Захворювання щитовидної залози (1)

Захворювання щитовидної залози (1)

Захворювання щитовидної залози

При лікуванні гіпотиреозі препаратом вибору є L-тироксин в індивідуально підібраній дозі (зазвичай 1,6 мкг на 1 кг фактичної маси тіла). Контроль рівнів гормонів (ТТГ, св Т4) необхідний 1 раз на 2 місяці. Тіреотом містить трийодтиронін (другий гормон щитовидної залози) і L-тироксин. На вибір препарату, його дозування впливають такі фактори, як супутні захворювання, вік, тому я рекомендую Вам очну консультацію ендокринолога для визначення оптимальної подальшої тактики.

Уточніть пожайлуста результати рівня ТТГ. Оскільки для цього гормону діапазон нормальних значень 0,4-4,0. Якщо немає помилки, ТТГ значно підвищений, але нормальний рівень заг Т4 суперечить цьому.

Хронічний аутоімунний тиреоїдит – ознака ультразвукової діагностики. При рівні гормонів щитовидної залози в межах норми лікування не потрібно. При субклінічному гіпотиреозі (рівень ТТГ незначно підвищений, св Т4 в межах норми) доцільна вичікувальна тактика – повторне визначення ТТГ і св Т4 через 2-3 місяці. Пізніше визначається доцільність замісної терапії.

Результати гормонів свідчать про субклінічний гіпотиреоз (рівень св Т4 в межах норми, ТТГ незначно підвищений). Гіпотиреоз – зниження функції щитовидної залози, коли необхідна замісна терапія L-тироксином в індивідуально підібраній дозі. У разі субклінічного гіпотиреозу (“прикордонного” стану) більш виправдана вичікувальна тактика – повторне визначення рівня ТТГ і св Т4 через 2 місяці. Йод входить в структуру гормону щитовидної залози, але при гіпотиреозі його прийом не має сенсу, оскільки порушений синтез гормонів. Рекомендую Вам повторно здати аналіз крові на ТТГ і св Т4 через 2 місяці, і з результатами очно проконсультуватися у ендокринолога для вибору оптимальної подальшої тактики.

Підвищення температури не є “характерним” симптомом захворювань щитовидної залози. Нормальне функціонування щитовидної залози підтверджують результати гормонів (вони в нормі). Зверніться до терапевта, ЛОР-лікаря. уролога і гінеколога для виявлення причини підвищення температури.

Лазерна терапія не використовується для лікування вузлових утворень щитовидної залози. При колоїдному різною мірою проліферуючих зобі невеликого розміру (до 3 см в діаметрі), гормонах крові в межах норми переважно динамічне спостереження. В інших випадках тактика може бути більш агресивною. Тому якщо у Вас є вузлове утворення щитовидної залози рекомендую очну консультацію ендокринолога.

Випадання волосся частіше спостерігається при гіпотиреозі (зниженні функції щитовидної залози), що пов’язано зі зменшенням вироблення цілого ряду клітинних ферментів внаслідок дефіциту тиреоїдних гормонів.

Преднізолон не використовується для лікування дифузного токсичного зобу. Для обговорення схеми лікування дифузного токсичного зобу, яка не зовсім “проста”, необхідна особиста консультація ендокринолога з результатами обстеження (УЗД і результати аналізу крові на гормони). Хочу зауважити, що лікування дифузного токсичного зобу тривалий і іноді не обмежується тільки консервативним методом (препаратами).

Для оцінки функції щитовидної залози дійсно необхідно визначення рівнів гормонів (ТТГ, св Т4). Результати аналізів, які Ви привели, говорять про наявність субклінічного гіпотиреозу (підвищення рівня ТТГ при нормальному рівні св Т4). Гіпотиреоз – зниження функції щитовидної залози, ситуація зворотна гіперфункції. Рекомендую Вам здати аналіз крові на ТТГ і св Т4 повторно через 2 місяці і з результатами проконсультуватися у ендокринолога для вирішення питання про необхідність терапії. В даний час лікування не потрібно.

Результати аналізів крові свідчать про наявність тиреотоксикозу, причин якого може бути декілька: передозування прийнятого L-тироксину, розвиток функціональної автономії (клітини вузлового освіти продукують надлишок гормонів), розвиток дифузного токсичного зобу та ін. Скільки часу пройшло з моменту скасування L – тироксину. коли Ви здавали аналіз крові на гормони (на фоні прийому L-тироксину чи ні)? Для діагностики функціональної автономії необхідно пройти дообстеження – сцинтиграфія щитовидної залози. Як бачите, питань багато, тому я настійно рекомендую Вам очну консультацію ендокринолога для опредленія подальшої тактики лікування.

Збільшення щитовидної залози – зоб – обсяг щітоівдной залози більше 18 мл у жінок і більше 25 мл у чоловіків. При проведеному у Вас УЗД обсяг щитовидної залози – 12,7 мл, що не є зобом. Повторне УЗД щитовидної залози не дозволяє розрахувати обсяг, оскільки немає третього розміру часток. Для визначення функціонального стану щитовидної залози (дифузний токсичний зоб чи ні) найбільш інформативним є рівень ТТГ, але ніяк не Т3. Тому бажано визначити рівень ТТГ. Причин випадіння волосся багато, вони не обмежуються тільки захворюваннями щитовидної залози. Але саме збільшення щитовидної залози без порушення функції не є такою. Для профілактики йодного дефіциту краще використовувати йодид 100 мкг 1 раз на день. Антістурмін в даний час не використовується. Що стосується йодованої солі, в цьому я Вас підтримую, використовуйте саме її. Рекомендую 1 раз в 1,5-2 роки проходити обстеження в ендокринолога (аналіз крові на ТТГ, св Т4; УЗД щитовидної залози).

Моїй дочці (вік 5 років) при огляді лікарем в дитячому садку поставили попередній діагноз ендемічний зоб I ступеня. УЗД показало: обсяг щитовидної залози 4.23 мл; ПДО 3.4 мл. розподіл луни однорідне у всіх частках, щільність луни норм. скрізь, контури щитовидної залози рівні; Л / вузли мен. НЕ візуал. Діагноз – гіперілазія I ступеня. Направили здавати аналіз крові на гормони. Результати такі: Т4 свобод = 34,47; ТТГ (тиреотропний) 4,15 (норма 0,2-4,5); АТ до ТПО = 21,94 (норма lt; 50). Ендокринолог призначив приймати йодомарин-100 по 1 табл. / День протягом 6 міс і будь-які полівітаміни. Це для випадку, якщо аналіз на гормони в нормі. А тут, наскільки я розумію Т4 не в нормі. Донька активна, плаксива, розвиток завжди було в нормі або опрережало, вага

22 кг, зріст 122 см. Не могли б ви роз’яснити результати аналізу, пояснити погані вони? Чи вірний попередній діагноз і чи приймати йодомарин? Може бути справа не в щитовидній залозі, а в інших органах? Або ж це ознаки наявності будь-яких інфекцій?

Більш інформативним є рівень ТТГ, який в межах норми. Тому аналізи “хороші”, в даний час немає приводів для хвилювання. Приймати йодомарин 100 мкг на добу бажано для заповнення йодного дефіциту, який присутній на всій . Йод необхідний для поліпшення діяльності ЦНС, пам’яті, навчання в школі. Через 2 місяці зробіть повторний аналіз крові ТТГ і св Т4 для контролю і з результатами проконсультуйтеся у ендокринолога.

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