UMary Allen
I-Feline hyperthyroidism (FTT) sesinye sezifo eziqhelekileyo kwiikati ezindala. Ukuxilongwa kunye nonyango alulula, kodwa unyango kunye nokuphilisa kunokwenzeka.
Malunga ne-20% yeekati ezingaphezu kweminyaka elishumi zifunyaniswa zinedlala lengqula elisebenza ngokugqithisileyo. Nangona kunjalo, kufuneka sicinge ukuba kukho inani elingenakulinganiswa leekati ezigulayo ezingabonwayo. Kwiikati ezine-hyperthyroidism, eyaziwa ngokuba yi-feline hyperthyroidism (FHT), izicubu ze-thyroid ezigulayo zivelisa amahomoni amaninzi kwaye ziwakhuphele egazini njenge-T4 (thyroxine) kunye ne-T3 (triiodothyronine).
Esi sifo saziwa kuphela ukuba sichaphazela iikati ukususela ngo-1979. Uphando oluninzi kunye noqwalaselo lwenziwe ukususela ngoko. Izifundo ezingenakubalwa ziye zacubungula amanani amatyala, idatha yebhubhoratri, kunye nempumelelo yonyango, ukuze namhlanje, emva kweminyaka engama-40 kuphela, sinokubonisa ulwazi oluninzi olusekelwe kubungqina malunga nesi sifo esitsha.
Ngaba sesona sifo siqhelekileyo sangaphakathi okanye ithumba eliqhelekileyo kwiikati ezindala? I-Hyperthyroidism ibangelwa kuninzi lwamatyala ngamaseli e-benign tumor, eyaziwa ngokuba yinto esebenzayo i-adenoma (i-adenoma = i-tumor e-benign ye-tissue glandular), iiseli ezihlala zilungelelaniswa zibe ngamaqhuqhuva angama-2-20 mm ngobukhulu. Kunqabile kakhulu, malunga ne-2% yamatyala, sifumana kwakhona i-adenocarcinomas kwi-thyroid gland, uhlobo olubi lwe-hyperthyroidism. Amathuba okuba ne-carcinoma ayanda kunye nexesha lokunyangwa kweziyobisi; emva kweminyaka emine yi-20%.
Kwi-70-75% yamatyala, utshintsho lunokufumaneka kuzo zombini i-thyroid. I-20% yeekati ezigulayo zineeseli ze-tumor kungekhona kuphela kwi-thyroid kodwa kunye ne-ectopically, i. H. kwenye indawo, ubukhulu becala mediastinal kwi thorax.
Ukuxilongwa kunye nokulawula
I-hyperthyroidism yokuqala ye-feline ihlala ibonwa ngexesha lovavanyo lwegazi lwesiqhelo kuba iimpawu zokuqala zesi sifo azichanekanga. Ukuba isifo sihamba phambili, ikati ibonisa iimpawu zeklasi ezifana nokulahlekelwa kwesisindo ngaphandle kokunyuka kokusetyenziswa kokutya, ukunyuka kokoma, okanye ukuphazamiseka kwesisu.
Iimpawu eziqhelekileyo ze-FHT kuxhomekeke kwinqanaba lesifo:
- ukuhla ukusinda
- Polyphagia (ukutya okongeziweyo kokutya)
- I-Polyuria (i-PU, ukwanda kokuphuma komchamo)
- I-Polydipsia (i-PD, ukwanda kokungena kwamanzi)
- uboya obumdaka
- ukuvakalisa ilizwi
- ukungazinzi
- ukuziqhatha
- I-Tachycardia (izinga eliphezulu lentliziyo) / tachypnea (izinga lokuphefumla elongezelelweyo)
- ukugabha/urhudo
- Ukungakhathali, ukuphelelwa ngumdla, ukutyhafa
Abanini beekati bahlala bephosisa utshintsho olunxulunyaniswa nedlala lengqula elisebenza ngokugqithisileyo njengeempawu eziqhelekileyo zokuguga kwaye ke ngoko bathathe intshontsho labo balise kugqirha wezilwanyana xa isifo sikwinqanaba eliphezulu. Izigulane zihlala zilahlekelwa yi-10-20% yobunzima bomzimba kunye nobunzima bemisipha.
Uxilongo lwenziwa ngovavanyo lwegazi. I-T4 (thyroxine) ilinganiswa rhoqo. Ukuzimisela kwe-serum T4 kunovakalelo lwe-90% kunye ne-specific ye-100%, oku kuthetha ukuba ingasetyenziswa kakuhle kakhulu ukuqinisekisa ukuxilongwa. Uluhlu lwereferensi luxhomekeke kwisixhobo sebhubhoratri kwaye luhlala lufakwe kwiingxelo. Ukwandiswa kokugxininiswa kwale hormone egazini ngokubhekiselele kwiimpawu zeklinikhi ezihambelanayo kukhokelela ekuqinisekiseni ukuxilonga. Olunye utshintsho lwegazi lungabandakanya ukunyuka kwe-ALT (i-alanine aminotransferase) kunye nokunyuka kwe-alkaline phosphatase.
Kwisifo se-unilateral, i-thyroid eyandisiweyo ngamanye amaxesha inokubonwa nge-palpation kunye nokuthelekisa kwelinye icala. Nangona kunjalo, iikati ezininzi aziqhelekanga kwi-palpation kwaye azinamaxabiso e-T4 ngaphezulu koluhlu lwereferensi. Nangona kunjalo, ukuba iimpawu zeklinikhi zibonisa i-hyperthyroidism, ezi kati kufuneka zihlolwe kwakhona kwiiveki ezi-2-4. Ukongezelela, ezinye izifo ezineempawu ezifanayo kufuneka zingabandakanywa.
Olunye uvavanyo lwebhubhoratri eyaziwayo efana nokuzimisela kwe-T4 yamahhala kwi-dialysis elinganayo, iimvavanyo ze-TSH, iimvavanyo zokunciphisa i-T3, kunye neemvavanyo zokuvuselela i-TSH / TRH mhlawumbi ayinakwenzeka ukuba ikati ayifaki nayiphi na ixabiso ekuxilongweni.
Iikati ezineempawu zeklinikhi kunye nexabiso le-T4 kwisiqingatha esiphezulu soluhlu lwereferensi kufuneka luhlelwe kwaye luphathwe njenge-hyperthyroid. Kukwasebenza okufanayo kwiikati ezingabonisi (okwangoku) naziphi na iimpawu zakudala kodwa zabonisa amaxabiso e-T4 ngaphezulu koluhlu lwereferensi kwimilinganiselo emibini. Izifo ezineempawu ezifana ne-FHT ziquka:
- iswekile yemellitus,
- ukungasebenzi kakuhle kwesisu esiswini/ukungatyibiliki kakuhle,
- neoplasia yesisu, umz. B. alimentary lymphoma.
Cacisa izifo ezinokwenzeka ezihambelanayo
Iikati ze-Hyperthyroid zivame ukuba neminyaka yobudala ukuya kwinqanaba eliphezulu kwaye ngenxa yoko zixhomekeke kwezinye izifo ze-geriatric. Ezi zigulana kufuneka zifumane unyango kuzo zombini i-FHT kunye nezinye iziphazamiso kwaye zibekwe esweni rhoqo. Ezi zifo zilandelayo ziqhele ukunxulunyaniswa ne-FHT:
-
isifo sentliziyo,
-
igazi elonyukayo,
-
izifo ze-retinal,
-
isifo sezintso esinganyangekiyo (CKD),
-
ukuphazamiseka kwesisu, ukunqongophala kwe-cobalamin, i-malabsorption,
-
ukumelana ne-insulin,
-
ukudumba
Ukufumana umfanekiso opheleleyo wemeko yekati echaphazelekayo, iimvavanyo zaselabhorethri, imilinganiselo yoxinzelelo lwegazi, iimvavanyo zamehlo, ii-x-reyi/izikena ze-ultrasound, kwaye - ngokuxhomekeke kwiimpawu - ezinye iimvavanyo zokulandelela kufuneka zenziwe.
Uvavanyo lwe-FHT ekrokrelekayo ngokuxhomekeke kuphando olongezelelweyo
- Uvavanyo lwegazi T4
- I-hematology yovavanyo lwegazi
- Uvavanyo lwegazi lwekhemikhali yeklinikhi (esp. amaxabiso ezintso, amaxabiso esibindi, iswekile, ifructosamine)
- Uhlalutyo lokuchama (umxhuzulane okhethekileyo, umchamo weprotheyini ye-creatinine ratio/UPC)
- kwiimpawu zesisu kwakhona Spec.PL (pancreas-specific lipase) kunye ne-cobalamin
- I-Palpation ye-thyroid gland kunye nesisu
- uxinzelelo lwegazi
- Intliziyo ye-Auscultation, isifuba X-ray
- echocardiography
- isisu se-ultrasound
- Uviwo lwamehlo/lweretina
- Mhlawumbi i-scintigraphy
yenza izigqibo zonyango
Emva kokuba umfanekiso opheleleyo wesigulane senziwe, isigqibo sonyango silandela. Injongo yokuqala kukuzinzisa, kuba iikati zihlala zibhityile kakhulu, azinamdla, kwaye zibonakaliswa ngokuphazamiseka kwesisu. Ingxaki enkulu ye-hyperthyroidism yi-pancreatitis ebukhali okanye engapheliyo. Iikati ezichaphazelekayo zifuna unyango lwe-IV kunye nonyango lwe-symptomatic de zikwazi ukuzondla kwakhona. Ukufakwa ityhubhu yokutya kunokuxhasa unyango.
Isinyathelo esilandelayo kukubuyisela imeko ye-euthyroid ngokukhawuleza, i. H. imeko apho inqanaba le-T4 egazini likwisiqingatha esisezantsi soluhlu lwereferensi. Uvavanyo lokuqala emva kokuqala konyango lwechiza lwenzeka emva kweeveki ezimbini ukuya kwezintathu. Amaxabiso ezintso kufuneka asoloko ejongwa ngexesha lokuhlolwa. I-Hyperthyroidism inokugquma i-CKD (isifo sezintso esingapheliyo) ngokunciphisa amaxabiso ezintso ngokunyuka kwezintso kunye nokunyuka kwamanzi. Ukongezelela, ngenxa yokulahlekelwa kwemisipha kwizilwanyana ezichaphazelekayo, i-creatinine iphantsi ngamanga kwaye i-CKD ekhoyo ayikwazi ukufunyanwa. Kwezi kati, emva kokuqaliswa ngempumelelo konyango kunye namanqanaba aqhelekileyo ehomoni yegilo, i-CKD ibonakala njengesiphumo secala lechiza. Abanini beekati kufuneka baziswe ngexesha leseshoni yokuqala yonyango ukuba oku kunokwenzeka ngenxa yokuba kunokwenzeka ukuba ikati yabo sele inesifo sezintso ezingabonakaliyo.
Ngokuchasene nezinye iingcebiso, iikati ezine-CKD eyaziwayo kunye ne-azotemia (i-urea eninzi egazini) kunyango lwe-thyroid kufuneka ihlale iphathwa ngendlela efanayo neekati ezinezintso eziphilileyo. Injongo mayibe kukunyanga iT4 yekati ngaphantsi kombindi woluhlu lwereferensi. Ukuzama ukugcina amanqanaba ezintso ephantsi ngokushiya ikati "i-hyperthyroid encinci" ukusuka kunyango olungaphantsi kwe-FHT isinika imvakalelo yobuxoki yokhuseleko. Ngokwahlukileyo, i-T4 ephakamileyo ikhokelela ekusebenziseni inkqubo ye-renin-angiotensin-aldosterone (i-RAAS) ekhokelela ekuphumeni kwentliziyo, ukugqithiswa kwevolumu, ukugcinwa kwe-sodium, i-hypertension ye-renal, kunye ne-glomerular sclerotherapy, ekugqibeleni ikhokelela ekuqhubeleni phambili kwe-CKD kunye nokunyuka kwemeko. . Nangona kunjalo, uhlolo kufuneka luqhutywe rhoqo ukuze kuthintelwe i-iatrogenic (ugqirha-induced) hypothyroidism ngazo zonke iindleko.
Malunga nekati enye kwezintlanu ezine-thyroid esebenza ngokugqithisileyo nayo ine-BI ephakamileyo. Oku kunyuka koxinzelelo lwegazi kunokubangelwa yi-FHT kwaye ukuyinyanga kunokubuyisela uxinzelelo lwegazi kwimeko yesiqhelo. Ukujonga uxinzelelo lwegazi ngexesha lolawulo lonyango lwe-hyperthyroidism kubalulekile ukuchonga kunye nokunyanga uxinzelelo lwegazi olungahambisani ne-FTT. Kuyafana nakwimpawu zentliziyo, ezinokuthi zinxulumene ne-FHT kwaye inokuphucula ngokuphawulekayo ngokuyeka i-euthyroid. Nangona kunjalo, uhlolo lwe-echocardiographic kufuneka lwenziwe kwezi meko.
Iinketho zonyango
I-FHT yimeko esongela ubomi kwaye kufuneka iphathwe ukuseka imeko ye-euthyroid kwikati. Amayeza, ukutya, utyando, kwaye iradioodine unyango ziyafumaneka kunyango.
amayeza
Isithako esisebenzayo se-methimazole sivunyiwe kwiikati njengethebhulethi kwaye njengesisombululo esimnandi sokunikezelwa kabini ngosuku. I-Carbimazole, ekwavunyiweyo kwiikati, ifakwe kwi-methimazole emzimbeni kwaye inomphumo ofanayo. Zombini zivimba i-thyroid peroxidase kwaye ngaloo ndlela zinciphisa i-biosynthesis yehomoni yegilo.
Unyango ngezi arhente lunobomi okanye okwethutyana ukuzinzisa ikati ilindele utyando okanye unyango lweradiyoodine. Malunga ne-18% yazo zonke izigulane, nangona kunjalo, i-methimazole okanye i-carbimazole ibangela iziphumo ebezingalindelekanga. Oku kunokuba:
- i-anorexia
- ukugabha
- pruritus kunye nokukrala ebusweni
- ukudinwa
- hepathopathies, i-jaundice
- ukwanda kokuthanda ukopha
Ezi ziphumo bezingalindelekanga zingenzeka ngokukhawuleza okanye emva kokulawulwa kwenyanga enye ukuya kwiinyanga ezimbini. Ukugabha kunye nokulahlekelwa ngumdla wokutya ubukhulu becala kuxhomekeke kwidosi kwaye kuyanyamalala emva kokwehliswa kwethamo. Xa kwenzeka nayiphi na enye imiphumo emibi, iyeza kufuneka lipheliswe ngokukhawuleza kwaye ezinye iindlela zonyango kufuneka ziqwalaselwe.
Xa ulungelelanisa amayeza e-thyroid, umnini wekati kufuneka afundiswe ngokubanzi. Izithako ezisebenzayo zinokuba nefuthe le-teratogenic (i-malformation-causing) ebantwini, yingakho kucetyiswa ukuba unxibe iiglavu xa uziphatha kwaye iipilisi akufanele zihlulwe. Ulawulo kunye nezinto ezibizwa ngokuba "iipokethi zeepilisi" okanye "iitrojani" apho unokufihla khona iipilisi yinto efanelekileyo. Isisombululo se-methimazole siyathandeka kakhulu kwaye uninzi lweekati luyasithatha ngokuzithandela.
Enye indlela engekavunywa kwiikati eJamani ijeli ye-methimazole evumela ukuba into esebenzayo ifakwe kwi-transdermally. Apha, kwakhona, iiglavu kufuneka zinxitywe ngexesha lokufaka isicelo. Kwiikati ezifuna umthamo ophezulu, inani lejeli eliza kusetyenziswa likhulu kakhulu. Kodwa esi sicelo sechiza sinyanyezelwe kakuhle ziikati ezininzi.
Ukuhlolwa kwenqanaba legazi le-T4 kwaye, ukuba kuyimfuneko, ezinye iiparamitha zicetyiswa emva kweeveki ezintathu, ezintandathu, ezilishumi kunye ne-20. Kwanezigulane ezizinzileyo kufuneka zibe novavanyo lwegazi rhoqo kwiiveki ze-12 ngenxa yokuba i-FHT sisifo se-tumor kwaye sinokukhula ngakumbi ngokukhula kwe-tumor, apho i-dose kufuneka ilungiswe.
Enye ingxaki ngonyango lweziyobisi kukuthotyelwa komnini. Ngelishwa, iimpawu azibi ngokukhawuleza emva kokumisa iipilisi, kodwa kuphela inkqubo yesifo esincinci. Sihlala sibona iikati kwakhona xa imeko ibeka ubomi esichengeni.
ukutya
Ukutya kuyindlela efanelekileyo yonyango kwiikati ezihlala zodwa kunye nangaphakathi. Umphumo usekelwe kwisidlo apho umxholo we-iodine uncitshiswe ubuncinci obufunekayo. Ekubeni amadlala e-thyroid awakwazi ukudibanisa i-hormone ye-thyroid ngaphandle kwe-iodine njengesiseko sokwakha, imveliso iyancipha kakhulu. Nangona kunjalo, kufuneka kuqinisekiswe ukuba ikati ayinayo enye imithombo yokutya apho inokutya khona iodine.
utyando
Ukususwa ngokuhlinzwa kwe-thyroid gland yeyona ndlela ilula kodwa ayilona khetho lufanelekileyo lokunyanga i-FHT. Kunokuba luncedo ukuba icala elinye lichaphazelekayo kwaye ukuba akukho zicubu ze-ectopic ze-thyroid kwiindawo ezingenakufikeleleka, umz. B. kwi-thorax. Nangaphambili amaxabiso aphezulu kakhulu e-T4 sele ekuluhlu oluqhelekileyo kusuku olusemva kotyando. Ngelishwa, i-thyroid adenomas idla ngokusasazeka kumacala omabini, okukhokelela ekuphindaphindeni kwangexesha xa ithumba kwidlala eliseleyo liqala ukukhula. Ukususwa kwazo zombini i-thyroid glands akuyona indlela yokuzikhethela kuba, okokuqala, kukho umngcipheko wokuba amadlala e-parathyroid ambalwa kakhulu (imizimba ye-epithelial okanye i-parathyroid glands) ehlala emzimbeni, nto leyo ekhokelela ekunqongopheni ubomi be-hormone ye-parathyroid.
unyango nge-radioodine
Umgangatho wegolide kunyango lwe-FHT lunyango lwe-radioodine. Kuphela kokhetho olukhokelela ekuphiliseni. Kwiimeko ezininzi, unyango olulodwa lwanele kwaye phantse i-95% yeekati eziphathwayo zisempilweni ubomi bonke. I-iodine ye-radioactive iqokelela kwiiseli zegilo. Igxininisa phantse ngokukodwa kwiiseli zethumba esebenzayo ngakumbi kwaye izitshabalalise. Akukho anesthesia iyimfuneko kunyango. Ukungalungi kolu nyango ubude obufunekayo bokulaliswa esibhedlele, nangona kunjalo, buhluka kakhulu kwiindawo ngeendawo (ubuncinane iintsuku ezine, ukuya kwiiveki ezine, ngokuxhomekeke kwipalamente, umz. iintsuku ezilishumi kwikliniki yezilwanyana yaseNorderstedt). Ngeli xesha, i-kitten ayivumelekanga ukuba ityelelwe. Enye into engalunganga kukuba olu hlobo lonyango alufumaneki kuyo yonke indawo. Kukho iinkcazo ezahlukeneyo malunga neendleko: unyango lweradiyoodine lubiza kakhulu njengonyango lwamachiza kubandakanywa novavanyo lwegazi oluyimfuneko ngonyaka okanye ngaphezulu kobomi obuseleyo. Ngokwezifundo, ixesha lokuphila emva konyango lwe-radioiodine liphindwe kabini kunolo lweekati ezinyangwa nge-methimazole.
isishwankathelo
Kubalulekile ukufundisa umnini kunye nokuphuhlisa isicwangciso sonyango lomntu ngamnye. Intlalontle yezilwanyana yeyona nto ibalulekileyo. Injongo kukufumana amanqanaba e-T4 kwisiqingatha esisezantsi soluhlu lwereferensi kwaye uzigcine apho. Ezinye izifo ezifana ne-CKD, i-cardiomyopathies, uxinzelelo lwegazi oluphezulu, njl. Oku kubeka iliso kubalulekile kuba izifo geriatric, ingakumbi isifo sethumba FHT, zixhomekeke ukuqhubela phambili, kwaye iiprothokholi unyango kufuneka rhoqo uhlengahlengiso ukugcina umgangatho wobomi isigulana.
Umbuzo obuzwa rhoqo
Iziphatha njani ikati ene-thyroid gland?
Iimpawu eziqhelekileyo ze-thyroid esebenzayo kwiikati kukuZinzi. Ukuxakeka. Iminqweno (polyphagia).
Inokuhlala ixesha elingakanani ikati ene-thyroid gland?
Umgangatho wegolide kunyango lwe-FHT lunyango lwe-radioodine. Kuphela kokhetho olukhokelela ekuphiliseni. Kwiimeko ezininzi, unyango olulodwa lwanele kwaye phantse i-95% yeekati eziphathwayo zisempilweni ubomi bonke.
Wazi njani ukuba ikati iyabandezeleka?
Ukutsala umva, ukuthantamisa ukubamba, ukuba ndlongondlongo, ukuma okugobileyo, okanye ukuqhwalela kubonisa ukuba isilwanyana siyabandezeleka. Ukongeza kwindlela yokuziphatha, unokukhangela ezinye iimpawu eziya kunika isibonakaliso esichanekileyo sokuba kutheni ikati yakho ihlupheka.
Yintoni yokondla iikati nge-thyroid esebenzayo?
Iikati ezine-thyroid engasebenzi kakhulu kufuneka zondliwe kuphela i-Hills Feline y / d, njengoko umxholo ophezulu we-iodine wezinye ukutya ugatya umphumo wonyango.
Liliphi ichiza le-hyperthyroidism kwiikati?
Unyango lwe-hyperthyroidism luhlala luqala ngokulawulwa kwamacwecwe aqukethe izithako ezisebenzayo ze-thiamazole kunye ne-carbimazole. Ezi zilawulwa ngokufanelekileyo kabini ngemini kwaye zithintela ukuveliswa kwehomoni ye-thyroid, i-dose ephezulu, imveliso ephantsi.
Yintoni enceda i-hyperthyroidism kwiikati?
I-Hyperthyroidism kwiikati inokunyangwa ngeepilisi. Amachiza amabini "Thiamazol" kunye ne "Carbimazole" anciphisa ukuveliswa kwehomoni ye-thyroid. Oku kulungelelanisa amanqanaba ehomoni agqithisileyo egazini. Umthamo kufuneka unikwe kabini ngosuku.
Ngaba ikati iyakhala?
Njengabantu, iikati zinokukhala kwaye zive iimvakalelo. Nangona kunjalo, akukho nxu lumano phakathi kokukrazula kunye nokuziva, kuba iikati zivakalisa iimvakalelo zabo ngokwahlukileyo.
Ikhala njani ikati xa ilila?
Ukukhala okuvakalayo: ukukhala okulusizi, ukukhwaza, okanye ukukhwaza. Ukuncipha kwabafundi. Ukuxhuzula ngokukhawuleza kunye nokutyibilika komsila.