
thyroid tuphaanu

thyroid tuphaanu anedi hyper thyroidism yokka arudaina conny teevramaina mariyu praanaantakamaina samasya. athi churukaina thyroid charya hypermetabolizaniki daariteesinappudu idhi sambhavistundi, tudi phalitam gundepotu ledhaa bahula avayava vaiphalyam valla maranam.
idhi adhika jwaram (tarachugaa anthakante ekkuva ushnogratalu), vegavantamaina mariyu tarachugaa kramarahita hridaya spandana, adhika raktapotu, vaantulu, atisaaram mariyu aandolana kaligi untundi. vistruta pulls pressure thoo kuudina hyper tension prarambha nundi madhya sankshobhamlo sambhavistundi, hypotension thoo paatu shock chivari dasalo sambhavistundi. gunde vaiphalyam mariyu gundepotu sambhavinchavachhu. chikitsa unnappatikee maranam sambhavinchavachhu. chikitsa nilipiveyabadina ledhaa asamarthamgaa maarina hyper thyroidism unnavaarilo ledhaa chikitsa cheyani telikapati hyper thyroidism unnavaarilo (sankramana vantivi) antardhara anaarogyaanni abhivruddhi chesina vaarilo chaalaa episodelu sambhavistaayi.
thyroid tuphaanu yokka praadhamika chikitsa thyroid harmon samslaeshanha mariyu vidudalanu tagginchadaaniki akarbana iodine mariyu antithyroid mandulu (propyltiouracil ledhaa methimajol) thoo untundi. ushnograta niyantrana mariyu intravenous dravaalu kooda nirvahanaku pradhana aadharalu. beata blockers tarachugaa thyroid harmon prabhavalanu tagginchadaaniki upayogistaaru. rogulaku tarachugaa intensive cair unitlo cheraalsina avasaram untundi.
praanaantakamaina vaidya atyavasara paristhiti, chikitsa unnappatikee thyroid tuphaanu maranaala raetu 25 saatam varaku untundi. chikitsa lekunda, eee paristhiti chaalaa praanaantakam, maranaala raetu 80-100%. chaaritraatmakamgaa, aasupatri maranaala raetu 100% kii cherukovadamto, eee paristhiti chikitsa cheyalenidigaa pariganinchabadindi.
sankethaalu mariyu lakshanaalu.
thyroid tuphaanu anedi hyper thyroidism (vegavantamaina hridaya spandana raetu, ashanti, aandolana) lakshanaala yokka teevramaina praarambhamtho paatu jwaram (tarachugaa ushnogratalu 40 masim/104 efo kante ekkuva), adhika raktapotu, manasika sthithi maarpulu, atisaaram mariyu vaantulu vanti itara lakshanaalatoo untundi.
vyaktulu avayava panicheyakapovadam yokka vividha sankethaalanu pradarsinchavacchu. rogulu kaaleya panicheyakapovadam mariyu kaamerlu (charmam pasupu ranguloki maaradam) nuu anubhavinchavacchu, idhi paelavamaina rooga niruupana chihnamgaa pariganinchabadutundi. cardiac (gunde) lakshanaalalo asaadhaarana gunde layalu, myocardial inforction (gundepotu) mariyu raktasrava gunde vaiphalyam unnaayi, ivi cardiovascular kuppakuuladaaniki daariteeyavachchu. maranaala sankhya 20-30% varaku ekkuvagaa undavacchu.
konni sandarbhaallo, vyaktulu ashanti mariyu aandolana yokka praamaanika sankethaalanu anubhavinchakapovachhu, conny badulugaa balaheenata mariyu gandaragolam yokka udaaseenata sanketaalato kanipistaaru.
kaaranaalu.
hyper thyroidism nundi thyroid tuphaanuku parivartana saadhaaranamgaa jwaram, sepsis, nirjaleekaranam, myocardial inforction mariyu manasika vyaadhulatoe sahaa parimitam kakunda thyroid kaani avamaanamtho prerepinchabadutundi. vaari hyper thyroidizaniki asampuurnamgaa chikitsa cheyabadithe ledhaa vaari anty thyroid mandulu nilipiveyabadithe vyaktulu thyroid tuphaanu pramaadam ekkuvagaa untundi. eee vyaktulalo chaalaa mandiki hyper thyroidism (graves vyaadhi, vishapuurita bahula-nodular gonthu, ontari vishapuurita adenoma ledhaa ameodarone) yokka antarleena praathamika kaaranaalu unnaayi. ayithe, thyroid kaani shastrachikitsa, prasava, sankramana ledhaa konni mandulu mariyu radeo contrast rangulaku gurikavadam vanti vaatini edurkontunna gurtinchabadani thyrotoxicosis unna vyaktulalo thyroid tuphaanu sambhavinchavachhu.
pathophysiology.
thyroid tuphaanu abhivruddhiki khachitamaina yantraangam sarigga ardham kaaledu. maanava sareeramlo, thyroid harmon uchitam (jeevasaastraparamgaa churukaina tii3/tii4) ledhaa ravana cheyadaaniki thyroid binding harmon (jeevasaastraparamgaa kriyaarahitamgaa) kuu kattubadi undavacchu. thyroid harmon vidudala hypothalamous, petutory grandhi mariyu thyroid grandhitho kuudina feedback system dwara kathinamgaa niyantrinchabadutundi. hyper thyroidism eee vyavastha yokka kramabaddheekarana phalitamgaa vastundi, idhi chivariki uchita tii3/tii4 sthaayilalo perugudalaku daariteestundi. saadhaarana hyper thyroidism nundi thyroid tuphaanu yokka vaidya atyavasara paristhitulaku parivartana eee krindi vatiki daariteese paristhitula dwara prerepinchabadavachhu (kaaranaalanu chudandi):
uchita thyroid harmon perugudala.
thyroid tuphaanu unna vyaktulu uchita thyroid harmon sthaayilanu penchutaaru, ayithe mottam thyroid harmon sthaayilu saralamaina hyper thyroidismlo kante chaalaa ekkuvagaa undakapovachhu. uchita thyroid harmon labhyata peragadam anedi thyroid grandhini taarumaaru cheyadam valla kaavacchu. rediyodhaarmika iodine chikitsanu sweekarinche vyakti yokka nepadhyamlo, ksheeninchina thyroid kanajaalam nundi harmon vidudala kaaranamgaa uchita thyroid harmon sthaayilu teevramgaa peragavacchu.
thyroid harmon binding protein taggutundi.
vividha ottidi ledhaa mandula amarikalo thyroid harmon binding protein taggadam kooda uchita thyroid harmon perugudalaku kaaranam kaavacchu.
thyroid harmonku sunnitatvam penchutundi.
thyroid harmon labhyata perugudalato paatu, thyroid tuphaanu thyroid harmon patla sareeram yokka adhika sunnitatvaanni kaligi untundani kooda soochinchabadindi, idhi saanubhootigala kriyaaseelataku sambandhinchinadi kaavacchu (krinda chudandi).
saanubhootigala kriyaaseelata.
ottidi samayaallo saanubhootigala naadii vyavastha kriyaaseelata kooda thyroid tuphaanulo mukhyamaina paatra poeshistumdi. saanubhootigala kriyaaseelata thyroid grandhi dwara thyroid harmon utpattini penchutundi. perigina thyroid harmon amarikalo, thyroid harmon graahakaala saandrata (espisi. beata-receptorlu) kooda perugutaayi, idhi kaatekolaamainlaku pratispandananu penchutundi. thyroid tuphaanulo kanipinche aneka hridaya sambandha lakshanaalaku (perigina hridaya spandana raetu, hridaya spandana raetu, stroke valume) idhi kaaranam kaavacchu.
thyroid tuphaanu anedi allostatic vaiphalyam.
kotta siddhaantaala prakaram, thyroid tuphaanu anedi allostatic vaiphalyam valla sambhavistundi, thyroid kaani anaaroogyam syndrome abhivruddhiki thyrotoxicosis aatamkam kaliginche paristhitiloo, idhi klishtamaina anaaroogyam mariyu adhika jeevakriya demand unna itara paristhitulalo saktini aadaa cheyadaaniki sahaayapadutundi.
saadhaaranamgaa, teevramaina anaarogyamtho (udhaa.zii. sepsis, myocardial inforction mariyu shock yokka itara kaaranaalu) thyroid paniteerunu tagginchi, takkuva-tii3 syndromeku daariteestundi mariyu, appudappudu, takkuva tshech saandratalu, takkuva-tii4 syndrome mariyu thyroid harmonela yokka balaheenamaina plasma protein binding kooda erpadataayi. eee endocrine namuunaanu "euthyroid sick syndrome" (ss), "naan-thyroid anaarogya syndrome" (ntis) ledhaa "klishtamaina anaaroogyam, kanitulu, euramia mariyu aakali loe thyroid allostasis" (tacitus) anie pilustaaru. ntis gananeeyamgaa adhvaannamaina rooga niroopanhatho mudipadi unnappatikee, idhi prayojanakaramaina anusarananu (rakam 1 allostasis) suuchistumdani kooda bhaavistaaru. klishtamaina anaaroogyam thyrotoxicosisto kalisi unna sandarbhaallo, eee commorbidity thyroid paniteerunu tagginchadaanni nirodhistundi. anduvalla, shakti, oxygen mariyu glutathione viniyogam ekkuvagaa untundi, idhi marinta maranaalaku daariteestundi.
thyroid harmonela athi sarafaraaku jeevi yokka nirdishta pratispandanato thyroid tuphaanu yokka paraspara charya phalitamgaa thyroid tuphaanu erpadutundani eee kotta siddhaantaalu suuchistunnaayi.
rooga nirdhaarana.
thyroid tuphaanu nirdhaarana teevramaina hyper thyroidizaniki anugunamgaa unde sankethaalu mariyu lakshanaala uniki meeda aadharapadi untundi. clinical pramaanaala aadhaaramgaa thyroid tuphaanu sambhaavyatanu lekkinchadaaniki bahula vidhanalu pratipaadinchabaddaayi, ayithe, vaidyulu edhee vishwavyaaptamgaa avalambinchaledu. udaaharanaku, burch mariyu wartofsky 1993loe burch-wartofsky point scale (bdablups) nuu prachurinchaaru, eee krindi vargalalo nirvahinchabade nirdishta sankethaalu mariyu lakshanaala uniki aadhaaramgaa sankhya viluvanu ketayincharu ushnograta, hridayanaala panicheyakapovadam (hridaya spandana raetu mariyu karnika dada ledhaa raktaprasarana gunde vaiphalyam undatam), kendra naadii vyavastha (cns) panicheyakapovadam, jeernasayaantara ledhaa kaaleya panicheyakapovadam mariyu avakshepa sanghatana undatam. 25 kante takkuva burch-wartofsky skoru thyroid tuphaanuni suuchimchadu, ayithe 25 nundi 45 varaku raboye thyroid tuphaanuni suuchistumdi mariyu 45 kante ekkuva prastuta thyroid tuphaanuni suuchistumdi. pratyamnaayamgaa, japaanlo thyroid tuphaanu unna rogula pedda samuuham nundi udbhavinchina mariyu 2012loe prachurinchabadina japanese thyroid association (jta) pramaanaalu, thyroid tuphaanu sambhaavyatanu nirnayinchadaaniki gunaatmaka paddhatini andistaayi. jta pramaanaalu thyroid tuphaanu nirdhaarananu roogi pradarsinche sankethaalu mariyu lakshanaala nirdishta kalayika aadhaaramgaa khachitamaina mariyu anumanaspadamga vaeru chestaayi mariyu khachitamaina thyroid tuphaanu kosam elevated free triodothyronine (tii3) ledhaa free thyroxine (tii4) avasaram.
prayogasaalalo kanugonnavi.
hyper thyroidism maadirigaane, tshech anachiveyabadutundi. free mariyu seeram (ledhaa mottam) tii3 mariyu tii4 rendoo eguva sthaayiki chaerataayi. thyroid harmon sthaayilalo perugudala teevramaina hyper thyroidism sanketaalato kalisi unnappudu thyroid tuphanunu suuchistumdi, conny idhi roganirdhaarana kaadu, endukante idhi saralamaina hyper thyroidismtho kooda sambandham kaligi undavacchu. antekakunda, tii4 nundi tii3కii maaradam taggadam valla teevramgaa anaarogyamtho unna rogulalo seeram tii3 saadhaaranam kaavacchu. itara sambhaavya asaadhaaranatalu eee krindi vidhamgaa untayih
nirvahana.
thyroid tuphaanu nirvahanaku pradhana vyuuhaalu thyroid harmon utpattini mariyu vidudalanu tagginchadam, kanajaalaalapai thyroid harmon prabhavalanu tagginchadam, dravam nashtalanu bharti cheyadam mariyu ushnogratanu niyantrinchadam. thyroid tuphaanuku takshana chikitsa mariyu aasupatrilo cheradam avasaram. tarachugaa, intensive cair unitlo pravesam avasaram. hemodynamic kuppakuuladaaniki daariteese gunde vaiphalyam sandarbhaalalo, vaa-ekmotho sahaa cardio circulatory maddatu avasaram kaavacchu. 
adhika jwaramlo, parasetamol/acetaminophen vanti jwaram tagginche mandulu mariyu bahya sheetaleekarana charyalu (challani duppatlu, manchu pyaaklu) thoo ushnograta niyantrana saadhinchabadutundi. chemata, virechanaalu mariyu vaantula nundi dravam kolpovadam valla sambhavinche nirjaleekaranaaniki tarachugaa dravam bharteetho chikitsa chestaaru. teevramaina sandarbhaallo, yaantrika ventilation avasaram kaavacchu. edainaa anumaanaaspada antarleena kaaranam kooda parishkarinchabadutundi.
iodine.
thyroid harmon samslaeshanha mariyu vidudalanu tagginchadaaniki akarbana iodide (potassium iodide ledhaa lugols iodine) nuu ivvamani maargadarsakaalu sifaarsu chestaayi. adhika motaadulo, iodine wolf-chaikaf prabhavam dwara thyroid harmon samshlaeshanhanu tagginchavachhu mariyu plummer prabhavam dwara daani vidudalanu tagginchavachhu. konni maargadarsakaalu antithyroid mandulu praarambhinchina tarvaata iodine ivvaalani sifaarsu chestaayi, endukante iodine kooda thyroid harmon samshlaeshanhaku uparitalam, mariyu antithyroid mandulu lekunda isthe hyper thyroidism marinta digajaaravachu.
anty thyroid mandulu.
thyroid harmon samslaeshanha mariyu vidudalanu tagginchadaaniki antithyroid mandulu (propyltiouracil ledhaa methimajol) upayoginchabadataayi. T4 nundi T3 paridheeya maarpidini tagginchadamlo daani adanapu prabhaavaala kaaranamgaa methimajol kante propyltiouracil praadhaanyata ivvabadutundi, ayithe rendintinee saadhaaranamgaa upayogistaaru. etiologylo subcute thyroidities unte, anty thyroid mandulu ellappuduu upayoginchabadavu mariyu daani upayogam "vivadaspadamga" untundi. 
beata blockers.
beata-1-selective beata blockers yokka nirvahana (udhaa.zii. metoprolol) tudi avayavaalapai prasarana thyroid harmon prabhavanni tagginchadaaniki sifaarsu cheyabadindi. 
adhika motaadulo propranolol anedi oka saadhaarana modati-varusa chikitsa, endukante idhi thyroid harmon yokka marinta churukaina roopam ayina tii4 nundi tii3 yokka paridheeya maarpidini taggistundi. paridheeya diodineslapy vaati nirodhaka prabhaavaala kaaranamgaa empika kaani beata blackerlu prayojanakaramgaa untaayani suuchimchabaddaayi. iteevali konni parisoedhanalu ivi perigina maranaalatoe mudipadi unnayani suuchistunnaayi. anduvalla, cardioselective beata blackerlu anukuulamgaa undavacchu.
carticosteroids.
adhika sthaayi thyroid harmon hypermetabolic sthithiki daariteestundi, idhi adrenal grandhi utpatti chese cartisol anae harmon vichchinnam peragadaaniki daariteestundi. idhi saapeksha adrenal lopam sthithiki daariteestundi, dheenilo cartisol mottam saripodu. thyroid tuphaanu unna rogulandarikee carticosteroids (hydrocartisone mariyu dexamethasone prednisolone ledhaa methyl prednisolone kante praadhaanyata ivvabadataayi) ivvaalani maargadarsakaalu sifaarsu chestaayi. ayithe, dushprabhaavaala pramaadaanni taggistuu, saapeksha adrenal lopam taginantagaa chikitsa cheyabadindani nirdhaarinchadaaniki prati okka rogiki motaadulanu marchali.
plasmapheresis.
plasmapheresis plasma nundi saitokinlu, pratiroedhakaalu mariyu thyroid harmonelanu tolagistundi. idhi saadhaaranamgaa thyroid tuphaanu yokka teevramaina vakreebhavana kesulaku shastrachikitsaku vantenagaa ketayinchabadutundi.

