Ngā hua whakamātautau repe tenga kua whakamāramatia: TSH, free T4, T3 me ngā paturopi

Anei ō hua whakamātautau repe tenga (thyroid) kua whakamāramatia i te whakaaro kotahi: ko te TSH te tohu, ko te free T4 te hōmona. Ka kī te TSH i te kaha o te pana a tō tinana i te repe tenga. Ka kī te free T4 i te nui o te hōmona (hormone) e tino tukuna ana e te repe tenga. Pānuitia tahitia, ā, ka mutu te āhua panga o te nuinga o ngā pūrongo.

Ka haere tēnei aratohu i ia rārangi o tētahi pūrongo repe tenga noa, i ngā tauira e rapua ana e ngā tākuta, me ngā pātai e tika ana kia kawea ki tō toronga e whai ake nei. Kāore ia e tautohu i tō mate. Ka āwhina ia i a koe ki te whai i te kōrero.

Ngā mea kei te whakamātautau toto repe tenga i te nuinga o te wā

He maha ngā wā ko te TSH anake te tirotiro taketake. He maha ngā taiwhanga ka tāpiri anake i ētahi atu whakamātautau ina kei waho te TSH i te awhe: T4 mēnā he teitei te TSH, me te T4 me te T3 mēnā he hakahaka te TSH. Kei tētahi rōpū whakamātautau whānui ake pea:

• TSH (thyroid-stimulating hormone)
• Free T4 (te hōmona kore here), te T4 katoa rānei (thyroxine)
• T3, te free T3 rānei (triiodothyronine)
• Ngā paturopi repe tenga (thyroid antibodies), pērā i ngā paturopi TPO, ngā paturopi thyroglobulin me ngā paturopi TSH receptor

Kāore koe e hiahia i ēnei katoa i ia wā. Kei te mea e hiahia ana tō tākuta ki te kimi ko ēhea ka tonoa.

TSH: te tohu mai i te repe pituitary

Ka hangaia te TSH e te repe pituitary, kaua e te repe tenga. Whakaarohia he puku rōrahi. Ina iti haere te hōmona repe tenga, ka piki te TSH hei pana kaha ake i te repe tenga. Ina nui rawa te hōmona repe tenga, ka heke te TSH.

Koinā i āhua kōaro ai te ahunga:

• Ko te TSH teitei te nuinga o te wā ka tohu ki te repe tenga mahi iti rawa (hypothyroidism).
• Ko te TSH hakahaka i te nuinga o te wā ka tohu ki te repe tenga mahi nui rawa (hyperthyroidism), ki te kai rānei i te hōmona repe tenga nui ake i tāu e hiahia ana.

E kī ana te American Thyroid Association ko te TSH te whakamātautau tuatahi pai rawa, nā te mea he maha ngā wā ka huri i mua i te T4, i te T3 rānei.

Free T4: te hōmona tonu

Ko te T4 te hōmona matua ka tukuna e te repe tenga. Ka haere te nuinga i te toto, e piri ana ki ngā pūmua. Ka tatau te T4 katoa i te wāhanga piri me te wāhanga kore here. Ka tatau te free T4 i te hōmona kore here anake ka tae ki ō kiko, nō reira i te nuinga o te wā koinā te mea pai ake ki ngā tākuta.

He take nui tēnei nā te mea ka whakapiki ētahi mea i aua pūmua kawe me te kore raru repe tenga. Ka taea e te hapūtanga me ngā pire ārai hapū kei roto te estrogen te whakapiki i te T4 katoa, ā, ka noho noa tonu te free T4.

T3: te āhua mahi

Ka hurihia e tō ate me ō whatukuhu te nuinga o te T4 ki te T3, te āhua e tino whakamahia ana e ō pūtau. Ka tirotirohia te T3 i te nuinga o te wā ina whakapae ana ngā tākuta i te repe tenga mahi nui rawa, kia kitea rānei tōna kaha. He uaua ka whai hua mō te repe tenga mahi iti rawa, nā te mea ko te T3 te uara whakamutunga ka heke i te nuinga o te wā. Ka taea e tētahi tangata te whai repe tenga mahi iti rawa, ā, he noa tonu te T3.

Te awhe noa TSH, me te take ka rerekē pea tōu

Kāore he "TSH noa" kotahi. Ka whakarite ia taiwhanga i tōna ake awhe i runga i ōna taputapu me ōna tikanga. Anei te rerekē o ngā awhe pakeke kua whakaputaina, ahakoa i waenganui i ngā puna e whakawhirinakitia ana:

Whakamātautau	British Thyroid Foundation	Rōpū whakamātautau a Cleveland Clinic	MedlinePlus
TSH	0.4 ki te 4.0 mU/L	0.3 ki te 4.0 mIU/L	tata ki te 0.4 ki te 4.8 µU/mL
Free T4	9 ki te 25 pmol/L	0.7 ki te 2.1 ng/dL	kāore i whakarārangitia
Free T3	3.5 ki te 7.8 pmol/L	2.3 ki te 4.1 pg/mL	kāore i whakarārangitia

Ētahi mea hei āta tiro:

• Ka rerekē ngā waeine. Ka whakaahua te mU/L, te mIU/L me te µU/mL i te nui ōrite o te TSH, nō reira e hāngai ana aua tau. Kāore e pērā te free T4 i te pmol/L me te ng/dL, nō reira kaua rawa e whakataurite tōtika.
• He take te pakeke. Ka whakamahi ētahi taiwhanga i te rohe o runga TSH teitei ake mō ngā kaumātua, tae atu ki te 7 pea. Kei ngā tamariki me ngā taiohi ō rātou ake awhe free T4.
• Ka huri te awhe i te hapūtanga. He rerekē ngā awhe TSH i te hapūtanga i ērā mō ngā tāngata katoa, nō reira ka rerekē pea te pānui i tētahi hua i te wā e hapū ana koe.
• Te mea he tāne, he wāhine rānei koe ka neke pea i ētahi awhe. Hei tauira, ka whakarārangi a Cleveland Clinic i ngā awhe free T4 rerekē mō ngā tama taiohi me ngā kōtiro taiohi.

He māmā te ture: whakamahia te awhe kua tāia ki tō ake pūrongo, ā, pātai ki tō tākuta he aha te tikanga mōu.

TSH teitei, T4 hakahaka me ētahi atu tauira noa

Ka pānui ngā tākuta i te TSH me te free T4 hei takirua. Ko ēnei ngā tauira ka tino kite koe:

TSH	Free T4	Te mea ka tohua i te nuinga o te wā
Teitei	Hakahaka	Te repe tenga mahi iti rawa (hypothyroidism)
Teitei	Noa	Subclinical hypothyroidism
Hakahaka	Teitei	Te repe tenga mahi nui rawa (hyperthyroidism)
Hakahaka	Noa, me te T3 teitei	I ētahi wā te repe tenga mahi nui rawa ka puta tuatahi i te T3
Hakahaka	Hakahaka	He raru repe pituitary, te pānga rānei o tētahi māuiui taumaha i wāhi kē
Noa	Noa	I te nuinga o te wā kei te mahi te repe tenga pērā i te tika

He tino take te kupu "ka tohua i te nuinga o te wā" i taua tūtohi. Ka whakaaro hoki tō tākuta ki ō tohumate, tō hītori hauora, ō rongoā, i ētahi wā ki tētahi whakamātautau anō, i mua i te whakaingoa i tētahi mea.

Subclinical hypothyroidism

Ko te ingoa tēnei mō te TSH kua piki, ā, he noa tonu te free T4. He mea noa, ā, he maha ngā wā kāore rawa he tohumate. Ina puta ngā tohumate, ko ētahi pea, ko te ngenge, te rongo i te makariri, te kōroke (constipation), te kiri maroke, ngā mate wahine taumaha ake rānei.

Ka wehea e Cleveland Clinic ki ngā taumata e rua: he TSH tata ki te 4.5 ki te 9.9, me te TSH 10 neke atu. He pai kia mōhio ki ētahi mea:

• He maha ngā take ka hoki noa. He maha ngā wā ka whakamātautau anō ngā tākuta i te TSH i roto i ngā marama e toru pea i mua i te whakatau i tētahi mea.
• Ka kino haere ētahi take. Tata ki te 2% ki te 6% o te hunga kei a rātou ka whakawhanake i te repe tenga mahi iti rawa katoa i ia tau.
• He whakatau tā te maimoatanga. Ka nui ake te tūponotanga ka tukuna ina 10 neke atu te TSH, ina he tohumate tō tētahi tangata taitamariki ake, mō te hunga rānei e ngana ana kia hapū.

Te kōrero a ngā paturopi repe tenga

Kāore ngā whakamātautau paturopi e ine i te pai o te mahi a tō repe tenga. Ka āwhina rātou ki te whakamārama he aha i kore ai pea e mahi pērā i te noa.

• Ngā paturopi TPO te tohu matua mō te mate Hashimoto, he take noa o te repe tenga mahi iti rawa. Ko te hua positive (kua kitea ngā paturopi) me te TSH noa, ka tohu pea ka pōturi te repe tenga ā muri ake.
• Ngā paturopi thyroglobulin ka piki pea hoki i te mate Hashimoto, ā, ka aroturukitia i muri i te maimoatanga mate pukupuku repe tenga.
• Ngā paturopi TSH receptor (TRAb), tae atu ki te thyroid stimulating immunoglobulin (TSI), e hono ana ki te mate Graves. Tata ki te 95% o te hunga he mate Graves tō rātou, kua piki te TRAb.

E rua ngā meka mārie ka āwhina. Ka puta he hua positive i ētahi tāngata, ahakoa kāore rawa he mate repe tenga. Ā, mō ngā pakeke, he uaua ka whai hua te whakamātautau anō i ngā paturopi TPO, nā te mea ko te TSH me te free T4 ka whakaatu i te tino āhua o te repe tenga.

Ngā mea ka whakararu pea i ō hua

I mua i tō āwangawanga mō tētahi tau kei te rohe, tirohia mēnā e pā ana ēnei:

• Ngā kai tāpiri biotin. Ka taea e te biotin (huaora B7), e noa ana i ngā hua makawe me ngā hua maikuku, te whakaāhua i ngā whakamātautau repe tenga kia kāore i te noa, ahakoa he noa. He rerekē ngā tohutohu mō te roa e whakatārewatia ai, mai i te rua rā pea (American Thyroid Association) ki te toru ki te rima rā (Cleveland Clinic). Pātai ki te tangata nāna tō whakamātautau i tono.
• Ngā rongoā. Ka pā pea ngā steroid, te lithium, te amiodarone, ētahi rongoā hūkeke (seizure medicines) me ngā pire ārai hapū ki ngā hua. Kōrero ki tō tākuta mō ngā mea katoa e kai ana koe, ā, kaua e whakamutu i tētahi rongoā kua tonoa, māu anake.
• Te māuiui tata nei. Ka neke pea ngā taumata repe tenga mō tētahi wā i tētahi pokenga taumaha, i tētahi mate manawa ohorere (heart attack), i tētahi mate ate, whatukuhu rānei e nui ana.
• Te wā o te rā. Ka huri te TSH i roto i te rā, nō reira e tūtohu ana a MedlinePlus i ngā whakamātautau o te ata tū. Ina whakamātautau anō koe, ngana kia haere i tētahi wā ōrite.
• Iodine. Ka pā pea ngā kai tāpiri iodine, te wai tae (contrast dye) rānei e whakamahia ana i ētahi matawai CT ki te repe tenga.

Ngā pātai mō ō hua repe tenga

1. Ko tēhea awhe e whakamahia ana e taku taiwhanga, ā, kei hea taku hua i roto?
2. Me whakamātautau anō tēnei, ā, āhea?
3. Ka pā pea tētahi rongoā, kai tāpiri rānei e kai ana au?
4. Me whai whakamātautau free T4, T3, paturopi rānei au?
5. Mēnā kei te hapū au, kei te whakamahere rānei kia hapū, ka huri tētahi mea?
6. He aha ka tīmata, ka whakamutu, ka huri rānei koe i te maimoatanga?

Mēnā he maha ō whakamātautau repe tenga, kia noho tahi ō pūrongo. He whakaahua o te wā kotahi te TSH kotahi. Ka whakaatu ngā hua maha i roto i ngā marama i te ahunga o ngā mea.

Ka āwhina a Saluvo i tērā wāhanga. E rua ngā tauira AI ka pānui i ia pūrongo ka tukuake e koe, ka whakaū koe i ngā uara e kore e whakaae ana rāua, ā, ka whakaatu te taupānga i te huri o tō TSH me tō T4 puta noa i ngā pūrongo. Kei reira ia hei āwhina i a koe ki te whakarite, kaua hei whakakapi i te pānui a tō tākuta.