{"id":8432,"date":"2013-06-18T14:54:05","date_gmt":"2013-06-18T14:54:05","guid":{"rendered":""},"modified":"2017-10-27T00:44:44","modified_gmt":"2017-10-27T00:44:44","slug":"gydymas-skydliaukes-hormonais","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/gydymas-skydliaukes-hormonais\/8432\/","title":{"rendered":"Gydymas skydliauk\u0117s hormonais"},"content":{"rendered":"<p><!-- [if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:HyphenationZone>19<\/w:HyphenationZone>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p><!-- [if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";}\n<\/style>\n\n\n<![endif]--><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Dr.Aurelija Krasauskien\u0117<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">LSMU Endokrinologijos klinika<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">UAB<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>Bendrosios medicinos praktika<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Pastaruoju metu vis da\u017eniau tenka gird\u0117ti , kad sergan\u010di\u0173 skydliauk\u0117s ligom sergan\u010di\u0173 did\u0117ja , jiems gydytojai endokrinologai gydymui skiria skydliauk\u0117s hormonus ,visiems pana\u0161iom doz\u0117m ir kad laisvai to paskyrimo galima atsisakyti ar ma\u017einti dozes savo nuo\u017ei\u016br\u0105 pagal savijaut\u0105.Li\u016bdniausis , kad tokie svarstymai kyla ir i\u0161 koleg\u0173 , kit\u0173 specialybi\u0173 gydytoj\u0173. Taigi , matyt , laikas papildyti \u017einias <span style=\"mso-spacerun: yes;\">\u00a0<\/span>apie greitai \u0161imtmet\u012f<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>nuo susintetinimo min\u0117siat\u012f<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>skydliauk\u0117s hormon\u0105 levotiroksin\u0105.B\u016btent jis da\u017eniausiai skiriamas skydliauk\u0117s veiklos nepakankamumui gydyti .Literat\u016bros duomenimis , turin\u010di\u0173 nepakankam\u0105 skydliauk\u0117s veikl\u0105 ne taip jau ir ma\u017eai \u2013 nuo 1 iki 10 procent\u0173 populiacijos.\u0160i patologija \u017eymiai da\u017enesn\u0117 vyresnio am\u017eiaus \u017emoni\u0173 tarpe, kai g\u0119sta beveik vis\u0173 endokrinini\u0173 laik\u0173 veikla.Moterys serga \u017eymiai da\u017eniau negu vyrai \u2013 santykiu 3:1Ta\u010diu jei kalb\u0117sime ir apie subklinikin\u0119 hipotiroz\u0119 , kuri nepasirei\u0161kia jokias klinikiniais po\u017eymiais , o da\u017eniausiai atsitikinai randamas vir\u0161ijantis normos ribas TTH kiekis. , Tokius<span style=\"mso-spacerun: yes;\">\u00a0 <\/span><span style=\"mso-spacerun: yes;\">\u00a0<\/span>poky\u010dius turin\u010di\u0173 <span style=\"mso-spacerun: yes;\">\u00a0<\/span>moter\u0173 vyresni\u0173 50 met\u0173 tarpe paplitimas i\u0161auga nuo 10 iki 20 procent\u0173.Da\u017eniausia prie\u017eastis- l\u0117tinis autoimuninis tiroiditas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>Apie 10 procent\u0173 jaun\u0173 moter\u0173 po gimdymo 6 -12 m\u0117nesi\u0173<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>laikotapyje turi savaime praeinan\u010di\u0105 skydliauk\u0117s nepakankam\u0105<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>veikl\u0105 , atsirandan\u010di\u0105 d\u0117l pogimdyvinio l\u0117tinio tiroidito . \u0160i\u0105 patologij\u0105 taipogi<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>reikt\u0173 laikinai gydyti skydliauk\u0117s hormonais.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Ilgalaik\u012f gydym\u0105 skydliauk\u0117s hormonais turi vartoti pacientai , kuriems skydliauk\u0117 \u0161alinta d\u0117l mazg\u0173 ar gydyta d\u0117l padidintos veiklos operuojant ar gydant radiojodu.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Kitos retesn\u0117s hipotiroz\u0117s prie\u017eastys:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level2 lfo1; tab-stops: list 72.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Po\u016bmis tiroiditas<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level2 lfo1; tab-stops: list 72.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Kaklo organ\u0173 ap\u0161vita<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level2 lfo1; tab-stops: list 72.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Medikamentai (antitiroidiniai,amiodaronas,litis,interferonas)<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level2 lfo1; tab-stops: list 72.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">\u012egimti defektai<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level2 lfo1; tab-stops: list 72.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Endeminis g\u016b\u017eys ,esant ry\u0161kiam jodo tr\u016bkumui <\/span><\/li>\n<\/ul>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Aptar\u0117me da\u017eniausiais hipotiroz\u0117s prie\u017eastis.J\u0105 diagnozavus , b\u016btina prad\u0117ti gydym\u0105. Skydliauk\u0117s hormonai b\u016btini normaliam augimui ir vystymuisi ir ne tik vaisiaus ar vaiko organizmui, jie kontroliuoja<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>organizmo metabolizm\u0105 ir beveik vis\u0173 organ\u0173 veikl\u0105 . Ta\u010diau skydliauk\u0117s hormon\u0173 biologinis poveikis skiriasi priklausomai nuo organo audinio., pvz.kepenyse stimuliuoja lipogenez\u0119 ir lipoliz\u0119<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>veikian\u010dius fermentus,smegenyse stimuliuoja akson\u0173 augim\u0105 ir diferencijacij\u0105,kauluose palaiko pusiausvyr\u0105 tarp osteoklast\u0173 ir osteoblast\u0173.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Skydliauk\u0117 gamina<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>tetrajodtironin\u0105 <span style=\"mso-tab-count: 1;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>( T 4 )<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>ir trujodtironin\u0105 (T3). Pastarojo gamina ma\u017eai , nestai aktyvusis skydliauk\u0117s hormonas , veikiantis l\u0105stel\u0117se.Jis gaunamas<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>,veikaint fermentui dejodinazei i\u0161 tetrajodtironino atskeliant vien\u0105 jodo molekul\u0119.\u0160iuo metu nustatyti<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>keli dejodinaz\u0117s tipai,veikiantys skirtinguose organuose. Tuo daugumoje ir paai\u0161kinamas skirtingas skydlaiuk\u0117s hormon\u0173 poveikis \u012f atskirus audinius.\u0160iuos skydliauk\u0117s hormon\u0173 metabolizmo principus reikia \u017einoti , nes kartais endokrinologai skiria kombinuot\u0105 gydym\u0105 abiem skydliauk\u0117s hormonais. Esti atvej\u0173 , kai ne\u017ei\u016brint atitinkan\u010di\u0173 norm\u0105 skydliauk\u0117s hormon\u0173 ir TTH kiekio, i\u0161lieka hipotiroz\u0117s klinika .Tuomet galima \u012ftarti sutrikim\u0105 dejodinazi\u0173 lygyje. Kol kas vieningos nuomon\u0117s d\u0117l kombinuoto gydymo abiem skydliauk\u0117s hormonais n\u0117ra.Tik visiems ai\u0161ku , kad hipotiroz\u0117 turi b\u016bti pastoviai gydoma.1891 metais hipotiroz\u0117 prad\u0117ta gydyti i\u0161d\u017eiovintu avi\u0173 skydliauki\u0173<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>ekstraktu.Jame buvo abu skydliauk\u0117s hormonai.Ta\u010diau avi\u0173 , kaip ir \u017emoni\u0173 skydliauk\u0117s n\u0117ra vienodai gaminan\u010dios hormonus , tod\u0117l ir vaisto dozavimas tapo sud\u0117tingu1914 metais susintetintas tiroksinas-levotiroksino natrio druska. ,o nuo 1930 met\u0173<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>pla\u010diai naudojamas klinikin\u0117je praktikoje.Kod\u0117l b\u016btent tiroksinas , o ne trijodtironinas tapo tokiu nepakei\u010diamu.? Jis gerai <span style=\"mso-spacerun: yes;\">\u00a0<\/span>iki 80 procent\u0173 \u012fsisavinamas \u017earmyne,u\u017etikrina pastovi\u0105 koncentracij\u0105 kraujyje visas 24 valandas, jo pusiauskilimo pusperiodis 6-7 dienos (T3 -2,5 dienos) koncentracijos pikas pasiekiamas per 2-4 valandas, i\u0161 jo , veikiant dejodinz\u0117m ,pagal organizmo poreikius , gaminamas aktyvusis trijodtironinas.L-tiroksinas 2007 metais JAV tapo vienu i\u0161 5 labiausiai<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>i\u0161perkam\u0173<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>gydytoj\u0173 i\u0161ra\u0161yt\u0173 medikament\u0173.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Taigi pastoviai ir ilgai<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>naudojan\u010di\u0173 L tiroksin\u0105 pasaulyje yra nema\u017eaiTod\u0117l nenuostabu , kad pasirod\u0117 nema\u017eai darb\u0173 , kuriuose aptariamos<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>tokio gydymo komplikacijos ir sprendimo b\u016bdai joms i\u0161vengti.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Pirmiausiai suprasti kuriuo tikslu skiriaimas gydymas L \u2013tiroksinu;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Pakaitin\u0117 terapija skydliauk\u0117s hormonais<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Supresin\u0117<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>TTH<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>terapija <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Pakaitin\u0117 terapija skydliauk\u0117s hormonais<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Ji skiriama daugeliu atveju , kai esti<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>skydliauk\u0117s hormon\u0173 stoka d\u0117l anks\u010diau i\u0161vardint\u0173 prie\u017eas\u010di\u0173.Kontrok\u017eliuojant tiroksino dozes, TTH palaikomas arti nurodom\u0173 aptin\u0117s ir vir\u0161utin\u0117s norm\u0173 ribos.Tai daugeliui pacient\u0173 pasiekiama , kai skirama tiroksino doz\u0117 esti nuo 1,6-1,8 mikrogramo kilogramui svorio per dien\u0105.Jei tokios doz\u0117s nepakanka,prie\u0161 j\u0105 didinant patartina paie\u0161koti<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>prie\u017easties , kod\u0117l doz\u0117 neadekvati.Da\u017eniausios prie\u017eastys skirstomos \u012f pseudomalabsorbcij\u0105 ir malabsorbcij\u0105.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Pseudomalabsorbcijos atveju da\u017eniausiai kaltas pacientas ir valgymo ypro\u010diai: tirokainas vartojamas po valgio ar i\u0161geriamas nevalgius , bet<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>valgoma anks\u010diau nei <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0 <\/span>Pusvalandis po jo i\u0161gerimo. Pacientas gausiai vartoja skaidulomis praturtint\u0105 maist\u0105,sojos patiekalus , kav\u0105<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>, kas taipogi blogina tiroksino \u012fsisavinim\u0105.Tiroksino doz\u0119 reikia didinti , did\u0117jant KMI ,ne\u0161tumo metu..Tiroksino nevaliaa vartoti drauge su proton\u0173 siurblio inhibitoriais,aliumunio oksidu, kalcio karbonatu,gele\u017eies sulfatu estrogenais.Kei\u010diant vaistinio preparato gamintoj\u0105,10-15 procent\u0173 kei\u010diasi ir bioakvivalenti\u0161kumas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Malabsorbcij\u0105 sukelia\u00a0<a href=\"http:\/\/www.gastroklinika.lt\/nutukimo-operacijos\/\" target=\"_blank\">skrand\u017eio<\/a> ir \u017earnyno ligos.Atrofinis <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/gastritas\/4354\">gastritas<\/a> ir celiakija ,kaip ir l\u0117tinis tiroiditas ,priskiriami autoimunini\u0173 lig\u0173 grupei. D\u0117l ma\u017eo r\u016bg\u0161tingumo skrandyje pablog\u0117ja tiroksino \u012fsisavinimas .Tod\u0117l kartais verta paie\u0161koti \u0161i\u0173 susirgim\u0173 derinio.Helicobacter pyliori buvimas taipogi blogina tiroksino pasisavinim\u0105 ir reikalauja didesni\u0173 dozi\u0173.Pana\u0161i situacija esti d\u0117l lamblij\u0173 ar kit\u0173 parazit\u0173,sergant l\u0117tin\u0117mis \u017earnyno ligomis. Didesni\u0173 tiroksino dozi\u0173 reikia sergant<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>imunoendokrinopatijomis , kai d\u0117l autoagresijos nuken\u010dia ir kitos endokrinin\u0117s liaukos.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong style=\"mso-bidi-font-weight: normal;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Supresin\u0117<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>TTH<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>terapija <\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Ji skiriama siekiant TTH kiek\u012f<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>laikyti<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>ma\u017eiau leistinos apatin\u0117s normos ribos.Tokio TTH slopinimo siekiama, kai skydliauk\u0117s audinio gaus\u0117jimas yra ne:pageidaujamas:<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0\u00a0 <\/span>Skydliauk\u0117s mazg\u0173 ir hiperplazijos gydymui,<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0 <\/span>Po dalin\u0117s skydliauk\u0117s dalies rezekcijos,<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0 <\/span>Po diferencijuoto skydliauk\u0117s\u00a0<a href=\"http:\/\/www.gastroklinika.lt\/paslaugos\/onkologines-operacijos\/\" target=\"_blank\">v\u0117\u017eio chirurginio<\/a> ir gydymo radiojodu<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">\u0160iuo atveju vidutin\u0117 tiroksino doz\u0117 yra 2,0-2,2 mikrogramai kilogramui svorio dienai.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Toki\u0105 tiroksino doz\u0119 gaunantieji turi didel\u0119 rizik\u0105 perdozuoti tiroksin\u0105.Perdozavimas gali pasireik tirotoksikoze,yra didesnis pavojus sutrikti \u0161irdies ritmui,\u012fvykti kaul\u0173 l\u016b\u017eiams pomenopauziniu laikotarpiu,padid\u0117ja kraujo kre\u0161amumas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>Tiriam\u0173j\u0173 grup\u0117je<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>prie\u0161ird\u017ei\u0173 virp\u0117jimas 12,7 %<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>\u012fvyksta da\u017eniau tiems , kuri\u0173 TTH nesiekia 0,4 \u00b5U\/ml , o Ft4 ir fT3 yra normos ribose<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>Tuo tarpu tiraim\u0173j\u0173 grup\u0117je , kuriems TTH buvo normos ribose, prie\u0161ird\u017ei\u0173 virp\u0117jimas rastas 2,3 %.Konstatuota, kad subklinikin\u0117s hipertiroz\u0117s metu blog\u0117ja \u0161irdies diastolin\u0117 funkcija,vystosi kairio skilvelio hipertrofija,ma\u017e\u0117ja prisitaikymas fiziniam kr\u016bviui,did\u0117ja kraujo kre\u0161amumas, ypa\u010d esrgant v\u0117\u017eiu.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Apie da\u017enesn\u0119 tikimyb\u0119 patirti osteoporotinio kaulo l\u016b\u017e\u012f pomenopauziniame laikotarpyje prane\u0161ta tiriam\u0173j\u0173 skai\u010diumi gausiame<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>Kanados tyrime. Jame dalyvavo 200,000 osteoporoze sergan\u010di\u0173<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>moter\u0173 , kuri\u0173 am\u017eiaus vidurkis daugiau 70 m. Visos jos naudojo arba kada nors naudojo tiroksin\u0105.Pasirodo , kad l\u016b\u017ei\u0173 tikimyb\u0117 2 katus didesn\u0117 toms , kurios \u0161iuo metu naudoja tiroksin\u0105 ir kad l\u016b\u017ei\u0173 tikimyb\u0117 priklausonuo vidutin\u0117s tiroksino doz\u0117s: naudojan\u010dios 93 \u00b5g L-tiroksino dienai l\u016b\u017eius patiria 3,5 karto da\u017eniau , negu tos , kurios vartoja 44\u00b5g dienai.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">\u00a0<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">\u0160ie duomenys privert\u0117 susim\u0105styti ar visada<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>auks\u010diau nurodytais atvejais reikalingos supresin\u0117s tiroksino doz\u0117s.Tuo labiau , kad n\u0117ra vieningos nuomon\u0117s gydytoj\u0173 praktik\u0173 tarpe d\u0117l tiroksino naudojimo skydliauk\u0117s<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>mazg\u0173 ma\u017einimui , j\u0173 recidyvavimui po dalin\u0117s skydliauk\u0117s pa\u0161alinimo operacijos.O ir diferencijuoto skydliauk\u0117s v\u0117\u017eio atveju ,TTH supresija si\u016bloma tik tais atvejais , kai metastazavimo galimyb\u0117 yra didel\u0117. \u0160i galimyb\u0117 apsprend\u017eiama<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>\u012fvertimus vis\u0105 eil\u0119 aplinkybi\u0173- v\u0117\u017eio histologij\u0105 ir jo agresyvum\u0105 , paciento am\u017ei\u0173 , patologinio \u017eidinio dyd\u012f , i\u0161plitim\u0105 ir t.t<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Kaip min\u0117ta auk\u0161\u010diau , daugumai pacient\u0173 skydliauk\u0117s veikla normalizuojasi , naudojant tiroksin\u0105 ir tik nedaugeliui reikalinga kombinuota terapija tiroksinu ir trijodtironinu.\u0160iuo klausimu vyksta nema\u017eai debat\u0173 beveik kiekvienoje tarptautin\u0117je skydlaiuk\u0117s patologijai skirtoje konferencijoje.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial; mso-ansi-language: LT;\">Baigiant belieka pasakyti , kad greitai savo \u0161imtmet\u012f \u0161v\u0119siantis tiroksinas kol kas yra vienintelis patikimas hipotiroz\u0117s gydytojas.Ta\u010diau kaip ir viskam<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>reikia \u017einoti gydymo tikslus , ir vartojimo komplikacijas.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p><!-- [if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:HyphenationZone>19<\/w:HyphenationZone>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p style=\"text-align: justify;\"><!-- [if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";}\n<\/style>\n\n\n<![endif]--><span style=\"font-size: 10.0pt; font-family: Arial; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: LT; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;\">Pastaruoju metu vis da\u017eniau tenka gird\u0117ti , kad sergan\u010di\u0173 skydliauk\u0117s ligom sergan\u010di\u0173 did\u0117ja , jiems gydytojai endokrinologai gydymui skiria skydliauk\u0117s hormonus ,visiems pana\u0161iom doz\u0117m ir kad laisvai to paskyrimo galima atsisakyti ar ma\u017einti dozes savo nuo\u017ei\u016br\u0105 pagal savijaut\u0105.Li\u016bdniausis , kad tokie svarstymai kyla ir i\u0161 koleg\u0173 , kit\u0173 specialybi\u0173 gydytoj\u0173. Taigi , matyt , laikas papildyti \u017einias <span style=\"mso-spacerun: yes;\">\u00a0<\/span>apie greitai \u0161imtmet\u012f<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>nuo susintetinimo min\u0117siat\u012f<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>skydliauk\u0117s hormon\u0105 levotiroksin\u0105.<\/span><\/p>\n","protected":false},"author":1,"featured_media":8433,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[8386,234,3534,5972,60,6175,2021],"site":[],"post_item_type":[27345],"class_list":["post-8432","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-hipotiroze","tag-klinika","tag-kresamumas","tag-pacientas","tag-terapija","tag-tikimybe","tag-tiroiditas"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8432","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\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=8432"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8432\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8433"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8432"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8432"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8432"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8432"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8432"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}