indlala yegilo yomuntu

Indlala yegilo incane, kodwa iyisakhi esikhulu kunazo zonke ohlelweni lwe-endocrine lomzimba. "Uyavutha" ezincwadini zezokwelapha ezinamagama ahlukahlukene ezinkondlo: ubizwa ngokuthi "indlovukazi yamahomoni" kanye "nenkosikazi yomzimba." Kungani?

Iqiniso liwukuthi indlala yegilo ikhiqiza amahomoni alawula izinqubo eziyinhloko ze-metabolic emzimbeni womuntu, alawula ukukhiqizwa kwamandla kanye nokunikezwa komoya-mpilo ezicutshini.

- Amahomoni e-thyroid athinta ukusebenza kwazo zonke izitho nezinhlelo, - kuchaza Isazi se-endocrinologist u-Elena Kulikova. – Lapho umsebenzi wendlala yegilo ushintsha, isisindo somzimba, amandla kanye nemvamisa yokufinyela kwenhliziyo, izinga lokuphefumula kanye nomsebenzi wepheshana lesisu liyashintsha. Ijubane lokucabanga kanye nesimo somzwelo somuntu sincike ekusebenzeni kwegland yegilo. Futhi ngisho nekhono lokuba nezingane, ukukhulelwa nokuzalwa kwengane enempilo nakho kuncike kakhulu ezingeni lamahomoni egilo.

Uma ubona izinguquko ekubukeni naseqophelweni lesikhumba, ukuvuvukala okuphinyiselwe kwamajwabu amehlo, ukhathazekile ngezinwele ezifiphele neziphukayo, ukulahleka kwezinwele, kungenzeka ukuthi lokhu kungenxa yezinkinga zegilo.

Okubalulekile ukwazi ngendlala yegilo yomuntu

Itholakala kuphi indlala yegilo yomuntu?

Indlala yegilo itholakala esifundeni sikanxantathu wangaphambili wentamo, eboshwe ukusuka phezulu ngesisekelo somhlathi ongezansi, ukusuka ngezansi ngenotshi ye-jugular ye-sternum, ezinhlangothini ngamaphethelo angaphambili kwesokudla futhi. kwesokunxele imisipha sternocleidomastoid¹.

Uma uncike ngesandla entanyeni, ungezwa uqwanga lwegilo (lolo olubizwa ngokuthi i-apula lika-Adamu) – ukwakheka okuminyene noma okuqinile okuphumela ngaphandle. Uma igwinywa, iyashibilika. Ngokuqondile ngaphansi kwayo kunendlala yegilo ngokwayo - ngokuvamile izwakala ngendlela "yokukhula" okuthambile kuqhoqhoqho.².

Ibukeka kanjani indlala yegilo futhi isebenza kanjani?

Ukuma kwendlala yegilo kuvame ukuqhathaniswa novemvane. I-lobes yayo yesokudla nesobunxele ixhunywe yi-isthmus, futhi ku-30% yamacala kukhona futhi i-pyramidal lobe ephuma emgodleni.³.

Indlala yegilo iqukethe izakhi zesakhiwo ezifana nama-vesicles ngokubukeka - i-follicle. Balinganiselwa ezigidini ezingu-30². I-follicle ngayinye igcwele into efana nejeli ebizwa ngokuthi i-colloid. Iqukethe amahomoni akhiqizwa amaseli. Wonke ama-follicle ahlanganiswe yizicucu ezingu-20-30: amaqembu anjalo abizwa ngokuthi ama-thyreons.

Indlala yegilo ilawulwa izindlela ezi-3.

1. Indlela yokuqala i-hypothalamic-pituitary system, etholakala ebuchosheni. Ukushintshaniswa kolwazi phakathi kwendlala yegilo, i-hypothalamus kanye ne-pituitary gland kwenzeka ngosizo lwe-hormone evuselela i-thyroid (TSH) ne-thyreoliberin (TRH).
2. Isimiso sezinzwa esimaphakathi sinesibopho sohlelo lwesibili lokulawula. Isibonelo esihle ukwanda kwamazinga e-hormone yegilo ngezikhathi zokucindezeleka.
3. Indlela yesithathu yokulawula okuqukethwe kwe-iodine engaphili endaweni ezungezile (ikakhulukazi amanzi nokudla). Ngokudla okunganele kwe-iodine emzimbeni, izinga lamahomoni egilo liyancipha futhi ama-pathologies ahlukahlukene wegland yegilo athuthuke.

Kungani indlala yegilo ingalimaza kubantu

Akuwona wonke umuntu ongakwazi ukubona isignali evela ku-thyroid gland. Ngokuvamile, umuntu udidanisa ubuhlungu kule ndawo ngezimpawu ze-osteochondrosis noma ucabanga ukuthi unomkhuhlane emphinjeni wakhe.

Ngendlela, umuntu akahlali ezwa ubuhlungu. Ngokuvamile, ubuhlungu buwuphawu lwe-thyroiditis esithathelwanayo (ukuvuvukala), futhi nge-hypothyroidism kanye ne-hyperthyroidism, kanye nokwakhiwa kwamaqhuqhuva e-thyroid, njengomthetho, akulimazi.

Ngaphezu kwalokho, umuntu angase angazinaki izimpawu zomzimba isikhathi eside futhi angacabangi ukuthi unezinkinga zempilo. Ngakho-ke, kubalulekile ukwazi izimpawu zezinkinga zegilo. Lokhu kufaka phakathi: ukwehla kokusebenza, ukucasuka okukhulu, ubunzima bokugwinya, ukuphazamiseka kokulala, ukukhathazeka (kuze kufike ku-paranoia), ukulahlekelwa isisindo ngesifiso esihle sokudla, njll Izifo ezahlukene zinezimpawu zazo.

Esinye sezimbangela ezivame kakhulu zezinkinga zegilo ukuntuleka kwe-iodine ekudleni.

"Ukuntuleka kwe-iodine kuvamile ezifundeni eziningi zezwe lethu: kusukela komnene kuye kokuqina," kuphawula u-Elena Kulikova. - Isidingo sokuthatha okwengeziwe kwezidakamizwa ezine-iodine noma ukudla okuphezulu kwe-iodine kubaluleke kakhulu ezinganeni, kwabesifazane abakhulelwe nabancelisayo. Ukusetshenziswa ngesikhathi sokudla okune-iodized kuwukuvimbela okuyinhloko ekuvimbeleni izifo zegilo ezinganeni nakubantu abadala.

Phakathi kwezimbangela zezifo ze-thyroid kungaba: amagciwane namabhaktheriya, ukuhlukunyezwa kwe-autoimmune, i-oncology. Isizinda esihle sokuvela kwezinkinga ngendlala yegilo ukucindezeleka okungapheli, ukuntuleka kwe-iodine, kanye nemvelo engalungile.

Izifo ze-thyroid ziyi-pathology evame kakhulu ohlelweni lwe-endocrine. Zivamile izikhathi ezingu-10-17 kwabesifazane kunabesilisa.⁵.

Zonke izifo zegland yegilo zihlukaniswe ngamaqembu ama-3 kuye ngezinga lamahomoni egilo:

1. I-Thyrotoxicosis yisimo esibonakala ngokukhuphuka kwezinga lamahomoni egilo. Izifo ezivame kakhulu ezihambisana nesifo se-thyrotoxicosis yisifo se-Graves (kufika ku-80% amacala eRussia.⁶), sakaza i-goiter enobuthi noma i-nodular goiter enobuthi.

   Ukwenyuka kwezinga lamahomoni egilo kungalindelwa futhi ngokukhula okungapheli kanye nokuvela kwe-acute and subacute thyroiditis.

2. I-Hypothyroidism. Kuhlotshaniswa nokwehla okukhulu kwamazinga e-hormone yegilo. Ezimweni eziningi, i-hypothyroidism iqala ngokumelene nesizinda se-autoimmune thyroiditis (ukuvuvukala kwegland yegilo) futhi kungenzeka ngemuva kokukhishwa (ukususwa kwengxenye) yegland yegilo.
3. Izifo ze-thyroid ezenzeka ngaphandle kokuphazamiseka kwe-hormonal (i-euthyroid goiter, izimila, i-thyroiditis).

Ake sihlaziye izifo ezivame kakhulu.

I-Hypothyroidism

Isisekelo salesi sifo ukuntula okuqhubekayo kwamahomoni egilo, noma ukwehla komphumela wawo ezicutshini zomzimba.⁷.

I-hypothyroidism eyinhloko ivame ukukhula ngokumelene nesizinda se-autoimmune thyroiditis. Izimpawu zingahlukahluka kakhulu, futhi ngokuvamile ngisho nodokotela akahloli ngokushesha i-hypothyroidism. Iqembu labasengozini lihlanganisa abantu abahlinzwe indlala yegilo, iziguli ezinesifo sikashukela kanye nesifo sika-Addison, ababhemayo kakhulu. Abesifazane kufanele baqaphele ikakhulukazi ngemva kokubeletha.

Ngeke kube yinto engafaneleki ukuhlola i-hypothyroidism uma, ngaphandle kwesizathu esithile, isisindo saqala ukukhula, ukukhathala, ukozela, ukukhathazeka okungenangqondo nokucindezeleka kubonakala. Futhi, i-hypothyroidism ingabonakaliswa ngokuncipha kwenkumbulo nokunaka, ukuvuvukala kobuso nemilenze, nokulahlekelwa izinwele. Emadodeni, le syndrome ingase ihambisane nokuncipha kwe-libido kanye namandla, kwabesifazane - ukwephulwa komjikelezo wokuya esikhathini. I-anemia ingenye uphawu oluvamile lwe-hypothyroidism.

Isifo se-Graves (ukusabalalisa i-goiter enobuthi)

Uma kwenzeka lesi sifo, isimiso somzimba sokuzivikela ezifweni sikhiqiza amasosha omzimba “akhuthaza” indlala yegilo ukuthi isebenze kakhulu kunalokho okufanele. Ngenxa yalokho, amahomoni egilo ngokweqile avela emzimbeni, okuthinta kabi izitho nezinhlelo eziningi, ikakhulukazi izinzwa nezinhliziyo.

Izimpawu zokuqala zesifo sikaGraves yilezi: ukushaya kwenhliziyo, ukujuluka, ukuncipha kwesisindo ngokumelene nesizinda sokwanda kwesifiso sokudla, ubuthakathaka bemisipha, ukucasuka nokucasuka.⁸. Ezimweni eziningi, indlala yegilo iyanda futhi ibonakale. Ngokuvamile, isifo sika-Graves sihambisana ne-ophthalmopathy ye-endocrine, ebonakaliswa yi-exophthalmos (amehlo aqhumayo) nokuvuvukala kwamajwabu amehlo.

"Ukuba khona kwe-ophthalmopathy ezimweni eziningi kuwuphawu lwe-goiter enobuthi esakazekile," kusho uchwepheshe wethu. – Kubalulekile ukukhumbula ukuthi i-Graves’ disease yisifo esibuyayo. Ezimweni eziningi, ibuya, okwenza ucabange ngokukhetha indlela yokwelapha eqinile.

Ukusabalalisa kanye ne-nodular goiter ye-euthyroid

I-Euthyroid goiter ibizwa nangokuthi i-non-toxic. Kulesi simo, kukhona ukwanda kobukhulu begland yegilo ngaphandle kokuphazamisa umsebenzi wayo. Isilinganiso senkinga singahluka: i-goiter ngezinye izikhathi ibonakala kuphela, futhi ngezinye izikhathi ingabonakala ngeso lenyama.

Kunezizathu eziningi zokuthuthukiswa kwe-pathology enjalo, kodwa okuvame kakhulu kuzo ukuntuleka kwe-iodine, okudingekayo ukuze kuhlanganiswe amahomoni e-thyroid. Ukwandisa ukukhiqizwa kwamahomoni, indlala yegilo iqala ukwanda ngosayizi.

Nge-diffuse goiter, insimbi ikhula ngokulinganayo, futhi nge-nodular goiter, ukwakheka okuhlukile kwe-volumetric noma ama-node avela kuyo. Zingaba zodwa noma eziningi. Kukhona futhi uhlobo oluxubile - lwe-diffuse-nodular yesifo. Kubantu abangu-95%, ama-nodule anempilo. Kodwa-ke, le pathology idinga ukuxilongwa ngokucophelela ukuze ungafaki umdlavuza wegilo.

Ukuzilimaza i-thyroiditis

Izifo ze-thyroid ezivuthayo ze-autoimmune etiology zingaholela ku-hypothyroidism. I-Autoimmune thyroiditis ingatholwa ngengozi futhi ingahambisana nokungasebenzi kahle kwendlala yegilo.

Izici ezibangela ukuthuthukiswa kwalesi sifo zihlanganisa: ufuzo, imvelo engalungile, ukungasebenzi kahle kwamasosha omzimba.

“Njengoba lesi sifo siqhubeka, indlala yegilo iba nezinguquko ze-sclerotic futhi kancane kancane inciphisa ukusebenza kwayo,” kusho isazi se-endocrinologist u-Elena Kulikova. – Isifo singahamba kancane futhi sisheshiswe. Ngeke wazi kusengaphambili ukuthi indlala yegilo izolahlekelwa umsebenzi wayo ngokushesha kangakanani. Ukuze ungaphuthelwa yilo mzuzu futhi uqale ukwelashwa kokubuyisela ngesikhathi, sikweluleka ukuthi unikele ngegazi le-TSH okungenani kanye ngonyaka.

Umdlavuza we-yegilo

Umdlavuza we-thyroid ezimweni eziningi uhluke kakhulu. Lokhu kusho ukuthi ukukhula nokuthuthukiswa kwesimila kuhamba kancane. Kodwa-ke, kunezinhlobo ezihlukumezayo zesifo, ngakho-ke kufanele uqaphele kakhulu futhi ngesikhathi esifanele uhlole i-ultrasound yegland yegilo futhi, uma kunesidingo, wenze i-fine-needle aspiration biopsy.

Ngokuya ngemvelaphi, kukhona umdlavuza we-papillary, follicular kanye ne-medullary thyroid. Ezimweni eziningi, izinhlobo ezingezona ezinolaka zomdlavuza we-papillary kanye ne-follicular zenzeka. Ngokwelashwa okufika ngesikhathi, izinga lempilo yesiguli empeleni alihlupheki. Ezimweni ezinjalo, izindlela zokwelapha zokuhlinzwa ezingenele kancane zanele. Nokho, lapho inqubo isebenza noma ingatholakali ngesikhathi, kudingeka ukuhlinzwa okunzima.

Yelashwa kanjani i-thyroid yomuntu?

Izifo ezihlobene nokuntuleka kwama-hormone egilo ngokwezinga “legolide” zisikisela ukwelapha okunye. Okuvame ukusetshenziswa levothyroxine sodium⁹. Inkomba yokuqokwa kwe-L-thyroxine i-hypothyroidism kuphela. Kwezinye izimo, ukuqokwa kwayo akunangqondo futhi kungaba yingozi.

Izidakamizwa ze-Thyrostatic zisetshenziselwa ukwelapha izifo eziningi ze-thyroid ezihlobene nokusebenza kwayo ngokweqile.

Izindlela zokwelapha eziqinile zihlanganisa ukwelashwa kwe-radioiodine kanye nokungenelela kokuhlinzwa. Ukuze uqonde ukuthi iyiphi indlela yokwelapha ekufanele, udinga ukubonana nodokotela.

Ukwelashwa esikhundleni

Lolu hlobo lokwelashwa lunqunyelwe ezimweni lapho umsebenzi we-gland yegilo uncishisiwe, futhi ukushintshwa kwayo ngokuphelele noma ingxenye kuyadingeka. Umsebenzi we-hormone replacement therapy uwukujwayeza izinga lamahomoni egilo.

Isidakamizwa esikhethwayo yi-L-thyroxine. Kubaluleke kakhulu ukukhetha umthamo ofanele womuntu ngamunye futhi uthathe umuthi ngendlela efanele: ngokuqinile esiswini esingenalutho, ekuseni, imizuzu engama-30 ngaphambi kokudla, ngamanzi. Uma imiyalelo yephulwa, inhlalakahle ingase ibe yimbi.

Amazinga e-hormone yegilo ajwayelekile abaluleke kakhulu ngesikhathi sokukhulelwa. I-L-thyroxine inqunywe kwabesifazane abakhulelwe uma kunesidingo, iphephile ngokuphelele kumama nomntwana.

Ukwelashwa kwe-Thyrostatic

Isetshenziselwa ukwelapha i-thyrotooticosis. Kulokhu, izidakamizwa ze-thiourea (thiamazole, propylthiouracil) zisetshenziswa. Banqwabelana endlaleni yegilo futhi bavimbele ukuhlanganiswa kwamahomoni egilo. Ukwelashwa kwe-Thyrostatic kunqunyelwe inkambo yeminyaka engu-1-1,5, noma kusetshenziswe njengesigaba sokulungiselela ngaphambi kokuhlinzwa.

Lapho uthatha i-thyreostatics, kwezinye izimo, imiphumela emibi evela esibindini kanye nohlelo lokujikeleza kwegazi kungenzeka. Ngakho-ke, ngesikhathi sokuhlolwa kokulawula, kuyadingeka ukuthatha ukuhlolwa kwegazi hhayi kuphela inani lamahomoni e-thyroid, kodwa futhi nokuhlolwa kwegazi lomtholampilo kanye nemingcele yesibindi.

Ngokumelene nesizinda sokwelashwa kwe-thyreostatic, ukuqubuka kwesikhumba okungezwani nakho kungenzeka. Kubaluleke kakhulu ukubheka umthamo kanye nendlela yokuphuza imithi.

Izindlela zokuhlinza

Isidingo kanye nezinga lokuhlinzwa lincike ohlotsheni lwesifo segilo. Nge-goiter enobuthi esakazwayo, i-thyroidectomy iboniswa (ukususwa okuphelele kwegland yegilo). Ezimila ezihlukahlukene, kungaba i-thyroidectomy noma i-hemithyroidectomy (ukususwa ingxenye). Umthamo wokungenelela ohlinzayo unqunywa udokotela ohlinzayo-endocrinologist noma isazi se-endocrinologist.

Ukuhlinzwa kungenziwa ngendlela evulekile (i-classical) noma i-invasive kancane (endoscopic). Izindlela ze-Endoscopic (ngaphandle kokusikeka okukhulu) zinezinzuzo ezingenakuphikwa ngaphezu kokuhlinzwa okuvulekile: ukulimala okuncane kwezicubu, isikhathi sokuvuselela esifushane, izibazi ezingabonakali zangemuva kokuhlinzwa.

Ukwelashwa kokuhlinzwa kwe-thyroid pathology kunezinkomba zayo eziqinile. Kunezimo eziningana (isibonelo, ama-colloid nodes) ezingadingi ukwelashwa kokuhlinzwa futhi zingaphansi kokuqapha okunamandla.

Ukwelashwa kwe-Radioiodine

Ukwelashwa nge-iodine enemisebe kungenye indlela yokwelapha okukhulu kwezinhlobo ezahlukene ze-goiter enobuthi. Isetshenziswa uma kwenzeka lesi sifo sibuya njalo, futhi ukwelashwa kwe-thyreostatic akuzange kuveze imiphumela. Ukwelashwa nge-radioiodine kunconywa kuma-goiters amancane ukugwema ukuhlinzwa. 

Odokotela bayaqiniseka ukuthi ukwelashwa nge-iodine enemisebe ayithinti ingozi yokuba nomdlavuza wegilo¹⁰. Contraindications: ukukhulelwa, lactation, endocrine ophthalmopathy.

Ungayigcina kanjani i-thyroid yakho inempilo ekhaya

Isici esibaluleke kakhulu ekusebenzeni okuvamile kwendlala yegilo iodine. Imfuneko yansuku zonke yayo incike eminyakeni yobudala: kuze kufike eminyakeni engu-5 - 90 mcg, kuze kufike eminyakeni engu-12 - 120 mcg, kusukela eminyakeni engu-12 - 150 mcg, kwabesifazane abakhulelwe nabancelisayo - 250 mcg.¹¹.

Akubona ngaso sonke isikhathi ingxenye yansuku zonke ye-iodine ingatholakala ekudleni, ngakho odokotela bavame ukunikeza izidakamizwa ezine-iodine. Kodwa-ke, umuntu akufanele abe nentshiseko ekuthatheni amalungiselelo e-iodine. Kwezinye izimo, umthamo wansuku zonke ungatholakala ngokusebenzisa i-iodized noma usawoti olwandle ekudleni.

Izifo ze-thyroid zingabangelwa ukucindezeleka, ukusebenza ngokweqile, izifo ezibangelwa amagciwane kanye namagciwane, izifo ezingapheli zendlela yokuphefumula ephezulu. Uma ufuna indlala yakho yegilo izizwe kahle futhi isebenze ngaphandle kokwehluleka, udinga ukuqinisa amasosha omzimba, uphile ngendlela enempilo, ugweme ukucindezeleka futhi ulale ngokwanele.

Maye, ezinye izici (isibonelo, izakhi zofuzo) azikwazi ukuthonywa. Ngakho-ke, uma wazi ukuthi unomlando womndeni wesifo se-thyroid, qapha isimo saso nge-ultrasound yonyaka kanye nokuhlolwa kwegazi kwe-TSH.

Imibuzo nezimpendulo ezidumile

Uchwepheshe wethu, i-endocrinologist u-Elena Kulikova, uphendula imibuzo mayelana nokusebenza kwendlala yegilo.

Imithombo:

1. Indlala yegilo. izici eziyisisekelo. U-Ed. uphrof. AI Kubarko, prof. S. Yamashita. I-Minsk-Nagasaki. 1998. https://goo.su/U6ZKX
2. AV Ushakov. Ukubuyiselwa kwendlala yegilo. Umhlahlandlela weziguli. https://coollib.com/b/185291/read
3. AM Mkrtumyan, SV Podachina, NA Petunina. Izifo ze-thyroid gland. Umhlahlandlela odokotela. eMoscow. 2012. http://www.lib.knigi-x.ru/23raznoe/260583-1-am-mkrtumyan-podachina-petunina-zabolevaniya-schitovidnoy-zhelezi-rukovodstvo-dlya-vrachey-moskva-2012-oglavlen.php
4. OA Butakov. Mayelana nendlala yegilo // Umtapo wezincwadi we-Academy of Health. 2010 https://coral-info.com/shhitovidnaya-zheleza-olga-butakova/
5. SV Mikhailova, TA Zykov. Izifo ze-Autoimmune yegilo kanye nokuphazamiseka kokuzala kwabesifazane // I-Siberian Medical Journal. 2013. No. 8. pp. 26-31 https://cyberleninka.ru/article/n/autoimmunnye-bolezni-schitovidnoy-zhelezy-i-reproduktivnye-narusheniya-u-zhenschin/viewer
6. Yu.V. Kukhtenko, co-authors. Isakhiwo sezifo ze-thyroid ezigulini zeminyaka ehlukene // I-Vestnik VolgGMU. 2016. №3. https://cyberleninka.ru/article/n/struktura-zabolevaniy-schitovidnoy-zhelezy-u-patsientov-razlichnyh-vozrastnyh-grupp/viewer
7. Yu.A. Dolgikh, TV Lomonov. I-Hypothyroidism: ukuxilongwa okunzima // I-Endocrinology: izindaba, imibono, ukuqeqeshwa. 2021. Umqulu 10. No. 4. https://cyberleninka.ru/article/n/gipotireoz-neprostoy-diagnoz
8. II Dedov, GA Melnichenko, VV Fadeev. I-Endocrinology. Uhlelo lwesibili, lubuyekeziwe futhi lwandiswa. eMoscow. IG “GEOTAR-Media”. 2007. https://goo.su/5kAVT
9. OV Paramonova, EG Korenskaya. Ukwelashwa kwe-hypothyroidism ekusebenzeni kwe-geriatric // I-gerontology yomtholampilo. 2019. No. 5. https://cyberleninka.ru/article/n/lechenie-gipoterioza-v-geriatricheskoy-praktike/viewer
10. USE. Petunina, NS Martirosyan, LV Trukhin. thyrotoxicosis syndrome. Izindlela zokuxilongwa nokwelashwa // Isiguli esinzima. 2012. Umqulu 10. No. 1. pp. 20-24 https://cyberleninka.ru/article/n/sindrom-tireotoksikoza-podhody-k-diagnostike-i-lecheniyu/viewer
11. Ukhozi FM Abdulkhabirova, co-ababhali. Izincomo zomtholampilo "Izifo nezimo ezihambisana nokushoda kwe-iodine" // Izinkinga ze-endocrinology. 2021. Umqulu 67. No. 3. https://cyberleninka.ru/article/n/klinicheskie-rekomendatsii-zabolevaniya-i-sostoyaniya-svyazannye-s-defitsitom-yoda/viewer