Thyrotoxicosis yog ib qho kev mob tshwm sim los ntawm ntau dhau lawm kev tsim cov thyroid hormones. Txog rau hnub tim, kev sib xyaw ntawm no pathology nrog insulin deficiency yog qhov tsis tshua muaj tshwm sim. Raws li kev txheeb cais, los ntawm 2 mus rau 6% ntawm cov neeg mob ntshav qab zib kuj raug mob los ntawm thyrotoxic goiter.
Ntau cov kev tshawb fawb tau qhia tias cov ntshav qab zib tau tshwm sim hauv 7.4% ntawm cov neeg mob thyrotoxicosis, thiab nce cov thyroid ua haujlwm hauv tsuas yog 1% ntawm cov neeg muaj insulin deficiency.
Raws li koj tuaj yeem pom, mob ntshav qab zib tuaj yeem tsim ntau sai dua li thyrotoxicosis lossis npaj mus rau nws cov keeb kwm yav dhau los, uas yog qhov tsis tshua muaj. Ntxiv mus, ob hom kab mob tuaj yeem pib hauv tus neeg mob lub cev tib lub sijhawm.
Feem ntau ntawm cov kws tshawb nrhiav tau sau tseg tias cov mob plab mus thiab thyrotoxicosis yog qhov muaj feem yuav ua rau cov insulin tsis txaus. Hauv cov neeg kev txom nyem los ntawm pathologies ntawm lub qog caj pas, ib hom ntshav qab zib hom qab zib nkhaus tau kuaj pom. Ntawm lawv:
- 10% tau mob ntshav qab zib mellitus;
- nyob rau hauv 17% nws txheej txheem nyob rau hauv ib daim ntawv latent;
- hauv 31%, ib qho kev kuaj ntshav qabzib tau ua lus nug.
Nws yog cov xeeb ceem tias kev kho mob ntawm thyrotoxic goiter yuav favorably cuam tshuam rau cov metabolism hauv carbohydrate thiab tej zaum yuav ua rau nws qhov tsis txawv txav.
Yog tias qhov no tsis tshwm sim, tom qab ntawv qhov no peb tuaj yeem hais tias thyrotoxicosis tsim muaj ntau dua tom qab mob ntshav qab zib.
Yog tias cov thyrogenic ntshav qab zib mellitus yog cov yam ntxwv ntawm glucosuria thiab hyperglycemia tsuas yog ua ntej kev ua haujlwm, tom qab ntawd cov neeg mob pom tseeb thyrotoxic goiter thiab teeb meem nrog insulin tom qab phais mob ntawm cov thyroid caj pas yuav tsis tu tsis tseg kom paub cov tsos mob ntshav qab zib.
Vim li cas rau kev loj hlob ntawm pathology
Thaum hloov pauv hauv lub cev tiv thaiv kab mob tiv thaiv keeb kwm ntawm ntshav qab zib mellitus, ib feem ntawm cov txheej txheem no tuaj yeem piav qhia los ntawm qhov pom ntawm kev siv tshuaj tiv thaiv. Txawm li cas los xij, cov kab mob pathogenesis thiab etiology ntawm thyrotoxicosis tseem tsis tau kawm tag nrho.
Tau ntev, nws ntseeg tau tias qhov laj thawj tseem ceeb ntawm kev tshwm sim thiab kev loj hlob ntawm ob qho tshuaj lom (Cov kab mob hauv tus mob) yog thyrotoxicosis syndrome, uas tshwm sim los ntawm kev puas siab puas ntsws.
Ntxiv rau kev ntxhov siab thiab nws cov teebmeem ua kom puas, thyrotoxic goiter yog qhov tsis meej:
- kev tshuaj ntsuam genetic predisposition;
- ua tsis tiav cov tshuaj hormones poj niam txiv neej;
- cov kab mob tshwj xeeb thiab kis (mob ntsws, khaub thuas).
Tsis tas li ntawd, tus mob nyob rau hauv kev txiav txim siab, ntxiv rau diffuse goiter, tuaj yeem pom nrog ntau tshaj ntawm iodine hauv lub cev, thyrotoxic adenoma, trophoblastic neoplasms ua chorionic gonadotropin, polynodous toxic goiter, muaj kev zais ntau ntawm TSH (thyroid stimulating hormone), subacute thiab thyroid fibroids, Cov.
Etiologically diffuse thyrotoxic goiter tau muab cais ua qhov autoimmune hloov khoom nruab nrog. Hauv qhov no, lymphocytic infiltration ntawm lub caj pas thiab ua kom lub cev tsis muaj zog tiv thaiv tau pom. Tus txheej txheem no yog nrog cov yam ntxwv hauv cov hlab ntshav ntawm cov tshuaj autoantibodies mus rau TSH receptor thiab T-lymphocytes.
Nws feem ntau lees txais tias diffuse toxic goiter yog polygenic multifactorial pathology. Feem ntau nws tsim nyob hauv qab ntawm ntau yam kev cuam tshuam ib puag ncig. Cov no tuaj yeem yog cov xwm txheej ntxhov siab, kis kab mob, thiab tshuaj noj.
Cov txheej txheem ntawm kev ua kom lub cev tiv thaiv kab mob tshwm sim tiv thaiv keeb kwm yav dhau los ntawm kev tsim cov tshuaj tiv thaiv B-lymphocytic rau thyrotropin receptors. Lawv ua raws li lub luag haujlwm ntawm ntuj TSH, uas ua rau cov txheej txheem ntawm cov qog cov thyroid ntshav tawm mus rau hauv cov ntshav thiab ua kom muaj kuab lom mus rau neeg lub cev.
Kev zais cia ntawm cov thyroid-txhawb cov tshuaj tiv thaiv cov kab mob uas ib txwm cuam tshuam rau cov thyroid caj pas ua rau cov neeg tso ntshav.
Hauv cov ntawv kho mob muaj ob peb lus piav qhia sib txawv rau cov txheej txheem ntawm kev ua tsis tiav ntawm cov khoom noj khoom haus carbohydrate nyob rau hauv cov ntaub ntawv ntawm thyrotoxicosis. Yog li, qee cov kws kho mob ntseeg tias thyroxine tsub kom lub zais ntawm cov kua dej thaum txhim kho oxidation ntawm carbohydrates.
Nrog rau lub sijhawm ntev tyrosinemia, tib neeg cov kab mob ua haujlwm tsis muaj zog, thiab kev hloov pauv pathological ua rau cov ntshav qab zib thiab ketoacidosis tsis tu ncua.
Raws li lwm tus kws kho mob, kev loj hlob ntawm thyrotoxicosis nyob rau hauv cov teeb meem nrog insulin yog txuam nrog kev tsim ntau hauv cov tshuaj steroid thiab kev ua haujlwm tsis txaus ntawm lub siab ntsws-adrenal system.
Nws yog qhov tsim nyog tias cov qauv zoo li no pom meej meej thaum muaj ntshav qab zib yog decompensated.
Nta ntawm thyrotoxicosis
Cov kev sib koom ua ke ntawm kev hloov pauv ntawm cov txiav thiab lub qog ua haujlwm nrog lub pov thawj tau qhia los ntawm cov pov thawj tias ib qho ntawm cov xwm txheej ua ntej cov pathologies:
- o tuaj
- kis tau tus mob
- kev ntxhov siab.
Ntxiv mus, nyob rau hauv xyoo tas los no, qhov tseeb tau dhau los ua paub tias thyrotoxicosis thiab ntshav qab zib mellitus yog tus cwj pwm los ntawm ib qho pathogenesis - autoimmunization. Nws tau tshawb pom tias HLAB8 antigen nrog tib lub zog tshwm sim ntawm cov ntshav tsis muaj qhov mob ntshav qab zib-kev mob ntshav qab zib uas muaj kev txom nyem los ntawm idiopathic raum tsis ua haujlwm thiab diffuse lom mus.
Yog hais tias thyrotoxicosis muab tso ua ke nrog ntshav qab zib, ces ob hom kabmob tuaj ib txhij. Kev tsim tawm ntawm insulin hormone tsis kam thiab adrenal tsis txaus yuav ntxim.
Txhawm rau them nyiaj rau cov teeb meem uas muaj suab thaj nrog cov kab ke sib xyaw, kev siv cov tshuaj insulin ntau dua yog xav tau vim tias cov metabolism nce ntxiv tiv thaiv cov keeb kwm dhau los ntawm kev tsim cov tshuaj hormones ntau dhau.
Xws li tus neeg mob tshwj xeeb yog tas li ntawm kev pheej hmoo ntawm ketoacidosis, tus poj koob yawm txwv lossis tus uas mob ntshav qab zib tsis xeev. Hauv qhov no, qhov yuav tsum tau ntim txhua hnub ntawm insulin yuav tsum nce ntxiv 25 lossis txawm 100%. Ntxiv mus, ib qho yuav tsum them sai sai rau qhov tseeb tias nrog decompensation ntawm cov ntshav qab zib vim qhov ntxiv ntawm thyrotoxicosis, kev txhim kho ntawm cov "plab plab" tsis tseeb lossis ntuav ntawm hom "kas fes thaj av" yog qhov ua tau. Hauv cov xwm txheej zoo li no, tus kws kho mob yuav ua txhaum thiab sau ntawv laparotomy.
Nws tau pom tias decompensated mob ntshav qab zib yuav luag ib txwm pab txhawb qhov pib thiab kev loj hlob ntawm thyrotoxic ntsoog. Thaum muab sib xyaw nrog cov ntshav qab zib tsis hnov qab, muaj qhov txaus ntshai rau tus neeg mob lub neej, vim tias cov cim ntawm cov kab mob no muaj teeb meem loj heev. Nrog daim duab no, kev kuaj mob yog qhov nyuaj heev.
Yog li, yuav tsum pib nrog, nws yog ib qhov tsim nyog yuav tsum tau tshem tus neeg mob los ntawm kev kub ntxhov, vim hais tias kev kho mob ntawm tus mob ntshav qab zib tsis tuaj yeem coj lub txiaj ntsig uas tau npaj tseg, txawm hais tias siv tshuaj tua kabmob ntau kawg ntawm cov tshuaj insulin siv.
Los ntawm 8 rau 22% ntawm cov neeg mob uas muaj tus mob concomitant yuav raug kev txom nyem los ntawm tus neeg mob nthuav tawm ntawm tus mob thyrotoxicosis.
Yog hais tias thyrotoxicosis yog qhov tsis yooj yim, ces hauv qhov no glucosuria thiab hyperglycemia tuaj yeem pom zoo. Lawv tuaj yeem tsim teeb meem rau kev kuaj ntshav qab zib.
Hauv cov xwm txheej no, kev kuaj mob sib txawv ntawm thyrotoxicosis thiab ntshav qab zib mellitus yuav tsum tau ua los ntawm kev saib xyuas lub sijhawm ntawm kev txo qis qab zib nyob hauv cov xwm txheej ntawm qabzib load.
Qhov phom sij ntawm thyrotoxicosis hauv ntshav qab zib yog dab tsi?
Cov kws kho mob tau mob siab rau cov neeg mob uas muaj ntshav qab zib tsawg nrog mob thyrotoxicosis hnyav. Yog tias ntshav qab zib tsis pom thiab lees paub tias yog cov thyrogenic hyperglycemia, ces qhov no tshwj xeeb tshaj yog muaj:
- ua ib qho haujlwm;
- koom nrog tus kab mob concomitant.
Kev loj hlob ntawm lub cev tsis nco qab tshwm sim los ntawm ketoacidosis tom qab kev phais mob qog yuav ua rau muaj kev pheej hmoo ntau ntxiv hauv cov neeg mob ntshav qab zib lossis tsis paub txog ntshav qab zib.
Kev txiav txim siab cov ntshav qab zib rau ntawm lub plab khoob nrog kev soj ntsuam tag nrho ntawm tus neeg mob nrog thyrotoxic goiter yog qhov yuav tsum tau ua hauv ib qho xwm txheej twg.
Tsis muaj tsawg dua kev phom sij thaum kev kuaj mob thyrotoxicosis hauv kev mob ntshav qab zib tsis tau nqa tawm. Cov kws kho mob yuav tsum tau ceeb toom tas li:
- unmotivated poob phaus;
- kev npau taws ntev dhau;
- tawm hws ntau dhau;
- nquag decompensation ntawm cov ntshav qab zib raug rau kev noj haus thiab cov kab ke hauv kev siv tshuaj los txo cov suab thaj.
Txij lub sijhawm ua kom pom tseeb ntawm thyrotoxicosis tshwm sim, cov tsos mob ntawm tus mob ntshav qab zib yuav pib ploj mus. Hauv qhov no, cov cim qhia ntawm insulin tsis txaus yuav pib nce sai heev thiab tus neeg mob yuav txawm poob rau hauv tsis xeev. Ntxiv mus, yog hais tias tus txheej txheem mob kav ntev dua 5 lub lis piam, cov tsos mob ntawm thyrotoxicosis yuav pib tsim txom cov neeg mob ntau dua. Cov theem ntawm cov ntshav siab yuav dhau los tsis ruaj khov, nrog txoj kev nyiam nce. Cov mem tes yuav dhau los ua neeg tsis xis thiab khaus.
Thaum kuaj ntshav rau cov ntsiab lus ntawm thyroxine, iodine thiab catecholamines hauv cov neeg zoo li no nrog cov kab ke sib xyaw, nws yuav tsim tau tias nrog qhov pib ntawm kev txhim kho ntawm cov txheej txheem sib kis, cov concentration ntawm thyroxine poob qis. Yog hais tias tus txheej txheem sib kis tau ntev ntev, tom qab ntawd kev khaws lub cev ntawm cov tshuaj tiv thaiv tau kho kom zoo dua nrog cov kab mob txo qis ntawm triiodothyronine thiab khi cov protein. Nyob rau tib lub sijhawm, qhov concentration ntawm norepinephrine thiab adrenaline nce ntau.
Qee tus kws kho mob ntseeg tias qhov mob hnyav thiab lub sijhawm ntawm thyrotoxicosis yuav ua raws li kev mob loj ntawm cov mob ntawm endocrine pancreatic apparatus. Txawm li cas los xij, lwm tus kws kho mob sib cav hais tias cov neeg mob thyrotoxicosis hnyav yuav muaj cov mob ntshav qab zib me me. Nrog kev mob thyrotoxicosis me me, cov tshuaj insulin muaj zog yuav tshwm sim.
Kev kho mob ntawm thyrotoxicosis
Nrog kev sib xyaw ntawm thyrotoxic goiter thiab ntshav qab zib, uas yog lub nra hnyav rau txhua lwm yam, kev phais mob ntawm cov thyroid caj pas yog qhia, tsis hais qhov hnyav ntawm pathology.
Thawj qhov xwm txheej rau kev txo qis haujlwm txaus ntshai yuav txhawb nqa kev mob ntshav qab zib thiab kev ua haujlwm ntawm cov thyroid kev ua haujlwm. Cov ntaub ntawv no yuav qhia tias them nyiaj:
- qhov txo qis dua cov piam thaj rau 8,9 mmol / l;
- normalization ntawm electrolyte metabolism thiab CBS;
- tshem tawm cov ketonuria thiab glucosuria.
Nws tseem yog qhov tseem ceeb los txo qis tag nrho cov metabolism hauv lub cev mus rau 10%, ib txwm ua haujlwm ntawm cov mem tes, qhov ploj ntawm nws qhov lability, ua kom pw tsaug zog, nce qhov hnyav ntawm tus neeg mob. Yog tias cov mob no tau ntsib, ces tus neeg mob tau npaj tiav ntawm kev phais mob ntawm lub qog caj pas.
Vim tias kev ua txhaum ntawm lub luag haujlwm tseem ceeb ntawm lub siab (protein, antitoxic), kev hloov pauv hauv microelement thiab macroelement muaj pes tsawg leeg ntawm cov ntshav, dhau cardiac, vascular tsis txaus, nquag decompensation ntawm ntshav qab zib, concomitant kub siab thiab mob thyrotoxicosis, npaj rau kev phais mob tuaj yeem ncua sijhawm rau 8 txog 12 lub lis piam.
Ua cov kev kho mob ua ntej nrog cov tshuaj yuav tsum tau npaj ua qhov kev txiav txim siab ntawm lub hnub nyoog ntawm tus neeg mob, mob hnyav ntawm cov tsos mob, qhov mob hnyav ntawm concomitant pathologies thiab qhov kev loj hlob ntawm cov thyroid caj pas. Feem ntau siv rau cov laj thawj no:
- beta blockers;
- iodine sib txuas;
- lithium carbonate;
- thyreostatics.
Ntawm palpation thiab sab nraud, qhov yuav txo tau qhov loj thiab qhov ceev ntawm lub qog yuav raug sau tseg. Thaum phais mob, cov khoom nruab nrog ntshav tsawg dua.
Txawm li cas los xij, iodides ib leeg tsis tuaj yeem siv ntev ntev. Tom qab li 2 lub lis piam, kev ruaj khov ntawm kev thaiv ntawm cov thyroid hormone ntau lawm yuav nres.
Rau kev kho mob ntawm thyrotoxic goiter, lithium carbonate yog siv hauv qhov ntim ntawm 900 mus rau 1200 mg rau ib hnub. Cov tshuaj pabcuam pab ua kom lub hlwb ntawm lub qog ua haujlwm ntawm lub qog, thiab txo cov nyhuv stimulating ntawm TSH thiab cov thyroid-txhawb cov tshuaj tiv thaiv. Tsis tas li ntawd, cov ntsiab lus ntawm hormone H thiab T4 nyob rau hauv cov ntshav cov ntshav qis.
Yog hais tias tus neeg mob tau mob tsis txaus rau thyreostatics thiab ib daim ntawv me me ntawm thyrotoxicosis, tom qab ntawv kho yog nyob rau 2-3 lub hlis. Nws yog lub sijhawm no uas qhov cuam tshuam ntawm lithium carbonate ntawm qhov tsis txaus ua haujlwm ntawm cov thyroid caj pas tag nrho ploj.
Hauv qee kis, lub sijhawm ua haujlwm ntawm kev kho tuaj yeem nce ntxiv mus rau 1.5 xyoo. Nws yog txwv tsis pub sau ntawv tshuaj iodine rau cov neeg mob thyrotoxic goiter, muab tias euthyroidism tiav nrog thyreostatics vim qhov pheej hmoo loj ntawm qhov pib ntawm kev rov huam mob tuaj.
