov txiaj ntsig ntawm kev hloov pauv rau latent hypothyroidism tsis muaj nyob rau hnub no, thiab cov kws tshawb fawb muaj kev xav sib txawv ntawm qhov teeb meem no. Hauv cov xwm txheej zoo li no, thaum txiav txim siab txog qhov tsim nyog ntawm kev kho, tus neeg mob ua ke nrog tus kws kho mob sib tham txog kev them nyiaj ntawm cov nuj nqis ntawm kev kho mob thiab qhov pheej hmoo txaus ntshai los ntawm nws nrog cov txiaj ntsig tsim nyog.

Ua tib zoo mloog! Cov neeg mob uas tau mob los ntawm cov kab mob ntawm cov hlab plawv thiab ntshav qab zib mellitus tshwj xeeb tshaj yog xav tau qhov tseeb ntawm kev noj tshuaj, vim tias kev noj tshuaj ntau dhau los yog fraught nrog qhov tshwm sim ntawm angina pectoris lossis atrial fibrillation (lub plawv tsis sib xws).

Kev Kho Mob

Nrog kev kuaj mob ntawm tus kab mob ntshav qab zib ua hauj lwm (Congenital hypothyroidism), tus kws kho mob tau sau tshuaj rau cov tshuaj uas suav nrog sodium levothyroxine, uas yog cov tshuaj nquag:

Cov tshuaj yuav tsum noj raws li cov lus qhia thiab teem sijhawm ntawm tus kws kho keeb. Tom qab 1.5-2 lub hlis ntawm kev kho mob, nws yog ib qho tsim nyog yuav tsum tau mus ntsib kws kho mob txhawm rau txhawm rau txheeb xyuas qhov tseeb ntawm cov koob tshuaj uas tau hais tseg. Yog tias nws hloov tawm tias koob tshuaj tsawg dhau, tus neeg mob muaj cov tsos mob ntawm hypothyroidism:

Yog tias qhov koob tshuaj tshaj, qhov tsos mob yuav txawv me ntsis:

Hauv cov neeg mob uas lub plawv tsis ua haujlwm, thaum pib kho, ib koob tshuaj levothyroxine feem ntau yog kws kho, uas yog maj mam nce ntxiv raws li qhov tsim nyog. Yog tias kev mob hypothyroidism hnyav heev thaum lub sijhawm kuaj mob, nws tsis tuaj yeem lees txais txhawm rau kho mob.

Tseem Ceeb! Thaum tsis muaj kev kho kom zoo txaus, mob ntshav qab zib (Congenital hypothyroidism) hauv cov menyuam yaus tuaj yeem ua rau muaj mob uas tsis tshua pom muaj, tab sis muaj kev phom sij heev rau lub neej - mob ntshav qab zib (com myxedema coma). Cov kev kho mob ntawm tus kab mob no yog nqa tawm tshwj xeeb hauv tsev kho mob, hauv chav kho mob ntau ntxiv nrog kev tswj hwm kev kho mob ntawm cov thyroid hormones npaj.

Yog tias lub ntsws ua pa tsis zoo, lub tshuab ua pa lub tshuab ua pa yog siv. Tus neeg mob yauv mus kuaj mob tag nrho rau lub xub ntiag ntawm tus neeg lub siab lub ntsws. Yog tias lawv kuaj pom, kev kho tsim nyog raug kho.

Kev tiv thaiv ntawm hypothyroidism hauv menyuam yaus

Hypothyroidism thaum cev xeeb tub yuav tsum tau kho nrog kev saib xyuas tshwj xeeb, vim nws tuaj yeem cuam tshuam kev loj hlob ntawm tus me nyuam hauv plab thiab ua rau mob hnyav rau ntawm lub cev.

Nrog hypothyroidism hauv tus pojniam cev xeeb tub, kev kho yuav tsum pib tam sim ntawd.Yog tias tus kab mob tau kuaj pom ua ntej cev xeeb tub, tus poj niam yuav tsum soj ntsuam xyuas qib theem ntawm cov thyroid hormones txaus thiab nqa tawm kev kho kom tsim nyog ntawm cov tshuaj tau hais tseg. Thaum nqa tus menyuam yaus, qhov kev xav tau rau lub cev qoj ib ce tuaj yeem nce ntxiv txog 25-50%.
Qhov xav tau kev kho mob kuj tseem tuaj yeem tshwm sim nrog kev tiv thaiv tom qab yug menyuam hypothyroidism. Nrog rau qhov pib ntawm txhua qhov kev xeeb menyuam tshiab, tus pojniam yuav tsum yauv mus kuaj mob tag nrho rau hypothyroidism. Qee lub sij hawm tom qab tus qauv ntawm hypothyroidism ploj mus ntawm nws tus kheej, thiab lwm qhov, tus kab mob tsuas kav thoob plaws tus poj niam lub neej.

Pab txhawb nqa kev kho mob

Feem ntau feem ntau, kev kho mob ntawm hypothyroidism yog lub neej ntev, yog li cov tshuaj uas tus kws kho mob pom zoo yuav tsum ua rau nruj raws li lub hom phiaj. Qee lub sij hawm yug cov hlab ntsws hypothyroidism loj zuj zus, yog li cov koob tshuaj ntawm lub sijhawm dhau los yuav tsum tau nce ntxiv, raws li tus nqi ntawm attenuation ntawm cov thyroid muaj nuj nqi.

Hauv ntau tus neeg mob noj cov thyroid hormones npaj, tom qab lawv tshem tawm, cov tsos mob ntawm hypothyroidism tsim nrog cov kev tawm dag zog tshiab. Thaum zoo li no, kev noj tshuaj yuav tsum tau rov ua dua.

Congenital hypothyroidism tuaj yeem tsim kho raws li kev cuam tshuam ntawm tus mob kis. Hauv qhov no, tom qab kho cov kabmob uas nyob hauv qab, lub qog ua haujlwm rov qab tau zoo tag nrho. Txhawm rau kuaj nws txoj haujlwm, kev cuam tshuam ib ntus ntawm kev siv cov thyroid hormones npaj tau ua.

Feem ntau ntawm cov neeg mob nrog qhov kev tshem tawm no tsom xam ib ntus rov qab los ntawm cov tsos mob tseem ceeb ntawm hypothyroidism. Qhov no yog vim hais tias lub cev, nrog qee qhov kev ncua, xa cov cim qhia rau cov thyroid caj pas hais txog qhov yuav tsum tau rov ua txoj haujlwm.

Yog tias lub qog nws muaj peev xwm tiv thaiv nws tus kheej yav tom ntej, kev kho mob tuaj yeem raug tso tseg. Zoo, yog tias cov tshuaj hormone ntau lawm poob qis, koj yuav tsum rov pib siv cov tshuaj no.

Kev noj cov tshuaj thyroid los npaj yuav tsum ua rau tus neeg mob mus ntsib tsev kho mob 2 zaug hauv ib xyoos (rau kev txheeb xyuas qhov tseeb). Cov neeg mob mus kuaj cov thyroid stimulating hormone (TSH). Qhov tshwm sim ntawm txoj kev tshawb no qhia pom kev ua tiav ntawm cov tshuaj hormones concentration nrog tus qauv.

Congenital

Kev kuaj mob ntawm tus kab mob hlav ntshav qab zib (Congenital hypothyroidism) yog ua yog tias ib tus menyuam mos tom qab yug menyuam tas kuaj pom muaj cov thyroid tsis txaus. Nws tshwm sim hauv kev loj hlob hauv kev yug menyuam thiab tuaj yeem yog thawj, hauv nruab nrab (theem nrab, qib nrab) thiab ntu nyob rau hauv cov nqe ntawm cell puas. Cov tsos mob ntawm tus kab mob yog qhov hloov, tas mus li, thiab chav kawm ntawm hypothyroidism yog subclinical lossis tshwm sim, nyuaj.

Xws li hypothyroidism hu ua muaj tseeb lossis thyrogenic. Qhov no txhais tau hais tias cov theem qes ntawm cov thyroid hormones T4 thiab T3 yog txuam nrog pathology ntawm cov thyroid caj pas nws tus kheej.

Nruab Nrab

Cov qe ntshav (secretory cells) uas tsim cov thyroxin thiab triiodothyronine yog tswj hwm los ntawm lub caj pas pituitary nrog kev pab los ntawm cov thyroid-stimulating hormone - TSH. Nrog nws cov lus tsis txaus ntseeg, kev tsim khoom ntawm T3 thiab T4 txo. Hom mob no hu ua pituitary lossis secondary. Dhau ntawm lub caj pas pituitary hauv cov tshuaj hormones "qib siab" yog qhov hypothalamus. Siv cov thyroliberin, nws ua kom sai ntawm kev tsim TSH. Hypothalamic tsis txaus ntseeg hu ua tertiary.

Transient

Ua los ntawm cov tshuaj tiv thaiv leej niam, uas tsim rau cov thyroid-stimulating hormone ntawm lub caj pas pituitary ntawm tus menyuam. Nws lub sijhawm yog feem ntau 1-3 lub lis piam. Qhov kev xaiv thib ob yog kev hloov pauv mus rau daim ntawv txuas mus tas li. Hauv qhov no, lub sijhawm ntawm kev txhim kho hloov nrog rau qhov nce ntawm cov tsos mob, uas yuav tsum muaj kev tswj hwm nyob ntev ntawm cov tshuaj hormones hauv cov ntsiav tshuaj.

Neej Neeg

Tshaj tawm qhov tsis muaj cov tshuaj hormones. Cov thyroid-stimulating hormone yog siab dua li ib txwm, thiab cov thyroid caj pas ua cov thyroxine tsawg. Nws ua rau tag nrho cov ncauj lus kom ntxaws ntawm hypothyroidism, thiab nrog qhov tsis txaus ntawm T 4 - cov nyom. Cov no suav nrog kev ua haujlwm circulatory tsis ua haujlwm, mob hlwb, mob hlwb hypothyroid nco ntsoov.

Thiab ntawm no yog hais ntau txog cov nodular goiter ntawm lub qog caj pas.

Ua rau tus neeg mob hypothyroidism txog li ib xyoos

Feem ntau cov menyuam mos yug tshiab (txog 90% ntawm tag nrho cov mob ntawm tus kabmob) muaj thawj daim ntawv. Nws tuaj yeem tshwm sim los ntawm:

kev tsis xws luag hauv kev txhim kho ntawm cov khoom nruab nrog - hloov mus tom qab sternum, hauv qab tus nplaig, kev tsim tsis txaus (hypoplasia), tsawg dua qhov tsis tuaj yeem ua tiav ntawm cov thyroid caj pas,
muaj mob rau hauv plab,
cov qhov txhab autoimmune,
kev siv cov tshuaj cev xeeb tub uas ua txhaum txoj kev loj hlob (cytostatics, lithium ntsev, bromine, tranquilizers),
raug tshuaj lom
raug hluav taws xob ntev
iodine tsis muaj txaus nyob hauv leej niam lub pluas noj zaub mov, lub qog, mob cov leeg ntshav,
kev hloov pauv ntawm cov noob (feem ntau yog ua ke nrog cov kev mob plawv, cov pob txha pob txha),
ua txhaum ntawm kev tsim cov tshuaj hormones vim muaj kev cuam tshuam hauv qhov nqus tau ntawm iodine los ntawm cov thyroid caj pas,
kab mob kev loj hlob mob anomaly - Pendred syndrome (lag ntseg thiab loj ntawm cov thyroid caj pas).

Cov ntaub ntawv nruab nrab ntawm hypothyroidism (theem nrab thiab qib nrab) tshwm sim hauv pathology ntawm lub paj hlwb - hlwv, kev loj hlob tsis zoo, benign lossis malignant neoplasms, kev mob thaum yug menyuam, mob hlwb txhawm rau vim muaj txoj hlab ntaws.

Daim foos peripheral tshwm sim thaum tsim ntawm receptor proteins yog qhov tsis zoo, uas yog nyob rau ntawm daim nyias nyias ntawm cov hlwb thiab ua ke nrog cov thyroid hormones.Cov. Qhov laj thawj rau qhov no yog kev mob caj ces kis tau los ntawm qub txeeg qub teg, thiab qhov tsim nyog tau yog qhov tsim kom muaj cov tshuaj tiv thaiv cov tshuaj hormones (tiv thaiv mob). Hauv qhov no, keeb kwm keeb kwm keeb kwm hauv ntshav yog qhov ib txwm los yog me ntsis ntxiv, tab sis cov hlwb tsis teb T3 thiab T4.

Cov laj thawj ntawm kev xav tau hypothyroidism hauv menyuam yaus tuaj yeem yog:

hlav hlwb
raug mob pob txha taub hau, kev khiav haujlwm,
tsis muaj iodine nyob rau hauv cov zaub mov thiab dej (muaj cov leeg iodine tsis txaus).

Thawj qhov tshwm sim hauv cov menyuam yaus

Kev paub txog hypothyroidism hauv tus menyuam mos tshiab tuaj yeem nyuaj nyuaj. Cov cim tseem ceeb tsis txawv hauv qhov tshwj xeeb thiab muaj nyob hauv pathologies ntawm cov plab hnyuv siab raum, lwm qhov kev loj hlob tsis pom tseeb. Cov tsos mob tsis xws yog xws li:

tom qab yug me nyuam tag (40-42 lis piam),
cov txiv hmab txiv ntoo loj (los ntawm 3.5 kg),
txawj lus coob
o rau lub ntsej muag, tshwj xeeb tshaj yog nyob rau ntawm daim tawv muag,
o ntawm cov ntiv tes rau ntawm txhais tes thiab taw,
txog siav
lub suab qis ntawm kev quaj (lub suab ntxhoo),
hlwv caj dab, qeeb kho kom zoo nkauj ntawm rab riam,
Lub ntsej muag daj ntseg ntev ntawm cov menyuam mos,
nkees sai thaum pub mis,
cov tsos ntawm cyanosis thiab ua tsis taus pa thaum nqus.

Yog hais tias tus me nyuam noj niam mis, ces cov tsos mob hauv tsev kho mob tej zaum yuav tsis muaj zog. Tab sis xws li cov menyuam yaus feem ntau poob qis dua qhov muaj hnub nyoog hauv kev nce lub cev, lawv muaj teeb meem ntawm kev zom zaub mov - tsam plab, cem quav, tsis qab los. Lawv pom qhov nthuav dav fontanel, tsis txaus ntawm kev sib txuas ntawm cov pob txha pob txha taub hau, txhim kho qhov tsim ntawm ntsag pob qij txha.

Psychomotor txoj kev loj hlob ntawm menyuam yaus

Cov kev mob tshwm sim hnyav tshaj plaws ntawm hypothyroidism cuam tshuam rau cov leeg hlwb. Los ntawm lub sijhawm neonatal, muaj cov cim ntawm kev lag hauv kev txhim kho psychomotor:

kev ua kom tsis muaj zog, qaug zog,
kev tsis nyiam ntawm ib puag ncig - tus menyuam tsis sim ua suab nrov, mus taug kev, tsis teb qhov lus hais rau nws,
thaum lub sij hawm tshaib plab los yog ntub cov pawm, nws tseem nyob tsis txav mus li ib teev,
kev mus los yeej tsis tshua muaj pes tsawg, leeg nkees thiab cov leeg tsis muaj zog yog sau tseg,
lig pib tuav nws lub taub hau, yob nyob rau hauv txaj, tsis zaum.

Yog tias muaj tus mob Congenital hypothyroidism hloov zuj zus, ces kev dementia (cretinism) tshwm sim, mob lub siab, lub ntsej muag thiab hais lus tsis meej. Cov tsos mob zoo li no tuaj yeem pom twb tshwm sim hauv ib nrab xyoo ntawm lub xyoo nrog kev tsis txaus ntseeg ntawm cov tshuaj hormones. Cov uas mob tsawg dua yuav tshwm sim yam tsis pub leejtwg paub thiab tshawb pom tsuas yog txog li 5-6 xyoo lossis nyob rau xyoo thaum tiav nkauj tiav nraug.

Nrhiav cov foos ntawm cov kab mob, tshwj xeeb tshaj yog tom qab 2 xyoos, tsis tshua muaj kev phom sij. Lub paj hlwb tsis raug kev txom nyem nrog lawv. Tej zaum kev rog dhau, kev loj hlob qeeb qeeb, kev ua nkauj nraug, thiab qeeb ntawm kev xav yog pom los ntawm kev kawm tsis tiav.

Kev tiv thaiv kabmob

Kev tiv thaiv kab mob siab ntsws Congenital hypothyroidism yog ua nrog pab pawg tiv thaiv ntawm iodine tsis muaj peev xwm nyob rau thaj chaw muaj kab mob tsawg (cov ntsiab lus iodine tsawg hauv dej), nrog rau kev txheeb xyuas qhov tseeb ntawm cov tib neeg muaj kev phom sij thaum npaj kev xeeb tub. Cia siab niam pom zoo:

hloov lub rooj ntsev nrog iodized ntsev (ntxiv rau tsuas yog npaj pluas noj),
nce ntxiv hauv kev faib tawm ntawm cov khoom noj muaj cov tshuaj iodine - hiav txwv ntses, nqaij ntses, algae, ntses siab, ntses roj, hiav txwv kale, feijoa, kiwi, txiv apples,
yauv mus kuaj ntshav rau cov ntsiab lus ntawm cov thyroid hormones thiab kev kuaj mob nrog tus kws kho keeb endocrinologist,
noj tshuaj los yog vitamin complex nrog iodine (Vitrum Prenatal Forte, Multi Tabs Intensive, Multimax rau Cov Poj Niam Cev Xeeb Tub, zoo meej, Cev xeeb tub) raws li kws kho mob qhia.

Mob Hypothyroidism rau menyuam yaus yog yam kabmob feem ntau. Nws tshwm sim los ntawm kev hloov caj ces, tsis muaj iodine nyob rau hauv leej niam txoj kev noj zaub mov, thiab kev sib kis thiab cov kab mob autoimmune. Thaum yug los, qhov tsis pom tseeb tseem ceeb tau sau tseg; thaum lawv loj dua, tsis muaj cov txheej txheem tsis kho tus kab mob ua rau dementia, deformation ntawm pob txha pob txha.

Thiab ntawm no yog ntau txog kev tiv thaiv ntawm tus nkag mus.

Txhawm rau kuaj hypothyroidism, tus menyuam mos liab tau kuaj cov thyroid stimulating hormone. Txoj kev kho yuav tsum tau pib thaum ntxov li sai tau. Cov menyuam yaus raug muab lub cev hloov kho lub neej nrog levothyroxine.

Cov thyroid caj pas yog tsim nyob rau hauv cov menyuam yaus hauv plab kev loj hlob. Nquag, nws tsis muaj qhov hloov pauv ntawm qhov nkhaus, nodes. Qhov loj me (nce ntxiv, txo qis), nrog rau lwm cov tsos mob kuj qhia tau tias muaj cov kabmob (hypofunction, hyperfunction) thiab qhov yuav tsum tau pib kho.

Hauv thawj theem, mob qog ua ntshav rau menyuam yaus tuaj yeem yog asymptomatic. Hashimoto's autoimmune disease yog tshwm sim los ntawm kev tsis txaus ntseeg, tsim kua muag. Cov tsos mob ntawm tus mob mus ntev yuav ntev tshaj li cov lus qhia. Kev kuaj mob tsuas yog paub meej txog kev kuaj mob. Txoj kev kho yog xaiv raws li theem ntawm chav kawm.

Txij thawj hnub, cov tshuaj hormones hauv menyuam yaus tau txiav txim siab. Txoj kev loj hlob, kev txawj ntse, thiab kev ua haujlwm ntawm cov plab hnyuv siab raum nyob rau hauv tus menyuam yaus nyob ntawm seb lawv cuam tshuam li cas rau lawv qib. Koj yuav tsum coj dab tsi? Qhov kev qhia zoo yuav hais dab tsi txog (tus txheej txheem, yog vim li cas nws thiaj li tsa, txo qis)?

Yog tias muaj tus mob ntsws ua paug rau lub raum, thiab cev xeeb tub tau tshwm sim, kev kho mob tam sim ntawd yuav tsum tau txuag tus me nyuam hauv plab. Kev npaj nrog ntau qhov kev soj ntsuam, vim tias qhov tshwm sim rau tus poj niam thiab tus menyuam tuaj yeem yog qhov kev tu siab tshaj plaws.

Feem ntau pituitary tsis txaus pom tshwm sim hauv cov neeg laus, tab sis nws yog yug los yog kis tau hauv cov menyuam yaus, tom qab yug menyuam tas. Tag nrho, ib nrab, thawj thiab theem nrab kuj muaj qhov txawv txav. Kev kuaj mob ntawm tus mob hypopituitaritis suav nrog kev txheeb xyuas cov tshuaj hormones, MRI, CT, X-ray thiab lwm yam. Txoj kev kho mob - rov ua dua haujlwm los ntawm cov tshuaj hormones.

Cov qauv ntawm tus kabmob

Hypothyroidism tau muab faib rau kev xeeb menyuam thiab tau txais. Ua kom mob Congenital hypothyroidism hauv cov menyuam yaus raug pom nrog ntau zaus ntawm 1 kis ib txog 5,000 tus menyuam mos yug tshiab. Qhov tshwm sim ntawm cov tub hluas yog 2 npaug qis dua li cov ntxhais.

Raws li qhov mob hnyav ntawm cov chaw kuaj mob uas tsis muaj cov thyroid hormones txaus, ua rau pom, hloov chaw (hloov chaw) thiab subclinical hypothyroidism hauv menyuam yaus yog qhov txawv.

Ua raws li qib uas cov thyroid hormone ntau lawm tau ntxhov, cov ntaub ntawv hauv qab no ntawm hypothyroidism raug cais:

thawj (thyrogenic) - vim yog kev puas tsuaj ncaj qha rau cov cov thyroid nqaij, yog tus cwj pwm los ntawm kev nce qib hauv TSH (cov thyroid stimulating hormone),
theem nrab (hypothalamic-pituitary) - Nws cuam tshuam nrog kev puas tsuaj rau lub hypothalamus thiab / lossis pituitary caj pas, uas nrog los ntawm kev tsis muaj peev xwm tso cov thyroid-stimulating hormone thiab thyroliberin, ua raws li los ntawm kev txo qis hauv cov thyroid muaj nuj nqi.

Cov Neeg Ua thiab Teeb Meem Qhov Tseeb

Cov laj thawj ntawm hypothyroidism hauv cov menyuam yaus yog ntau yam kev ua haujlwm ntawm kev ua haujlwm ntawm hypothalamic-pituitary-thyroid system. Hauv kwv yees li 20% ntawm tus neeg mob, qhov tshwm sim ntawm hypothyroidism hauv cov menyuam yaus yog cuam tshuam nrog kev mob caj ces tsis zoo uas tau txais los yog tshwm sim nthawv. Ntawm cov kev txiav txim siab txog cov caj ces ntawm cov mob, mob myxedema (mob caj dab) yog feem ntau pom.

Lwm qhov ua rau muaj tus mob Congenital hypothyroidism rau cov menyuam yaus yog qhov ua tsis tiav ntawm cov thyroid caj pas (hypoplasia, aplasia, dystopia), uas tuaj yeem ua rau mob ntxiv, nrog rau ntau yam tsis zoo cuam tshuam rau tus poj niam cev xeeb tub lub cev:

Cov kab mob ntshav siab (Congenital hypothyroidism) thib ob hauv cov menyuam yaus cuam tshuam nrog kev txawv txav hauv kev txhim kho hypothalamus thiab / lossis pituitary caj pas.

Tau txais hypothyroidism hauv cov menyuam yaus yog qhov pom ntau tsawg. Cov laj thawj nws tshwm sim yuav yog:

tshuaj iodine ntau heev,
kev puas tsuaj rau cov thyroid caj pas lossis cov qog pituitary los ntawm lub qog lossis cov txheej txheem o, mob, lossis phais.

Txog kev paub thaum ntxov ntawm tus kab mob Congenital Congenital hypothyroidism hauv cov menyuam yaus, kev soj ntsuam txhua tus menyuam mos tau tshwm sim.

Muaj peev xwm tshwm sim thiab muaj teeb meem

Thaum tsis muaj kev kho mob, hypothyroidism hauv cov menyuam yaus tuaj yeem ua rau cov teebmeem hauv qab no:

hlwb ruamqauj ntawm ua txawv heev,
retardation ntawm kev loj hlob lub cev,
rog dhau
myxedema coma,
muaj feem kis tau yooj yim rau kis tus kab mob,
megacolon:
pseudohyponatremia,
kab mob normocytic normochromic anemia,
hypoparathyroidism.

Nrog rau kev kho thaum ntxov, qhov mob txhawm feem ntau yog qhov muaj txiaj ntsig. Kev hloov kho Hormone ua rau muaj kev them sai sai ntawm qhov mob ntawm tus menyuam mob thiab yav tom ntej, nws txoj kev loj hlob psychomotor tshwm sim raws li cov xeeb ceem ntawm hnub nyoog.

Yog tias cov kev kho mob hloov kho tom qab cov tsos mob ntawm tus mob cretinism hauv menyuam yaus, ces nws tsuas tuaj yeem tiv thaiv lawv qhov kev vam meej ntxiv. Hauv cov xwm txheej zoo li no, tus menyuam muaj kev tsis hloov pauv thiab tob tob uas ua rau neeg xiam oob khab.

Cov menyuam yaus kev txom nyem los ntawm hypothyroidism yog nyob rau hauv kev saib xyuas tas mus li ntawm tus kws kho keeb, tus kws kho menyuam yaus, neuropathologist. Tsawg tsawg kawg ib zaug hauv lub hlis, lawv yuav tsum txiav txim siab txog theem ntawm cov thyroid-stimulating hormone hauv cov ntshav.

Hypothyroidism rau menyuam yaus ua rau lub txim hnyav dua lub hnub nyoog loj. Tus yau dua tus me nyuam, qhov kev phom sij ntau dua yog qhov tsis muaj cov thyroid hormones txaus rau nws txoj kev noj qab haus huv.