Chirwere cheGraves muvanhu vakuru
Kuwedzera kwekuita kweiyo thyroid gland kana chirwere cheBasedow muvanhu vakuru chirwere chakakomba che autoimmune chinotungamira kune zvakasiyana-siyana zviratidzo uye shanduko pamwero we metabolic process. Nzira yekuziva uye kubata sei iyi pathology?

Iyo thyroid gland inhengo diki ye endocrine system iri pasi peganda kumberi kwemutsipa. Basa rayo guru nderokusunungurwa kwehomoni yetroroid iyo inogadzirisa iyo yekutanga metabolism (kusunungurwa kwesimba rekuita basa rinokosha remasero uye matishu). Kana, nokuda kwezvikonzero zvakasiyana-siyana, gland inotanga kushanda zvakanyanya kudarika nguva dzose, izvi zvinogona kutungamirira kuchirwere cheGraves muvanhu vakuru.

Iri zita rakagara richiripo kubva pamazuva emushonga weSoviet uye rave kunzi harichashandi. Mumabhuku epasi rose uye nhungamiro yekiriniki, zita rekuti hyperthyroidism kana Graves Disease rinoshandiswa. Mamwe mazita anoshandiswa munyika dzakasiyana siyana anosanganisira aya anoreva zvakafanana:

  • exophthalmic goiter;
  • Graves 'hyperthyroidism;
  • Chirwere cheParry;
  • toxic diffuse goiter.

Mukuwedzera, kune zvakare kupatsanurwa kwemukati kwechirwere cheGraves, zvichienderana nekuwanda kwezvimwe zviratidzo:

  • dermopathy (apo ganda rinonyanya kukanganiswa);
  • osteopathy (zvinetso zveskeletal);
  • ophthalmopathy (kunyanya zviratidzo zvemaziso).

Chii chinonzi chirwere cheBasedow

Graves' disease kana Graves' thyroiditis chirwere chinokanganisa thyroid gland, pamwe neganda nemaziso.

The thyroid gland inhengo iyo iri chikamu che endocrine system, network ye endocrine glands uye matishu inovanza mahormone anodzora maitiro emakemikari (metabolism).

Mahomoni anokanganisa mabasa akakosha emuviri, uye zvakare anogadzirisa kurova kwemoyo, tembiricha yemuviri uye BP. Mahomoni anobudiswa zvakananga muropa, kubva kwaanofamba achienda kunzvimbo dzakasiyana-siyana dzemuviri.

Chirwere cheGraves chinoratidzwa nekukurisa kusingaenzaniswi kwegomarara rethyroid (inonzi goiter) uye kuwedzera kuburitswa kwehomoni yethyroid (hyperthyroidism). Mahomoni ethyroid anobatanidzwa mune dzakawanda dzakasiyana masisitimu emuviri uye, semhedzisiro, chaiyo zviratidzo uye zviratidzo zvechirwere cheGraves zvinogona kusiyanisa zvakanyanya pakati pevanhu vebonde nezera rakasiyana. Zviratidzo zvakajairika zvinosanganisira kuonda uremu usiri nemaune, kusashivirira kusinganzwisisike nekudikitira kukuru, kushaya simba kwetsandanyama, kuneta, uye kubuda kwemboni yeziso. Chirwere cheGraves chakagara chiri chirwere che autoimmune.

Mifananidzo isati yasvika uye shure kwechirwere cheGraves

Zvikonzero zveBasedow's disease muvanhu vakuru

Chirwere cheGraves chinoonekwa sechirwere che autoimmune, asi zvimwe zvinhu, zvinosanganisira majini, zvakatipoteredza, kana zvakatipoteredza, zvinogona kuita kuti chigadziriswe. Autoimmune kusagadzikana kunoitika apo immune system yemuviri inokanganisa zvinyama zvine hutano.

Masoja ekudzivirira zvirwere anowanzo gadzira mapuroteni anonzi masoja ekudzivirira chirwere. Masoja ekudzivirira chirwere aya anobata kune zvinhu zvekunze (senge mabhakitiriya, mavhairasi, chepfu) mumuviri zvichikonzera kuparadzwa. Masoja ekudzivirira chirwere anogona kuuraya tupukanana zvakananga kana kuapfekedza kuitira kuti zvive nyore kuputswa nemasero machena eropa. Masoja ekudzivirira chirwere anogadzirwa maererano nezvimwe zvinhu kana zvinhu zvinokurudzira kugadzirwa kwemasoja ekudzivirira chirwere. Anonzi maantigen.

Muchirwere cheGraves, immune system inogadzira antibody isina kujairika inonzi thyroid-stimulating immunoglobulin. Iyi antibody inotevedzera basa reyakajairika thyroid-stimulating hormone (iyo inovanzwa nepituitary gland). Iyi hormone inotevedzera inonamira pamusoro pemasero ethyroid uye inoita kuti masero abudise mahormone ethyroid, zvichikonzera kuwanda kwawo muropa. Iko kune hyperactivity yethyroid gland, iyo inowedzerwa, basa rakawandisa. MuGraves 'ophthalmopathy, masoja ekudzivirira chirwere aya anogona kukanganisa maseru akatenderedza mboni yeziso.

Vanhu vanenge vabatwa nechirwere ichi vanogona kunge vaine majini akaremara kana kuti genetic predisposition to Graves' disease. Munhu ane genetically predisposed kuchirwere anotakura gene (kana majini) echirwere ichocho, asi chirwere chacho hachigoni kuzviratidza kana geni racho risina kukonzerwa kana "kugadziriswa" mune mamwe mamiriro ezvinhu, semuenzaniso, nekuda kwekukurumidza kuchinja kwezvakatipoteredza zvinhu. (zvinonzi multifactorial nhaka).

Majini akasiyana-siyana akaonekwa akabatana nechirwere cheGraves, kusanganisira izvo:

  • kuderedza kana kugadzirisa mhinduro ye immune system (immunomodulators),
  • izvo zvine hukama zvakananga nebasa rethyroid, senge thyroglobulin (Tg) kana thyroid stimulating hormone receptor (TSHR) majini.

Gene Tg inoburitsa thyroglobulin, puroteni inowanikwa chete mumatishu ethyroid uye inoita basa mukugadzirwa kwemahomoni ayo.

Gene TSHR inoburitsa puroteni iyo inotambira uye inosungirira kune thyroid stimulating hormone. Nheyo chaiyo yekubatana kwemajini uye zvakatipoteredza zvinokonzera chirwere cheGraves hachinyatsonzwisiswi.

Kuwedzera genetic factor, inozivikanwa se modifier genes, inogona kuita basa mukukura kana kutaura kwechirwere. Zvinhu zvakatipoteredza zvinogona kukonzera kukura kwe hyperthyroidism zvinosanganisira kunyanya kunetseka mupfungwa kana mumuviri, utachiona, kana pamuviri. Vanhu vanoputa fodya vari panjodzi huru yekubatwa nechirwere cheGraves uye ophthalmopathy. Vanhu vane zvimwe zvirwere zvinokonzerwa nekusashanda zvakanaka kwesimba rekudzivirira zvirwere, senge Type 1 chirwere cheshuga kana rheumatoid arthritis, vari panjodzi huru yekubata chirwere cheGraves.

Ndiani anonyanya kubatwa nechirwere cheGraves?

Chirwere cheGraves chinobata vakadzi kakawanda kupfuura varume, pachiyero che10: 1. Chirwere ichi chinowanzokura muzera repakati uye chiitiko chikuru pakati pemakore makumi mana nemakumi matanhatu, asi chinogona kubata vana, vechidiki, uye vakwegura. Chirwere cheGraves chinoitika munharaunda dzese dzepasi. Inofungidzirwa kuti 40-60% yevanhu vanotambura nayo. Nenzira, chirwere cheGraves ndicho chinonyanya kukonzera hyperthyroidism.

Zvimwe zvinetso zvoutano nenhoroondo yemhuri zvinokoshawo. Vanhu vane chirwere cheGraves vanowanzova nenhoroondo yedzimwe nhengo dzemhuri dzine matambudziko ethyroid kana zvirwere zve autoimmune. Dzimwe hama dzinogona kunge dzine hyperthyroidism kana thyroid isingashande, vamwe vanogona kunge vaine zvimwe zvirwere zve autoimmune, kusanganisira kuchena kwebvudzi nguva isati yakwana (kutanga mumakore ekuma20). Nekuenzanisa, murwere angave akabatanidza matambudziko ekudzivirira zvirwere mumhuri, kusanganisira chirwere cheshuga chechidiki, pernicious anemia (nekuda kwekushomeka kwevhitamini B12), kana zvigamba zvichena zvisingarwadzi paganda (vitiligo).

Zvakakosha kubvisa zvimwe zvikonzero zve hyperthyroidism. Zvinosanganisira toxic nodular kana multinodular goiter, iyo inoratidzwa neine imwe kana akawanda nodules kana mapundu muthyroid gland iyo inokura zvishoma nezvishoma uye inowedzera basa ravo kuitira kuti kubudiswa kwehomoni yethyroid muropa kunopfuura kudarika.

Zvakare, vanhu vanogona kuve kwenguva pfupi zviratidzo zve hyperthyroidism kana vaine chirwere chinonzi thyroiditis. Chirwere ichi chinokonzerwa nedambudziko rekudzivirira muviri kana hutachiona hwehutachiona hunoita kuti gland ibude yakachengetwa hormone yethyroid. Mhando dze thyroiditis dzinosanganisira subacute, silent, infectious, radiation therapy-induced, uye postpartum thyroiditis.

Kashoma, mamwe marudzi egomarara rethyroid uye mamwe mamota, akadai seTSH-inoburitsa pituitary adenomas, anogona kukonzera zviratidzo zvakafanana nezvinoonekwa muGraves 'chirwere. Kashoma, zviratidzo zve hyperthyroidism zvinogonawo kukonzerwa nekutora yakawandisa thyroid hormone mufomu yepiritsi.

Zviratidzo zveBasedow's disease muvanhu vakuru

Zviratidzo zvine chokuita nechirwere cheBasedow zvinowanzoonekwa zvishoma nezvishoma, dzimwe nguva kunyange zvisingaoneki kune munhu pachake (vanogona kunge vari vekutanga kuona hama). Zvinotora mavhiki kana mwedzi kuti zvikure. Zviratidzo zvinogona kusanganisira kuchinja kwemaitiro sekunyanya kutya, kugumbuka, kufunganya, kusagadzikana, uye kutadza kurara (kusarara). Zvimwe zviratidzo zvinosanganisira kurasikirwa uremu usiri nemaune (pasina kutevera kudya kwakasimba uye kuchinja kwezvokudya), kushaya simba kwetsandanyama, kusashivirira kusina kujairika, kuwedzera kudikitira, kukurumidza, kurova kwemwoyo kusingawanzoitiki (tachycardia), uye kuneta.

Chirwere cheGraves chinowanzobatanidzwa nezvirwere zvinokanganisa maziso, zvinowanzonzi ophthalmopathy. Chimiro chinyoro che ophthalmopathy chiripo kune vanhu vakawanda vane hyperthyroidism pane imwe nguva yechirwere, pasi pe10% yevarwere vane maziso makuru ekubatanidzwa kunoda kurapwa kwakasimba. Zviratidzo zvemaziso zvinogona kukura zvisati zvaitika, panguva imwe chete, kana mushure mekugadzirwa kwe hyperthyroidism. Kashoma, vanhu vane zviratidzo zvemaziso havatombogadziri hyperthyroidism. Mune zvimwe zviitiko, kukuvara kweziso kunogona kutanga kuoneka kana kuipa mushure mekurapa hyperthyroidism.

Zvichemo mu ophthalmopathy zvakasiyana zvikuru. Kune vamwe vanhu, vanogona kuramba vasina kushanduka kwemakore mazhinji, nepo kune vamwe, mamiriro acho anogona kuvandudza kana kuwedzera mumwedzi mishoma. Shanduko dzinogona zvakare kutevedzera maitiro: kuderera kwakapinza (kuwedzeredza), uyezve kuvandudzwa kwakakosha (kuregererwa). Muvanhu vazhinji, chirwere chacho chinyoro uye hachifambire mberi.

Kuratidzira kwakajairika kwezviratidzo zveziso kuzvimba kwematishu akatenderedza mboni yeziso, izvo zvinogona kuita kuti ibude kunze kwe orbit, mamiriro anonzi proptosis (bulging eyes). Varwere vanogonawo kucherechedza kuoma kwakanyanya kwemaziso, kuzvimba kwemaziso uye kuvhara kwavo kusina kukwana, kupera kwemaziso, kuzvimba, kutsvuka, kurwadziwa uye kutsamwa kwemaziso. Vamwe vanhu vanotsanangura kunzwa kwejecha mumaziso avo. Kakawanda, kusaona kwakasviba kana kaviri, kunzwa kuchiedza, kana kusaona kunogona kuitika.

Kashoma, vanhu vane chirwere cheGraves vanoita ronda reganda rinozivikanwa sepretibial dermopathy kana myxedema. Ichi chimiro chinoratidzwa nekuonekwa kweganda rakakora, rakatsvuka pamberi pemakumbo. Kazhinji inogumira kune shins, asi dzimwe nguva inogonawo kuitika pamakumbo. Kashoma, gel-kufanana nekuzvimba kwematishu emaoko uye kuzvimba kweminwe nezvigunwe (acropachia) zvinoitika.

Zvimwe zviratidzo zvine chekuita nechirwere cheGraves zvinosanganisira:

  • cardiopalmus;
  • kudengenyeka kuduku (kudedera) kwemaoko uye / kana zvigunwe;
  • kurasikirwa nevhudzi;
  • zvipikiri zvinopwanyika;
  • kuwedzera mafungiro (hyperreflexia);
  • kuwedzera kuda kudya uye kuwedzera ura.

Vakadzi vane chirwere cheGraves vanogona kuona shanduko mukutevera kwavo. Varume vanogona kuwana erectile dysfunction (kusava nesimba).

Mune zvimwe zviitiko, chirwere cheGraves chinogona kufambira mberi, zvichikonzera kusagadzikana kwemoyo kana kutetepa zvisina kujairika uye kushaya simba kwemapfupa (osteoporosis), zvichiita kuti ave brittle uye kukonzera kutyoka kubva mukukuvara kudiki kana kufamba kusinganzwisisike.

Kurapa kweBasedow's disease muvanhu vakuru

Kuongororwa uye kurapwa kwechirwere cheBasedow kunoratidzwa mumaprotocol epasi rese uye nhungamiro yekiriniki yenyika. Urongwa hwekuongorora hunodhirowewa zvichinyatsoenderana nekuongororwa kwaitwa uye kunoitwa mumatanho.

Diagnostics

Kuongororwa kwechirwere cheGraves kunoitwa pahwaro hwenhoroondo yemurwere nemhuri yake (kuona kana hama dzepedyo dzine matambudziko echimiro chakafanana), kuongororwa kwekiriniki yakakwana, kuzivikanwa kwezviratidzo zvehunhu, etc. Mushure mezviratidzo zvechipatara. zvinoonekwa, bvunzo dze laboratori uye bvunzo dzechishandiso dzinotarwa.

Miedzo yakajairika (ropa, weti, biochemistry) uye ongororo dzakashongedzerwa dzakadai sekuongororwa ropa kunoyera mazinga ethyroid mahormone (T3 uye T4) uye thyroid stimulating hormone (TSH mazinga) anoratidzwa. Kusimbisa kuongororwa, kuongororwa kweropa kunogona kuitwa kuona kuvepo kwemasoja ekudzivirira e thyrogloulin uye thioperoxidase anokonzera chirwere cheGraves, asi izvi kazhinji hazvidiwi.

Mishonga yemazuva ano

Kurapa kwechirwere cheGraves kazhinji kunosanganisira imwe yenzira nhatu:

  • antithyroid zvinodhaka (kudzvinyirira basa rethyroid gland pane synthesis yehomoni);
  • kushandisa radioactive iodine;
  • kupindira kwekuvhiya.

Nzira chaiyo yekurapa inokurudzirwa inogona kuenderana nezera remurwere uye kukura kwechirwere.

Mirayiridzo yekliniki

Matanho ese ekurapa anoitwa maererano nekurudziro yeClinical protocols

Mushonga ushoma kwazvo wechirwere cheGraves kushandisa mishonga inoderedza kuburitswa kwehomoni yethyroid (antithyroid zvinodhaka). Ivo vanonyanya kufarirwa kurapwa kwevakadzi vane pamuviri, avo vane hunyoro hyperthyroidism, kana varwere vanoda kurapwa nekukurumidza hyperthyroidism. Mishonga chaiyo inosarudzwa nachiremba, zvichienderana nezera remurwere, mamiriro ake uye zvimwe zvinhu.

Mishonga yechokwadi yechirwere cheGraves ndeiya inoparadza thyroid gland, zvichikonzera hypothyroidism. Radioactive iodine therapy ndiyo inonyanya kurapa chirwere cheGraves munyika dzakawanda. Iodine chinhu chemakemikari chinoshandiswa nethyroid gland kugadzira (synthesise) mahomoni ethyroid. Inenge yese iodine mumuviri wemunhu inotorwa nematishu ethyroid gland. Varwere vanomedza mhinduro ine radioactive iodine, iyo inofamba nemuropa uye ichiungana mugomba rethyroid, iyo inokuvadza nekuparadza thyroid tishu. Izvi zvinoderedza thyroid gland uye kuderedza kuwandisa kwehomoni. Kana huwandu hwehomoni yethyroid hukadzikira zvakanyanya, kurapwa kwehomoni kungadikanwa kudzorera mazinga akakwana ehomoni yethyroid.

Imwe kurapa kwakanyanya kuvhiyiwa kubvisa zvese kana chikamu chethyroid gland (thyroidectomy). Iyi nzira yekurapa chirwere inowanzochengeterwa vanhu vane mamwe maitiro ekurapa asina kubudirira kana anopesana, kana pamberi pekukura kwegland tissue kusvika kuhukuru hunokosha. Mushure mekuvhiyiwa, hypothyroidism inowanzoitika - ichi ndicho chigumisiro chinodiwa, chinogadziriswa nekunyatsogadziriswa kwehomoni kubva kunze.

Pamusoro pemishonga mitatu yataurwa pamusoro apa, mishonga inogona kurongerwa inovharisa thyroid hormone inenge yatotenderera muropa (beta-blockers) kuita basa rayo. Beta blockers yakadai sepropranolol, atenolol, kana metoprolol inogona kushandiswa. Kana huwandu hwemahomoni ethyroid huchienderana, kurapwa ne beta-blockers kunogona kumiswa.

Muzviitiko zvakawanda, kutevedza kwehupenyu hwese uye kuongororwa kwema laboratori kunodiwa. Mune zvimwe zviitiko, kwehupenyu hwose hormone replacement therapy inogona kudiwa.

Zvirwere zvinyoro zve ophthalmopathy zvinogona kurapwa nemagirazi ezuva, mafuta ekuzora, misodzi yekugadzira. Zvimwe zviitiko zvakakomba zvinogona kurapwa necorticosteroids yakadai se prednisone kuderedza kuzvimba mumatumbu akakomberedza maziso.

Muzviitiko zvakakomba, kuvhiyiwa kweorbital decompression uye orbital radiation therapy inogona zvakare kudikanwa. Panguva yekuvhiyiwa kweorbital decompression, chiremba anovhiya anobvisa bhonzo pakati peziso reziso (orbit) uye sinus. Izvi zvinobvumira ziso kuti ridzokere kunzvimbo yaro yechisikigo muchigadziko. Kuvhiyiwa uku kunowanzochengeterwa vanhu vari panjodzi yekurasikirwa kwekuona nekuda kwekumanikidzwa patsinga yeoptic kana kune mamwe maitiro ekurapa asina kushanda.

Kudzivirirwa kwechirwere cheBasedow muvakuru kumba

Kufanotaura kukura kwechirwere mberi nekudzivirira kwakaoma. Asi pane matanho ekudzikisa njodzi dzezvinetso uye kufambira mberi kwe hyperthyroidism.

Kana chirwere cheGraves chikaonekwa, ita kuti pfungwa nemuviri zvive pekutanga.

Kudya kwakakodzera uye kurovedza muviri inogona kuvandudza zvimwe zviratidzo panguva yekurapa uye kukubatsira kuti unzwe zviri nani zvachose. Semuenzaniso, nekuda kwekuti thyroid gland inodzora metabolism, hyperthyroidism inogona kuzara uye brittle mushure mekunge hyperthyroidism yagadziriswa, uye kudzivirira kurovedza muviri kunogona kubatsira kuchengetedza kuwanda kwemapfupa uye uremu.

Kuderedza kushushikana inogona kubatsira sezvo inogona kukonzera kana kuwedzera chirwere cheGraves. Mimhanzi inonakidza, kugeza kunodziya kana kufamba kuchakubatsira kuti uzorore uye uvandudze manzwiro ako.

Kuramba tsika dzakaipa – usasvuta. Kusvuta kunowedzera Graves 'ophthalmopathy. Kana chirwere ichi chinokanganisa ganda rako (dermopathy), shandisa-over-the-counter creams kana mafuta ane hydrocortisone kubvisa kuzvimba nekutsvuka. Mukuwedzera, kusungirirwa kwemakumbo emakumbo kunogona kubatsira.

Mibvunzo nemhinduro dzakakurumbira

Mibvunzo ine chekuita nechirwere cheBasedow, takakurukura nayo general practitioner, endoscopist, mukuru wesangano uye methodological hofisi Lidia Golubenko.

Ndeipi njodzi yechirwere cheBasedow?
Kana uine thyroid gland yakawandisa (hyperthyroidism), mamwe matambudziko anogona kukura, kunyanya kana mamiriro acho akasiyiwa asina kurapwa.

Matambudziko ekuona, anozivikanwa sechirwere chethyroid kana Graves 'ophthalmopathy, anokanganisa anenge 1 muvanhu vatatu vane thyroid yakawandisa nekuda kwechirwere cheGraves. Matambudziko anogona kusanganisira:

● kunzwa kwekuoma uye jecha mumaziso;

● kupinza kwekunzwa kune chiedza;

● lacrimation;

● kusaona zvakanaka kana kuona kaviri;

● kutsvuka kwemaziso;

● maziso.

Zviitiko zvakawanda zvakapfava uye zvinovandudza nekurapa kwethyroid, asi nezve 1 mumakumi maviri kusvika makumi matatu zviitiko zviri panjodzi yekurasikirwa kwekuona.

Kurapa kwethyroid yakawandisa kunowanzokonzera kuderera kwehomoni. Izvi zvinodaidzwa kuti underactive thyroid gland (hypothyroidism). Zviratidzo zvekushaya simba kwethyroid zvinogona kusanganisira:

● kunzwa kunotonhora;

● kuneta;

● kuwedzera uremu;

● kuzvimba;

● kuora mwoyo.

Kuderera kwehuroyi dzimwe nguva ndeyechinguva, asi kurapwa kwechigarire uye kwenguva refu nehomoni yethyroid inowanzodiwa.

Vakadzi vanogona kunge vane matambudziko nemimba. Kana thyroid yako ikanyanya kushanda panguva yekuzvitakura uye mamiriro ako asina kudzorwa zvakanaka, zvinogona kuwedzera njodzi yako yeku:

● preeclampsia;

● kupfupfudzika;

● kuberekwa nguva isati yakwana (masvondo 37 asati aberekwa);

● Mwana wako angava ane uremu hushoma.

Kana usiri kuronga kubata pamuviri, zvakakosha kushandisa nzira dzekudzivirira kubereka nekuti mamwe marapiro echirwere cheGraves anogona kukuvadza mwana asati azvarwa.

Ndeapi matambudziko anogona kuitika echirwere cheBasedow?
Kashoma, kusazivikanwa kana kudzorwa zvisina kunaka hyperthyroidism kunogona kutungamirira kune yakakomba, inotyisidzira hupenyu iyo inonzi thyroid dambudziko. Uku ndiko kukurumidza kusimuka kwezviratidzo zvinogona kukonzerwa ne:

● utachiona;

● kutanga kwepamuviri;

● mishonga isiriyo;

● kukuvadzwa kwethyroid gland, sekurova pahuro.

Zviratidzo zvechirwere chethyroid zvinosanganisira:

● palpitations;

● kupisa kwepamusoro;

● manyoka uye kusvotwa;

● kutsvuka kweganda nemaziso (jaundice);

● kushungurudza kwakanyanya uye kuvhiringidzika;

● kurasikirwa nepfungwa uye kunaani.

The overactive thyroidism inogonawo kuwedzera mikana yako yekukura:

● atrial fibrillation - maronda emwoyo anokonzera kusagadzikana uye kazhinji kusingawanzoitiki kwemwoyo;

● pfupa rekugadzirisa (osteoporosis) - mamiriro ezvinhu apo mapfupa ako anova brittle uye anogona kuputsa;

● kutadza kushanda kwemwoyo - mwoyo haugoni kupomba ropa zvakanaka muviri wose.

Nguva yekufonera chiremba kumba neBasedow's disease?
Kuonekwa kwezviratidzo zvisingawanzoitiki kana zviratidzo zvinotsanangurwa pamusoro apa zvinofanira kuva chikonzero chekukurumidzira kuonana nachiremba, kusanganisira kumba.

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