Isifo samathuna kubantu abadala

Indlala yegilo iyisitho esincane kakhulu sohlelo lwe-endocrine esitholakala ngaphansi kwesikhumba esingaphambili kwentamo. Umsebenzi wayo oyinhloko ukukhululwa kwamahomoni egilo alawula i-metabolism eyisisekelo (ukukhululwa kwamandla omsebenzi obalulekile wamaseli nezicubu). Uma, ngenxa yezizathu ezihlukahlukene, indlala iqala ukusebenza ngenkuthalo kunokujwayelekile, lokhu kungaholela esifweni sikaGraves kubantu abadala.

Leli gama liye lahlala kusukela ezinsukwini zezokwelapha zaseSoviet futhi manje selibhekwa njengelingasebenzi. Ezincwadini zamazwe ngamazwe kanye nemihlahlandlela yomtholampilo, igama elithi hyperthyroidism noma i-Graves Disease lisetshenziswa. Amanye amagama asetshenziswa emazweni ahlukahlukene ahlanganisa lawa mazwi amqondofana:

• i-exophthalmic goiter;
• I-Graves 'hyperthyroidism;
• Isifo sikaParry;
• toxic diffuse goiter.

Ngaphezu kwalokho, kukhona nokuhlukaniswa kwangaphakathi kwesifo se-Graves, kuye ngokuthi izimpawu ezithile zivame kangakanani:

• i-dermopathy (lapho isikhumba sithinteka kakhulu);
• i-osteopathy (izinkinga zamathambo);
• i-ophthalmopathy (ikakhulukazi izimpawu zamehlo).

Siyini isifo sika-Basedow

I-Graves' disease noma i-Graves' thyroiditis yisifo esithinta indlala yegilo, kanye nesikhumba namehlo.

Indlala yegilo iyisitho esiyingxenye yesistimu ye-endocrine, inethiwekhi yezindlala ze-endocrine nezicubu ezikhiqiza amahomoni alawula izinqubo zamakhemikhali (i-metabolism).

Ama-hormone athinta imisebenzi ebalulekile yomzimba, futhi alawula izinga lokushaya kwenhliziyo, izinga lokushisa lomzimba nomfutho wegazi. Amahomoni akhishelwa ngqo egazini, ukusuka lapho aya khona ezindaweni ezihlukahlukene zomzimba.

Isifo sikaGraves sibonakala ngokukhula okungavamile kwendlala yegilo (okuthiwa i-goiter) kanye nokwanda kokukhiqizwa kwehomoni yegilo (hyperthyroidism). Amahomoni egilo abandakanyeka ezinhlelweni eziningi zomzimba ezihlukene futhi, ngenxa yalokho, izimpawu nezimpawu ezithile zesifo i-Graves zingahluka kakhulu kubantu bobulili obuhlukile nobudala. Izimpawu ezivamile zihlanganisa ukuncipha kwesisindo okungahlosiwe, ukungabekezelelani ukushisa okungavamile nokujuluka kakhulu, ubuthakathaka bemisipha, ukukhathala, nokuphuma kwenhlamvu yeso. Isifo se-Graves ngokwemvelo siyisifo esizimele.

Izithombe ngaphambi nangemva kwesifo se-Graves

Izimbangela zesifo sika-Basedow kubantu abadala

Isifo se-Graves sibhekwa njengesifo esizimele, kodwa ezinye izici, okuhlanganisa izici zofuzo, imvelo, noma imvelo, zingase zibe nomthelela ekuthuthukeni kwaso. Ukuphazamiseka kwe-autoimmune kwenzeka lapho amasosha omzimba ehlasela ngephutha izicubu ezinempilo.

Amasosha omzimba ngokuvamile akhiqiza amaprotheni akhethekile abizwa ngokuthi amasosha omzimba. Lawa amasosha omzimba asabela ezintweni zangaphandle (isb. amagciwane, amagciwane, ubuthi) emzimbeni, okwenza ukuthi abhujiswe. Amasosha omzimba angawabulala ngokuqondile ama-microorganisms noma awagqokise ukuze ahlakazwe kalula ngamangqamuzana amhlophe egazi. Amasosha omzimba athile akhiwa ngokusabela ezintweni ezithile noma izinto ezikhuthaza ukukhiqizwa kwamasosha omzimba. Abizwa ngokuthi ama-antigen.

Esifweni se-Graves, amasosha omzimba akhiqiza i-antibody engavamile ebizwa ngokuthi i-thyroid-stimulating immunoglobulin. Le antibody ilingisa ukusebenza kwehomoni evamile evuselela igilo (ekhishwa indlala ye-pituitary). Le hormone ilingisa inamathela phezu kwamangqamuzana egilo futhi ibangele ukuthi amangqamuzana akhiqize amahomoni egilo, okuholela ekweqiseni kwawo egazini. Kukhona ukungasebenzi kahle kwendlala yegilo, umsebenzi wayo othuthukisiwe, owedlulele. Ku-Ophthalmopathy ye-Graves, lamasosha omzimba angase futhi athinte amaseli azungeze inhlamvu yeso.

Abantu abathintekile bangase babe nezakhi zofuzo ezithile ezinesici noma isimo sofuzo se-Graves' disease. Umuntu othambekele ekuguleni uphethe isakhi sofuzo (noma izakhi zofuzo) zaleso sifo, kodwa i-pathology ingase ingabonakali uma isakhi sofuzo singaqaliswanga noma "sicushwe" ngaphansi kwezimo ezithile, isibonelo, ngenxa yezici zemvelo ezishintsha ngokushesha. (okubizwa nge-multifactorial herdity).

Kuye kwatholakala izakhi zofuzo ezihlukahlukene ezihlotshaniswa nesifo se-Graves, kuhlanganise nalezi:

• nciphisa noma uguqule ukuphendula kwamasosha omzimba (ama-immunomodulators),
• ahlobene ngokuqondile nomsebenzi we-thyroid, njenge-thyroglobulin (Tg) noma izakhi zofuzo ze-thyroid stimulating hormone receptor (TSHR).

UGene Tg ikhiqiza i-thyroglobulin, iphrotheni etholakala kuphela ezicutshini zegilo futhi idlala indima ekukhiqizweni kwamahomoni ayo.

IGene TSHR ikhiqiza iphrotheni eyi-receptor futhi ibophezele ku-hormone yegilo evuselelayo. Isisekelo esiqondile sokusebenzelana kwezici zofuzo nezemvelo ezibangela isifo se-Graves asiqondi ngokugcwele.

Izakhi zofuzo ezengeziwe, ezaziwa njengezakhi zofuzo, zingadlala indima ekuthuthukisweni noma ekuboniseni isifo. Izici zemvelo ezingabangela ukuthuthukiswa kwe-hyperthyroidism zihlanganisa ukucindezeleka okukhulu ngokomzwelo noma ngokomzimba, ukutheleleka, noma ukukhulelwa. Abantu ababhemayo basengozini enkulu yokuba nesifo i-Graves’ kanye ne-ophthalmopathy. Abantu abanamanye ama-pathologies okubangelwa ukungasebenzi kahle kwamasosha omzimba, njengesifo sikashukela sohlobo loku-1 noma isifo samathambo, basengozini enkulu yokuba nesifo i-Graves.

Ubani osethubeni elihle lokuthola i-Graves' disease?

Isifo se-Graves sihlasela abesifazane kaningi kunabesilisa, ngesilinganiso esingu-10:1. Lesi sifo sivame ukuvela eminyakeni ephakathi nendawo kanye nezigameko eziphezulu phakathi kweminyaka engama-40 no-60, kodwa futhi singathinta izingane, intsha, kanye nasebekhulile. Isifo samathuna sitholakala cishe kuzo zonke izingxenye zomhlaba. Kulinganiselwa ukuthi u-2-3% wabantu abaphethwe yiso. Ngendlela, isifo se-Graves yisona sizathu esivame kakhulu se-hyperthyroidism.

Ezinye izinkinga zempilo nomlando womndeni nakho kubalulekile. Abantu abanesifo sikaGraves bavame ukuba nomlando wamanye amalungu omndeni anezinkinga zegilo noma izifo ezizimele. Ezinye izihlobo kungenzeka ukuthi zine-hyperthyroidism noma i-thyroid engasebenzi, ezinye zingase zibe nezinye izifo ezizimele, kuhlanganise nokumpunga kwezinwele ngaphambi kwesikhathi (kusukela eminyakeni yawo-20). Ngokufanisa, isiguli singase sihlotshanise izinkinga zokuzivikela komzimba emndenini, kuhlanganise nesifo sikashukela sezingane, i-anemia eyingozi (ngenxa yokuntuleka kwevithamini B12), noma amabala amhlophe angenabuhlungu esikhumbeni (vitiligo).

Kubalulekile ukukhipha ezinye izimbangela ze-hyperthyroidism. Zihlanganisa i-nodular nodular goiter enobuthi noma i-multinodular goiter, ebonakala ngeqhuqhuva elilodwa noma ngaphezulu noma amaqhuqhuva endlaleni yegilo akhula kancane kancane futhi andise umsebenzi wawo ukuze inani eliphelele le-hormone yegilo egazini lidlule okujwayelekile.

Futhi, abantu bangase babe nezimpawu ze-hyperthyroidism okwesikhashana uma benesimo esibizwa ngokuthi i-thyroiditis. Lesi simo sibangelwa inkinga yamasosha omzimba noma ukutheleleka ngegciwane okubangela ukuthi indlala ivuze ihomoni yegilo egciniwe. Izinhlobo ze-thyroiditis zihlanganisa i-subacute, ithule, ethathelwanayo, i-radiation therapy-induced, kanye ne-postpartum thyroiditis.

Akuvamile, izinhlobo ezithile zomdlavuza wegilo kanye nezimila ezithile, njenge-TSH-producing pituitary adenomas, zingabangela izimpawu ezifana nalezo ezibonakala ku-Graves' disease. Akuvamile, izimpawu ze-hyperthyroidism zingabangelwa ukuthatha i-hormone yegilo eningi efomini lamaphilisi.

Izimpawu zesifo sika-Basedow kubantu abadala

Izimpawu ezihambisana nesifo sika-Basedow zivame ukuvela kancane kancane, kwesinye isikhathi zingabonakali kumuntu uqobo (kungenzeka kube ngabokuqala ukubona izihlobo). Zithatha amasonto noma izinyanga ukukhula. Izimpawu zingase zihlanganise izinguquko zokuziphatha ezifana nokwethuka okwedlulele, ukucasuka, ukukhathazeka, ukungahlaliseki, nobunzima bokulala (ukuqwasha). Izimpawu ezengeziwe zihlanganisa ukwehla kwesisindo okungahlosiwe (ngaphandle kokulandela ukudla okuqinile kanye nezinguquko zokudla okunomsoco), ubuthakathaka bemisipha, ukungabekezelelani ukushisa okungavamile, ukujuluka okukhulayo, ukushaya kwenhliziyo okusheshayo, okungavamile (tachycardia), nokukhathala.

Isifo se-Graves sivame ukuhlotshaniswa ne-pathologies ethinta amehlo, ngokuvamile ebizwa ngokuthi i-ophthalmopathy. Uhlobo oluncane lwe-ophthalmopathy lukhona kubantu abaningi abane-hyperthyroidism ngesikhathi esithile kulesi sifo, ngaphansi kwe-10% yeziguli ezinokubandakanyeka okuphawulekayo kwamehlo okudinga ukwelashwa okusebenzayo. Izimpawu zamehlo zingase zithuthuke ngaphambi, ngesikhathi esifanayo, noma ngemva kokuthuthukiswa kwe-hyperthyroidism. Akuvamile, abantu abanezimpawu zamehlo abalokothi babe ne-hyperthyroidism. Kwezinye izimo, ukulimala kwamehlo kungase kuqale kubonakale noma kubi nakakhulu ngemva kokwelashwa kwe-hyperthyroidism.

Izikhalazo ku-ophthalmopathy ziyahlukahluka kakhulu. Kwabanye abantu, zingase zihlale zingashintshile iminyaka eminingi, kanti kwabanye, isimo singase sibe ngcono noma sibe sibi kakhulu ezinyangeni ezimbalwa nje. Izinguquko zingabuye zilandele iphethini: ukuwohloka okubukhali (ukukhuphuka), bese kuba ngcono okuphawulekayo (ukukhululwa). Kubantu abaningi, lesi sifo sithambile futhi asiqhubeki.

Ukubonakaliswa okuvamile kwezimpawu zamehlo ukuvuvukala kwezicubu ezizungeze inhlamvu yeso, okungabangela ukuba liphume emzileni, isimo esibizwa ngokuthi i-proptosis (amehlo aqhumile). Iziguli zingase futhi ziqaphele ukomisa okukhulu kwamehlo, ukuvuvukala kwamajwabu amehlo kanye nokuvalwa kwawo okungaphelele, ukuwohloka kwamajwabu amehlo, ukuvuvukala, ububomvu, ubuhlungu nokucasuka kwamehlo. Abanye abantu bachaza umuzwa wesihlabathi emehlweni abo. Ngokuvamile, ukubona okufiphele noma okukabili, ukuzwela ekukhanyeni, noma ukubona okufiphele kungase kwenzeke.

Kuyaqabukela, abantu abane-Graves' disease baba nesilonda esikhumbeni esaziwa ngokuthi i-pretibial dermopathy noma i-myxedema. Lesi simo sibonakala ngokubonakala kwesikhumba esiqinile, esibomvu phambi kwemilenze. Ngokuvamile kunqunyelwe kuma-shins, kodwa ngezinye izikhathi kungase kwenzeke nasezinyaweni. Akuvamile, ukuvuvukala okufana nejeli kwezicubu zezandla nokuvuvukala kweminwe nezinzwane (i-acropachia) kwenzeka.

Izimpawu ezengeziwe ezihlobene nesifo se-Graves zihlanganisa:

• inhliziyo;
• ukuthuthumela okuncane (ukuthuthumela) kwezandla kanye / noma iminwe;
• ukulahleka kwezinwele;
• izipikili eziphukile;
• ukwanda kwe-reflexes (hyperreflexia);
• ukwanda kwesifiso sokudla kanye nokukhuphuka kwamathumbu.

Abesifazane abane-Graves' disease bangase babe nezinguquko emjikelezweni wabo wokuya esikhathini. Amadoda angase abe ne-erectile dysfunction (ukungabi namandla).

Kwezinye izimo, isifo se-Graves singathuthuka, sibangele ukwehluleka kwenhliziyo noma ukuncipha okungavamile kanye nokuba buthakathaka kwamathambo (i-osteoporosis), okuwenza abe brittle futhi abangele ukuphuka ngenxa yokuhlukumezeka okuncane noma ukunyakaza okungahambi kahle.

Ukwelashwa kwesifo sika-Basedow kubantu abadala

Ukuxilongwa nokwelashwa kwesifo sika-Basedow kubonakala kuzivumelwano zamazwe ngamazwe kanye nemihlahlandlela kazwelonke yomtholampilo. Uhlelo lokuhlola ludwetshwa ngokuhambisana ngokuqinile nokuxilongwa okuhlongozwayo futhi lwenziwa ngezigaba.

Diagnostics

Ukuxilongwa kwesifo se-Graves kwenziwa ngesisekelo somlando onemininingwane wesiguli nomndeni waso (ukuthola ukuthi izihlobo eziseduze zinezinkinga zemvelo efanayo), ukuhlolwa okuphelele komtholampilo, ukuhlonza izimpawu zesici, njll. Ngemva kwezimpawu zomtholampilo. zihlonziwe, ukuhlolwa kwaselabhorethri nokuhlolwa kwezinsimbi kuyanqunywa.

Ukuhlolwa okujwayelekile (igazi, umchamo, i-biochemistry) nokuhlolwa okukhethekile okufana nokuhlolwa kwegazi okulinganisa amazinga e-hormone yegilo (T3 kanye ne-T4) kanye ne-hormone yegilo evuselelayo (amazinga e-TSH). Ukuze kuqinisekiswe ukuxilongwa, ukuhlolwa kwegazi kungase kwenziwe ukuze kutholakale ukuba khona kwamasosha omzimba athile ku-thyrogloulin ne-thioperoxidase abangela isifo sika-Graves, kodwa lokhu ngokuvamile akudingekile.

Ukwelashwa kwesimanje

Ukwelashwa kwesifo se-Graves ngokuvamile kuhilela enye yezindlela ezintathu:

• izidakamizwa ze-antithyroid (zicindezela umsebenzi we-gland yegilo ekuhlanganiseni kwamahomoni);
• ukusetshenziswa kwe-iodine enemisebe;
• ukungenelela kokuhlinzwa.

Indlela ethile yokwelapha enconywayo ingase incike eminyakeni yobudala yesiguli kanye nezinga lesifo.

Iziqondiso zomtholampilo

Zonke izigaba zokwelashwa zenziwa ngokuhambisana nezincomo ze-Clinical protocols

Ukwelashwa okuncane kakhulu kwesifo sikaGraves ukusetshenziswa kwezidakamizwa ezinciphisa ukukhishwa kwehomoni yegilo (izidakamizwa ze-antithyroid). Zikhethwa ikakhulukazi ekwelapheni kwabesifazane abakhulelwe, labo abane-hyperthyroidism emnene, noma iziguli ezidinga ukwelashwa ngokushesha kwe-hyperthyroidism. Izidakamizwa eziqondile zikhethwa udokotela, ngokusekelwe eminyakeni yesiguli, isimo sakhe kanye nezici ezengeziwe.

Izindlela zokwelapha eziqondile zesifo sikaGraves yilezo ezibhubhisa indlala yegilo, okuholela ku-hypothyroidism. I-radioactive iodine therapy iyindlela yokwelapha evame kakhulu ye-Graves' disease emazweni amaningi. Iodine isakhi samakhemikhali esisetshenziswa indlala yegilo ukwakha (ukuhlanganiswa) amahomoni egilo. Cishe yonke iodine emzimbeni womuntu imuncwa izicubu zendlala yegilo. Iziguli zigwinya isixazululo esine-iodine enemisebe, ezohamba egazini futhi inqwabelane endlaleni yegilo, lapho izolimaza futhi ibhubhise izicubu zegilo. Lokhu kuzonciphisa indlala yegilo futhi kunciphise ukukhiqizwa ngokweqile kwamahomoni. Uma amazinga e-hormone yegilo ehla kakhulu, kungase kudingeke ukwelashwa ngama-hormone ukuze kubuyiselwe amazinga anele e-hormone yegilo.

Okunye ukwelashwa okunamandla ukuhlinzwa ukukhipha yonke noma ingxenye yegland yegilo (thyroidectomy). Le ndlela yokwelashwa kwalesi sifo ngokuvamile igcinelwe abantu lapho ezinye izinhlobo zokwelapha zingaphumelelanga noma ziphikisana, noma lapho kukhona ukukhula kwezicubu ze-gland zibe usayizi obalulekile. Ngemuva kokuhlinzwa, i-hypothyroidism ivame ukwenzeka - lokhu kungumphumela oyifunayo, olungiswa ngomthamo olungiswe ngokuqinile wamahomoni ovela ngaphandle.

Ngaphezu kokwelashwa okuthathu okukhulunywe ngenhla, kungase kunikezwe izidakamizwa ezivimba i-hormone yegilo eselijikeleza kakade egazini (beta-blockers) ekwenzeni umsebenzi walo. Ama-beta blockers afana ne-propranolol, i-atenolol, noma i-metoprolol angasetshenziswa. Lapho izinga lamahomoni egilo liba ngokwejwayelekile, ukwelashwa ngama-beta-blockers kungamiswa.

Ezimweni eziningi, ukulandelela impilo yonke kanye nophenyo lwaselabhorethri kuyadingeka. Kwezinye izimo, ukwelashwa kwe-hormone esikhundleni sokuphila konke kungase kudingeke.

Amacala amancane we-ophthalmopathy angelashwa ngezibuko zelanga, amafutha okugcoba, izinyembezi zokwenziwa. Izimo ezinzima kakhulu zingelashwa nge-corticosteroids njenge-prednisone ukunciphisa ukuvuvukala kwezicubu ezizungeze amehlo.

Ezimweni ezimbi kakhulu, ukuhlinzwa kwe-orbital decompression kanye nokwelashwa ngemisebe ye-orbital nakho kungase kudingeke. Ngesikhathi sokuhlinzwa kwe-orbital decompression, udokotela ohlinzayo ususa ithambo phakathi kwesokhethi yeso (i-orbit) kanye nezono. Lokhu kuvumela iso ukuthi libuyele endaweni yalo yemvelo kusokhethi. Lokhu kuhlinzwa kuvame ukugcinelwa abantu abasengozini yokulahlekelwa umbono ngenxa yokucindezela ku-optic nerve noma labo ezinye izindlela zokwelapha ezingasebenzanga.

Ukuvimbela isifo sika-Basedow kubantu abadala ekhaya

Ukubikezela ukuthuthukiswa kwalesi sifo kusengaphambili nokuvimbela kunzima. Kodwa kunezinyathelo zokunciphisa izingozi zezinkinga kanye nokuqhubekela phambili kwe-hyperthyroidism.

Uma kutholakala ukuthi isifo sikaGraves, yenza impilo yengqondo nengokwenyama ibe yinto eza kuqala.

Ukudla okunomsoco nokuzivocavoca umzimba ingase ithuthukise ezinye izimpawu phakathi nokwelashwa futhi ikusize uzizwe ungcono ngokuphelele. Isibonelo, ngenxa yokuthi indlala yegilo ilawula ukugaywa kwe-thyroid, i-hyperthyroidism ingase ithambekele ekugcwaleni futhi ibe brittle ngemva kokuba i-hyperthyroidism isilungisiwe, futhi ukuvivinya umzimba kokumelana kungasiza ekugcineni ukuminyana kwethambo nesisindo.

Ukuncishiswa kwengcindezi kungase kube nenzuzo njengoba kungase kubangele noma kubhebhethekise isifo se-Graves. Umculo omnandi, ukugeza okufudumele noma ukuhamba ngezinyawo kuzokusiza uphumule futhi uthuthukise isimo sakho sengqondo.

Ukwenqaba imikhuba emibi – ungabhemi. Ukubhema kwenza i-Graves's ophthalmopathy ibe nzima nakakhulu. Uma isifo sithinta isikhumba sakho (i-dermopathy), sebenzisa okhilimu otholakala ekhawuntaleni noma amafutha okugcoba aqukethe i-hydrocortisone ukuze ukhulule ukuvuvukala nokubabomvu. Ngaphezu kwalokho, ukugoqa kwemilenze yokucindezela kungasiza.

Imibuzo nezimpendulo ezidumile

Imibuzo ephathelene nesifo sika-Basedow, sixoxisane nayo udokotela ojwayelekile, i-endoscopist, inhloko yehhovisi lenhlangano kanye nendlela yokusebenza uLidia Golubenko.