{"id":69033,"date":"2023-02-01T05:54:27","date_gmt":"2023-02-01T07:54:27","guid":{"rendered":"https:\/\/www.pasveik.lt\/?p=69033\/sveikatos-ir-medicinos-naujienos"},"modified":"2023-02-03T05:22:23","modified_gmt":"2023-02-03T07:22:23","slug":"hipotiroze-sulaukus-vyresnio-amziaus","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/hipotiroze-sulaukus-vyresnio-amziaus\/69033\/","title":{"rendered":"Hipotiroz\u0117 sulaukus vyresnio am\u017eiaus<\/strong>"},"content":{"rendered":"\n

Hipotiroz\u0117\u00a0\u2013 tai klinikinis ir biocheminis skydliauk\u0117s hormon\u0173 tr\u016bkumo organuose taikiniuose pasirei\u0161kimas\u00a0[1]. Pasaulyje da\u017eniausia hipotiroz\u0117s prie\u017eastimi laikomas jodo tr\u016bkumas\u00a0[2]. Tiesa, \u0161alyse, kur jodo tr\u016bkumo nestebima (pvz., Jungtin\u0117se Amerikos Valstijose), da\u017eniausia prie\u017eastis yra l\u0117tinis autoimuninis tiroiditas. <\/p>\n\n\n\n

Autoimuninis skydliauk\u0117s pa\u017eeidimas 5\u201310 kart\u0173 da\u017eniau diagnozuojamas moterims, ta\u010diau skirtumas priklauso nuo tyrimo vertinimo kriterij\u0173, pavyzd\u017eiui, Whickham<\/em> tyrime 5\u00a0proc. moter\u0173 ir 1\u00a0proc. vyr\u0173 nustatyti teigiami antik\u016bnai bei >6\u00a0mIU\/l tirotropinis hormonas (TTH) [3]. Autoimuninis skydliauk\u0117s pa\u017eeidimas ir hipotiroz\u0117 b\u016bdingesn\u0117 asmenims, sergantiems kitomis autoimunin\u0117mis ligomis, esant teigiamai \u0161eiminei anamnezei, be to, rizika did\u0117ja su am\u017eiumi [4]. Senstant visuomenei, svarbu atkreipti d\u0117mes\u012f \u012f hipotiroz\u0117s i\u0161sivystym\u0105 vyresnio am\u017eiaus asmenims.<\/p>\n\n\n\n

Hipotiroz\u0117s paplitimas<\/strong><\/p>\n\n\n\n

Hipotiroz\u0117 skirstoma \u012f klini\u0161kai pasirei\u0161kian\u010di\u0105 ir subklinikin\u0119. Subklinikin\u0117 hipotiroz\u0117 (SKH) diagnozuojama esant padid\u0117jusiai serumo TTH koncentracijai, ta\u010diau kraujyje cirkuliuojan\u010di\u0173 laisvojo tiroksino (LT4) ir laisvojo trijodtironino (LT3) koncentracijoms atitinkant normos ribas [5\u2013<\/a>6]. Sergant klini\u0161kai reik\u0161minga hipotiroze, stebima padid\u0117jusi TTH bei suma\u017e\u0117jusi LT4 koncentracija\u00a0[4]. Klini\u0161kai pasirei\u0161kian\u010dios hipotiroz\u0117s da\u017enis siekia 0,1\u20130,2\u00a0proc., o SKH stebima kur kas da\u017eniau\u00a0\u2013 4\u201310\u00a0proc. suaugusi\u0173j\u0173 [3, 7\u20139]. SKH i\u0161sivystymo rizika didesn\u0117 moterims (7,5\u00a0proc.), vyresnio am\u017eiaus (>65 met\u0173) asmenims (iki 15\u00a0proc.), kaukazie\u010diams ir pakankamai jodo gaunan\u010diose populiacijose (iki 23,9\u00a0proc.) [8, 10\u201312]. <\/p>\n\n\n\n

Jungtin\u0117se Amerikos Valstijose atliktame NHANES (angl. National Health and Nutrition Examination Survey<\/em>) III tyrime dalyvavo 13\u00a0344 asmenys, kuriems nebuvo diagnozuotos skydliauk\u0117s patologijos ir j\u0173 \u0161eimin\u0117je anamnez\u0117je nebuvo sergan\u010di\u0173j\u0173 skydliauk\u0117s ligomis. Visiems tiriamiesiems atlikti serumo TTH, LT4, antik\u016bn\u0173 prie\u0161 tiroglobulin\u0105 ir antik\u016bn\u0173 prie\u0161 skydliauk\u0117s peroksidaz\u0119 (ATPO) tyrimai. Remiantis gautais rezultatais, hipotiroz\u0117 nustatyta 4,6\u00a0proc. (klini\u0161kai reik\u0161minga\u00a0\u2013 0,3\u00a0proc., SKH\u00a0\u2013 4,3\u00a0proc.), hipertiroz\u0117 nustatyta 1,3\u00a0proc. (0,5 proc.\u00a0\u2013 klini\u0161kai reik\u0161minga, 0,7\u00a0proc.\u00a0\u2013 SKH), serumo ATPO padid\u0117jimas nustatytas 11\u00a0proc. asmen\u0173. <\/p>\n\n\n\n

\u0160iame tyrime nedidelis TTH koncentracijos padid\u0117jimas nustatytas apie 70\u00a0proc. vyresnio am\u017eiaus asmen\u0173, kurie priskirti SKH grupei [8]. Klini\u0161kai reik\u0161mingos hipotiroz\u0117s paplitimas tarp vyresnio am\u017eiaus \u017emoni\u0173, literat\u016bros duomenimis, siekia 0,2\u20135,7\u00a0proc., o SKH\u00a0\u2013 1,5\u201312,5\u00a0proc. [13\u201324]. \u012evairiais duomenimis, hipotiroz\u0117 b\u016bdingesn\u0117 vyresnio am\u017eiaus moterims [3, 7\u20139]. Framinghamo tyrime tarp vyresni\u0173 nei 60 met\u0173 asmen\u0173 TTH koncentracijos padid\u0117jimas >10\u00a0mIU\/l steb\u0117tas 5,9\u00a0proc. moter\u0173 ir 2,3\u00a0proc. vyr\u0173, o i\u0161 j\u0173 39\u00a0proc. nustatyta nenormali LT4 koncentracija\u00a0[13].<\/p>\n\n\n\n

Nedidelis TTH koncentracijos padid\u0117jimas vyresnio am\u017eiaus asmenims neretai gali b\u016bti ne d\u0117l SKH, o d\u0117l nat\u016bralaus TTH did\u0117jimo senstant. Taigi, pagal am\u017ei\u0173 pritaikant TTH normos ribas, galimai hipotiroz\u0117s da\u017enis senstant nedid\u0117t\u0173, be to, b\u016bt\u0173 i\u0161vengiama perd\u0117tos hipotiroz\u0117s diagnoz\u0117s ir perteklinio skydliauk\u0117s hormon\u0173 skyrimo [25]. Toks TTH normos rib\u0173 pagal am\u017ei\u0173 pritaikymas labai reik\u0161mingas pacientams nuo 85 met\u0173, kai taikant vertinimo pagal am\u017ei\u0173 metodik\u0105 2\u20134,7\u00a0proc. pacient\u0173 SKH diagnoz\u0117 b\u016bt\u0173 kei\u010diama \u012f eutiroz\u0119 [26].<\/p>\n\n\n\n

Klinika<\/strong><\/p>\n\n\n\n

Tiek pirmin\u0117s, tiek antrin\u0117s hipotiroz\u0117s klinikiniai po\u017eymiai ir simptomai priklauso nuo skydliauk\u0117s hormon\u0173 tr\u016bkumo ir to, kaip greitai i\u0161 tr\u016bkumas i\u0161sivysto. Kuo l\u0117\u010diau ma\u017e\u0117ja skydliauk\u0117s hormon\u0173 koncentracija, tuo j\u0173 tr\u016bkumas geriau toleruojamas, palyginti su staiga pasirei\u0161kusiu tr\u016bkumu (pvz., pa\u0161alinus skydliauk\u0119, staiga nutraukus pakaitin\u0117s skydliauk\u0117s hormon\u0173 terapij\u0105). <\/p>\n\n\n\n

Klinikiniai po\u017eymiai ir simptomai (1\u00a0lentel\u0117<\/em>) pasirei\u0161kia d\u0117l skydliauk\u0117s hormon\u0173 tr\u016bkumo sukelto generalizuoto metabolini\u0173 proces\u0173 l\u0117t\u0117jimo (bradikardija, \u0161al\u010dio netoleravimas, svorio augimas ir kt.) bei glikozaminoglikan\u0173 kaupimosi audini\u0173 intersticiniuose tarpuose (veido paburkimas, odos ir plauk\u0173 sausumas, balso prikimimas, lie\u017euvio padid\u0117jimas ir kt.) [27].<\/p>\n\n\n\n

Sergantys SKH pacientai gali nenurodyti joki\u0173 nusiskundim\u0173 arba gali jausti anks\u010diau apra\u0161ytus hipotirozei b\u016bdingus simptomus. Fakt\u0105, remiantis vienais moksliniais tyrimais, kad simptom\u0173 pasirei\u0161kimas koreliuoja su serumo TTH koncentracija, kiti tyrimai paneigia [28\u201330]. SKH nustatyti paciento poj\u016b\u010diai diagnostin\u0117s reik\u0161m\u0117s neturi d\u0117l poj\u016b\u010di\u0173 subjektyvumo ir nepatvirtintos koreliacijos su laboratoriniais duomenimis. Vyresnio am\u017eiaus pacientai, kuriems nustatyta SKH, gali netur\u0117ti nusiskundim\u0173 arba gali sk\u0173stis nespecifiniais simptomais [31\u201332].<\/p>\n\n\n\n

Objektyvios ap\u017ei\u016bros metu galimas skydliauk\u0117s padid\u0117jimas (b\u016bdingas tr\u016bkstant jodo ar sergant autoimuniniu tiroiditu), bradikardija, diastolin\u0117 hipertenzija ir raumen\u0173 atsipalaidavimo sul\u0117t\u0117jimas i\u0161gaunant sausgyslinius refleksus (Woltmano simptomas). Laboratoriniuose tyrimuose aptinkami metabolizmo sutrikimus atspindintys pakitimai, tokie kaip hipercholesterolemija, makrocitin\u0117 anemija, kreatinkinaz\u0117s padid\u0117jimas ar hiponatremija [33].<\/p>\n\n\n\n

Senyvo am\u017eiaus pacientams hipotiroz\u0117s simptomai neretai gali b\u016bti supainiojami su gretutini\u0173 lig\u0173 pablog\u0117jimu ar sen\u0117jimo procesu [34]. Be to, palyginti su jaunesniais pacientais, hipotiroze sergantys senyvo am\u017eiaus \u017emon\u0117s i\u0161sako ma\u017eiau nusiskundim\u0173 [35\u201336]. Prospektyviajame tyrime, \u012fvertinus hipotiroze sergan\u010di\u0173 asmen\u0173 nusiskundimus, \u226570 met\u0173 pacientai reik\u0161mingai ma\u017eiau skund\u0117si svorio did\u0117jimu, raumen\u0173 m\u0117\u0161lungiu ar \u0161al\u010dio netoleravimu, palyginti su jaunesniais nei 50 met\u0173 tiriamaisiais [36]. Be to, tik ma\u017eesn\u0117 dalis vyresnio am\u017eiaus asmen\u0173, net ir biocheminiais tyrimais patvirtinus klini\u0161kai reik\u0161ming\u0105 hipotiroz\u0119, jaut\u0117 jai b\u016bdingus simptomus [37\u201338]. Ta\u010diau reta ir pavojinga komplikacija \u2013 miksedemin\u0117 koma \u2013 vyresnio am\u017eiaus pacientams b\u016bdingesn\u0117 [39].<\/p>\n\n\n\n

1 lentel\u0117. Pagrindiniai hipotiroz\u0117s klinikiniai po\u017eymiai ir simptomai<\/strong><\/p>\n\n\n\n

Mechanizmai<\/strong><\/td>Simptomai<\/strong><\/td>Klinikiniai po\u017eymiai<\/strong><\/td><\/tr>
Sukelti sul\u0117t\u0117jus metabolizmui<\/td>Bendras silpnumas
\u0160al\u010dio netoleravimas
Dusulys fizinio kr\u016bvio metu
Svorio did\u0117jimas
Kognityvini\u0173 funkcij\u0173 sutrikimas
Protinis atsilikimas
Obstipacijos
Augimo sutrikimas<\/td>		Sul\u0117t\u0117j\u0119 judesiai ir kalb\u0117jimas
Sul\u0117t\u0117j\u0119s raumen\u0173 atsipalaidavimas i\u0161gaunant sausgyslinius refleksus
Bradikardija
Karotenemija<\/td><\/tr>
D\u0117l med\u017eiag\u0173 kaupimosi audiniuose<\/td>Odos sausumas
Prikim\u0119s balsas
Edemos<\/td>		\u0160iurk\u0161ti oda
Paburk\u0119s veidas, antaki\u0173 i\u0161slinkimas
Periorbitin\u0117 edema
Lie\u017euvio padid\u0117jimas<\/td><\/tr>
Kiti<\/td>Pablog\u0117jusi klausa
Raumen\u0173 skausmai ar parestezijos
Depresija
Menoragija
Artralgijos
Brendimo sutrikimas<\/td>		Diastolin\u0117 hipertenzija
Skystis pleuros ar perikardo ertm\u0117se
Ascitas
Galaktor\u0117ja<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

<\/p>\n\n\n\n

<\/p>\n\n\n\n

Hipotiroz\u0117 ir kitos ligos<\/strong><\/p>\n\n\n\n

Skydliauk\u0117s disfunkcija<\/a> nustatoma apie 10\u00a0proc. 1 tipo cukriniu diabetu sergan\u010di\u0173j\u0173, o SKH arba ATPO padid\u0117jimas\u00a0\u2013 net apie 30\u00a0proc. [40\u201342]. Tod\u0117l visiems 1 tipo cukriniu diabetu sergantiems asmenims kiekvienais metais rekomenduojama \u012fvertinti skydliauk\u0117s funkcij\u0105. Sergant autoimunin\u0117s kilm\u0117s l\u0117tiniu antinks\u010di\u0173 nepakankamumu (Addisono liga), subklinikin\u0117s arba klinikin\u0117s hipotiroz\u0117s tikimyb\u0117 yra 50\u00a0proc., neretai tokie pacientai taip pat serga 1 tipo cukriniu diabetu [43\u201344]. Nusta\u010dius bet kokios kilm\u0117s antinks\u010di\u0173 nepakankamum\u0105, da\u017enai kartu nustatoma ir padid\u0117jusi TTH koncentracija, kuri da\u017enai sugr\u012f\u017eta \u012f normos ribas paskyrus pakaitin\u012f gydym\u0105 gliukokortikoidais. Tod\u0117l tik pra\u0117jus 4 savait\u0117ms nuo gydymo steroidais prad\u017eios b\u016bt\u0173 tikslinga spr\u0119sti d\u0117l SKH diagnoz\u0117s [45].<\/p>\n\n\n\n

Klinikin\u0117 ir SKH yra susijusios su insulino rezistenti\u0161kumu ir metabolinio sindromo i\u0161sivystymu [46\u201347]. \u012erodyta, kad svorio did\u0117jimas turi \u012ftakos FT4 ir FT3 koncentracijoms, o TTH koncentracija teigiamai koreliuoja su k\u016bno svoriu [48]. Sergant 2 tipo cukriniu diabetu ir atsiradus neai\u0161kios kilm\u0117s glikemijos svyravimams, reik\u0117t\u0173 pagalvoti apie skydliauk\u0117s patologij\u0105. Jeigu pacientams, sergantiems 2 tipo cukriniu diabetu ir SKH, nepavyksta pasiekti geros glikemijos kontrol\u0117s, reik\u0117t\u0173 spr\u0119sti d\u0117l gydymo levotiroksinu, kuris pagerina glikemijos kontrol\u0119 [49\u201351].<\/p>\n\n\n\n

SKH gydant levotiroksinu ir esant dislipidemijai, gali suma\u017e\u0117ti bendrojo ir ma\u017eo tankio lipoprotein\u0173 cholesterolio reik\u0161m\u0117s, ta\u010diau retai pasiekiamos j\u0173 normos ribos [52\u201354].<\/p>\n\n\n\n

Stebimuosiuose tyrimuose pacientams, sergantiems SKH, buvo da\u017eniau nustatoma kairiojo skilvelio sistolin\u0117 ir diastolin\u0117 disfunkcija, padid\u0117j\u0119s kraujagysli\u0173 sieneli\u0173 standumas ar endotelio disfunkcija [55\u201363]. Deja, iki \u0161iol nebuvo atliktas n\u0117 vienas atsitiktini\u0173 im\u010di\u0173 tyrimas, kuris \u012frodyt\u0173, kad SKH gydymas levotiroksinu suma\u017eina \u0161irdies ir kraujagysli\u0173 lig\u0173 rizik\u0105 arba sustabdo j\u0173 progresavim\u0105 [55\u201356]. SKH, kai TTH >10 mIU\/l, yra vienas i\u0161 daugelio \u0161irdies nepakankamumo i\u0161sivystymo ir progresavimo rizikos veiksni\u0173 [58]. Tyrimuose steb\u0117ta teigiama asociacija tarp SKH ir koronarin\u0117s \u0161irdies ligos bei kardiovaskulinio mirtingumo rizikos. Daugiau nei 50 t\u016bkst. asmen\u0173 duomen\u0173 analiz\u0117 parod\u0117, kad sergantieji SKH, ypa\u010d <70 met\u0173, turi didesn\u0119 kardiovaskulini\u0173 \u012fvyki\u0173 ir mirties rizik\u0105. Taip pat \u0161iame tyrime mirties rizika did\u0117jo, kai TTH koncentracija buvo >10 mIU\/l, bei steb\u0117ta tiesiogin\u0117 koreliacija tarp TTH koncentracijos ir kardiovaskulin\u0117s mirties rizikos [64].<\/p>\n\n\n\n

Gydymas<\/strong><\/p>\n\n\n\n

Pagrindinis vaistas gydant hipotiroz\u0119 yra levotiroksinas. Pagal 2013 met\u0173 Europos skydliauk\u0117s asociacijos (angl. European Thyroid Association \u2013 <\/em>ETA) SKH gydymo gaires, besimptomiams <65\u201370 met\u0173 pacientams nusta\u010dius >10 mIU\/l TTH koncentracij\u0105, rekomenduojama prad\u0117ti ilgalaik\u012f gydym\u0105 levotiroksinu. Jeigu pacientas skund\u017eiasi hipotirozei b\u016bdingais simptomais ir TTH koncentracija yra <10 mIU\/l, taip pat rekomenduojama prad\u0117ti gydym\u0105 levotiroksinu. Esant <10 mIU\/l TTH koncentracijai, ta\u010diau nesant hipotirozei b\u016bding\u0173 simptom\u0173, gydyti levotiroksinu nerekomenduojama. Vyresniems nei 80\u201385 met\u0173 leistinos TTH koncentracijos ribos yra didesn\u0117s d\u0117l adaptacini\u0173 sen\u0117jimo proces\u0173, o nusta\u010dius <10 mIU\/l TTH koncentracij\u0105, gydymo levotiroksinu skirti nerekomenduojama [5].<\/p>\n\n\n\n

Vyresnio am\u017eiaus \u017emoni\u0173 hipotirozei gydyti ir normaliai TTH koncentracijai pasiekti da\u017eniausiai pakanka ma\u017eesni\u0173 levotiroksino dozi\u0173 d\u0117l liesosios k\u016bno mas\u0117s ma\u017e\u0117jimo ir tiroksino metabolizmo poky\u010di\u0173 [65]. Be to, suma\u017e\u0117jusi vaisto absorbcija, kit\u0173 vaist\u0173 vartojimas, gretutin\u0117s ligos gali tur\u0117ti \u012ftak\u0105 levotiroksino metabolizmui. Kadangi vyresnio am\u017eiaus pacientams b\u016bdingesni su skydliauk\u0117s hormon\u0173 pertekliumi susij\u0119 rei\u0161kiniai, tokie kaip prie\u0161ird\u017ei\u0173 virp\u0117jimas ar osteoporoziniai kaul\u0173 l\u016b\u017eiai, levotiroksino doz\u0119 reikia parinkti atsargiau, kad b\u016bt\u0173 i\u0161vengta jatrogenin\u0117s hipertiroz\u0117s [66\u201368].<\/p>\n\n\n\n

12 m\u0117nesi\u0173 trukusiame levotiroksino poveikio vyresnio am\u017eiaus pacientams (tirti 773 >65 met\u0173 asmenys) tyrime, SKH gydymas levotiroksinu nepagerino gyvenimo kokyb\u0117s ar simptom\u0173 [69]. Keliuose nedidel\u0117s apimties, atsitiktini\u0173 im\u010di\u0173 tyrimuose gydant SKH levotiroksinu steb\u0117tas kognityvini\u0173 funkcij\u0173 pager\u0117jimas [70\u201372]. <\/p>\n\n\n\n

Tuo tarpu didesn\u0117s apimties, atsitiktini\u0173 im\u010di\u0173 tyrimuose, kuriuose tirti pacientai nuo 65 met\u0173, teigiamo levotiroksino poveikio kognityvin\u0117ms funkcijoms nesteb\u0117ta [31, 73]. Vadinasi, skiriant gydym\u0105 vyresnio am\u017eiaus pacientams, b\u016btina atsi\u017evelgti \u012f su levotiroksino metabolizmo pakitimais susijusius aspektus, vyresniems nei 70\u201380 met\u0173 asmenims taikyti didesnes TTH koncentracijos normos ribas (iki 6\u20137\u00a0mIU\/l), ypa\u010d esant \u0161irdies ritmo sutrikim\u0173 ar osteoporozini\u0173 kaul\u0173 l\u016b\u017ei\u0173 rizikai.<\/p>\n\n\n\n

Apibendrinimas<\/strong><\/p>\n\n\n\n

Skydliauk\u0117s<\/a> hormonai yra svarb\u016bs viso organizmo normaliam funkcionavimui, o j\u0173 suma\u017e\u0117jimas ir TTH koncentracijos padid\u0117jimas gali sukelti SKH ar klini\u0161kai reik\u0161ming\u0105 hipotiroz\u0119. Vyresni pacientai re\u010diau skund\u017eiasi hipotirozei b\u016bdingais simptomais, palyginti su jaunesniais, o juntami simptomai neretai siejami su sen\u0117jimo po\u017eymiais ar gretutini\u0173 lig\u0173 sukeltais negalavimais. <\/p>\n\n\n\n

Be to, skydliauk\u0117s funkcija kinta su am\u017eiumi, tod\u0117l vyresniems pacientams gali b\u016bti stebima didesn\u0117 TTH ir ma\u017eesn\u0117 LT4 koncentracija. \u012e tai b\u016btina atsi\u017evelgti skiriant hipotiroz\u0117s gydym\u0105, siekiant i\u0161vengti jatrogenin\u0117s hipertiroz\u0117s, galin\u010dios padidinti \u0161irdies ritmo sutrikim\u0173 ar osteoporozini\u0173 kaul\u0173 l\u016b\u017ei\u0173 rizik\u0105. Siekiant geriausi\u0173 gydymo rezultat\u0173 ir ma\u017eiausios komplikacij\u0173 rizikos, turi b\u016bti atliekami tolesni tyrimai TTH koncentracijai pagal am\u017ei\u0173 \u012fvertinti, be to, prie\u0161 gydym\u0105 kiekvien\u0105 atvej\u012f reikia \u012fvertinti individualiai.<\/p>\n\n\n\n

<\/p>\n\n\n\n

Aist\u0117 Aleknait\u0117<\/strong>
Vilniaus universiteto ligonin\u0117s Santaros<\/em> klinikos<\/p>\n\n\n\n

<\/p>\n\n\n\n

Literat\u016bra<\/strong><\/p>\n\n\n\n

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73. Parle J, Roberts L, Wilson S, Pattison H, Roalfe A, Haque MS, et al. A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham elderly thyroid study. J Clin Endocrinol Metab. 2010;95:3623\u201332. https:\/\/doi.org\/10.1210\/jc.2009-2571.<\/p>\n","protected":false},"excerpt":{"rendered":"

Hipotiroz\u0117\u00a0\u2013 tai klinikinis ir biocheminis skydliauk\u0117s hormon\u0173 tr\u016bkumo organuose taikiniuose pasirei\u0161kimas\u00a0[1]. Pasaulyje da\u017eniausia hipotiroz\u0117s prie\u017eastimi laikomas jodo tr\u016bkumas\u00a0[2]. Tiesa, \u0161alyse, kur jodo tr\u016bkumo nestebima (pvz., Jungtin\u0117se Amerikos Valstijose), da\u017eniausia prie\u017eastis yra l\u0117tinis autoimuninis tiroiditas. Autoimuninis skydliauk\u0117s pa\u017eeidimas 5\u201310 kart\u0173 da\u017eniau diagnozuojamas moterims, ta\u010diau skirtumas priklauso nuo tyrimo vertinimo kriterij\u0173, pavyzd\u017eiui, Whickham tyrime 5\u00a0proc. moter\u0173 ir…<\/p>\n","protected":false},"author":35,"featured_media":69034,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27322],"tags":[7574],"site":[27238],"post_item_type":[27345],"class_list":["post-69033","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ligu-gydymas","tag-skydliauke","site-sindromas-lt"],"acf":{"post_sites":[27238]},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/69033","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/35"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=69033"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/69033\/revisions"}],"acf:term":[{"embeddable":true,"taxonomy":"site","href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site\/27238"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/69034"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=69033"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=69033"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=69033"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=69033"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=69033"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}