I Danmark anslås det, at ca. 15-20 % af befolkningen på et eller andet tidspunkt i livet udvikler en stofskiftesygdom. Symptomerne er diffuse, kommer snigende og varierer fra person til person. Og noget tyder på, at rigtig mange mennesker ikke får den korrekte behandling.
Af Joan Loewe og Anett Kromann
Artiklen blev bragt i magasinet sund-forskning og //mig// – april/maj 2015
Hvorfor får vi lavt stofskifte?
Stofskifteproblemer kan have mange årsager. Omkring 85 % med stofskifte problemer får det på grund af autoimmune sygdomme (Graves, Hashmotos, Ord’s) som rammer skjoldbruskkirtlen direkte og kan være forårsaget af arvelige forhold. Derudover får nogle lavt stofskifte på grund af medicin, og andre får bortopereret kirtlen på grund af en cancer. Det kan være et medfødt lavt stofskifte eller en konsekvens af radioaktiv jodbehandling for en overaktiv kirtel (højt stofskifte). Også sygdomme i hypofyse eller i hypothalamus kan skabe problemer, ligesom problemer andre steder i kroppen kan forårsage lavt stofskifte.
Derudover har forskere i 2014-2015 fundet ud af, at konverteringsproblemer blandt andet kan stamme fra en genfejl.
Højt stofskifte kaldes også Thyreotoksikose, Hypertyreose eller Hyperthyreoidisme.
Lavt stofskifte kaldes også Myxødem, Hypothyreose eller Hypothyroidisme.
Hvordan fungerer vores krop
Uanset årsagen til det lave stofskifte, så består behandlingen af personer med stofskiftehormonmangel (lavt stofskifte) typisk i at tilføre patienten thyroxin (T4) i syntetisk form; i Danmark hedder medicinen Eltroxin eller Euthyrox. Teorien bag behandlingen er, at den raske krop konverterer T4 til T3 i rette mængde på rette tidspunkt. Derfor er det – i princippet – nemmest og ofte nok at give patienten en dosis T4 dagligt.
Når hypofysen råber på hjælp
I hypofysen produceres et signalhormon, TSH (Thyreoidea Stimulerende Hormon). Hypofysen i hjernen bruger hormonet som signal til skjoldbruskkirtlen om at ned- eller opregulere produktionen af stofskiftehormoner, som respons på de input hypofysen får fra bl.a. egne receptorer og signaler fra hypothalamus i hjernen. Hvis hypofysen mangler skjoldbruskkirtelhormoner ”råber” den ad skjoldbruskkirtlen (TSH bliver høj, lavt stofskifte), og mener hypofysen, at der findes for meget hormon, så ”hvisker” den (TSH bliver lav, højt stofskifte). I Danmark bruges dette TSH til at diagnosticere stofskiftesygdom, fordi den, i teorien, er et spejl på, hvor meget stofskiftehormon, skjoldbruskkirtlen laver.
Og her går det så galt for rigtig mange mennesker
Og sådan kunne fortællingen om behandlingen stoppe, hvis ikke lige det er fordi, rigtig mange patienter oplever, at TSH ikke viser, om patienterne mangler T4 eller T3. Ydermere: Tilførslen af T4 alene afhjælper ikke patienternes mangeartede symptomer, som for manges vedkommende betyder, at de får problemer med at forblive på arbejdsmarkedet, og i øvrigt påvirker deres livskvalitet negativt med depression og muskelsmerter; for blot at nævne et par af mange livsødelæggende symptomer.
Mere forskning
Heldigvis begynder forskningen nu at udfordre teorier, som bygger på den raske krop, for at finde ud af, hvorledes det faktisk forholder sig for kroppen, når den er stofskiftesyg og i behandling. Meget tyder på, at de teorier, der er gældende for raske mennesker, ikke automatisk kan overføres til stofskiftepatienter i behandling for lavt stofskifte.
For lidt T3, selvom der er nok T4
Meget tyder også på, at mange patienter mangler hormonet T3. Det er det hormon, som skjoldbruskkirtlen laver en smule af, men som primært produceres ”perifert” i kroppen ved det, der populært kaldes ”konvertering”. Det konverteres fra T4 ved, at der fjernes et jodatom fra molekylet. Denne konvertering fra T4 til T3 sker i lever, nyrer og mave-tarm-systemet, og en lille del produceres i hjernen.
Generne driller og skaber mistrivsel
Helt ny forskning viser, at mellem 12 % og 36 % af de stofskiftesyge har en genetisk variation, som gør, at de konverterer dårligt. Af de 300.000 stofskiftesyge i Danmark vil de 36.000-108.000 potentielt mistrives på den behandling, som de i dag bliver tilbudt, når de diagnosticeres hos lægen.
Hører du til blandt de 43.000 med en ikke optimal behandling?
Af de patienter, der aktuelt har en diagnose og er i behandling, betyder det i reelle tal – ud af de 128.000 patienter i behandling – at behandling med T4 ikke er optimal for 14.400-43.200 af dem.
Mange har gener trods behandling med den gængse medicin; i mange tilfælde pga. mangel på hormonet T3. Generne kan omfatte:
- Muskelsmerter
- Hovedpine
- Hukommelsesproblemer
- Depression og stress
- For tidlige fødsler og abort
- Konstant og voldsom træthed
- Forstoppelse og/eller diarre
- Lav kropstemperatur (fryser)
Fibromyalgi; kan det være et uopdaget stofskifteproblem?
For over 20 år siden begyndte en amerikansk læge, som specialiserede sig i patienter med fibromyalgi, at undre sig over, at der var så mange sammenfald i symptomer på stofskiftehormonmangel og fibromyalgi. Han undrede sig også over, at så mange patienter, som kom til ham med fibromyalgi også havde stofskiftesygdom.
Flere forskningsresultater viser tydeligt, at patienterne foretrækker kombinationsbehandling, hvor de får både T4 og T3. Også i de dobbelt-blinde forsøg, der er lavet. Selvom patienten ikke vidste, hvilken medicin, han eller hun fik, så foretrak 50 % af deltagerne faktisk kombinationsbehandling, og kun 18 % foretrak T4 alene. Den resterende gruppe foretrak hverken det ene eller det andet.
Læs meget mere på www.stofskiftesupport.dk
Gå til din læge og få hjælp
Du kan hos lægen få målt mængden af frit T3 og T4 og bede om at få skiftet din medicin ud til Thyroid eller Liothyronin T3.
Heldigvis findes der faktisk alternativer til den T4 behandling, som tilbydes i dag. Der kan nemlig også tilføres T3, så patienten ikke behøver at nøjes med T4, men kan tilbydes behandling med både T4 og T3. I Danmark hedder T3 medicinen Liothyronin. Den kan egen læge udskrive, hvis han kan se, at blodprøver viser, at patienten ligger lavt i T3, selvom T4 er høj, og patienten stadigt klager over symptomer, som kunne være stofskiftet.
Der findes også et andet alternativ til T4 behandling, nemlig en animalsk udvundet stofskiftemedicin, som indeholder både T4 og T3. I Danmark hedder den Thyreoid og fremstilles magistralt på Glostrup Apotek. Medicinen kræver udleveringstilladelse, som din læge kan søge, hvis du ikke trives på andet stofskiftemedicin. Der findes også andre mærker af animalsk udvundet stofskiftemedicin, som lægen kan udskrive, og som ikke kræver udleveringstilladelse. På Stofskiftesupports hjemmeside kan du læse meget mere om de forskellige medicintyper, der er tilgængelige for stofskiftepatienter i Danmark.
Husk, vi har frit lægevalg, hvis ikke du føler, at I har et godt samarbejde.
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