ʻO ka maʻi Graves i nā mākua

ʻO ka thyroid gland he mea liʻiliʻi liʻiliʻi o ka ʻōnaehana endocrine aia ma lalo o ka ʻili ma mua o ka ʻāʻī. ʻO kāna hana nui ka hoʻokuʻu ʻana i nā hormones thyroid e hoʻoponopono i ka metabolism maʻamau (ka hoʻokuʻu ʻana o ka ikehu no ka hana koʻikoʻi o nā cell a me nā ʻiʻo). Inā, no nā kumu like ʻole, hoʻomaka ka hana ʻoi aku ka ikaika ma mua o ka maʻamau, hiki i kēia ke alakaʻi i ka maʻi Graves i nā pākeke.

Ua kū mau kēia inoa mai ka wā o ka lāʻau lapaʻau Soviet a ua manaʻo ʻia he kahiko. Ma nā palapala honua a me nā alakaʻi alakaʻi, hoʻohana ʻia ka inoa hyperthyroidism a i ʻole maʻi Graves. ʻO nā inoa ʻē aʻe i hoʻohana ʻia ma nā ʻāina like ʻole kēia mau huaʻōlelo:

• exophthalmic goiter;
• ʻO ka hyperthyroidism o Graves;
• ʻO ka maʻi o Parry;
• toxic diffuse goiter.

Eia kekahi, aia kekahi mahele o loko o ka maʻi Graves, ma muli o ka nui o kekahi mau hōʻailona:

• dermopathy (ke pilikia nui ka ʻili);
• osteopathy (nā pilikia o ka iwi);
• ophthalmopathy (ʻo ka nui o nā hōʻailona maka).

He aha ka maʻi o Basedow

ʻO ka maʻi o Graves a i ʻole thyroiditis ʻo Graves kahi maʻi e pili ana i ka ʻili thyroid, a me ka ʻili a me nā maka.

ʻO ka thyroid gland he ʻāpana ia o ka ʻōnaehana endocrine, kahi ʻupena o nā ʻili endocrine a me nā ʻiʻo e hūnā i nā hormones e hoʻoponopono i nā kaʻina hana kemika (metabolism).

Hoʻopili nā Hormones i nā hana koʻikoʻi o ke kino, a hoʻoponopono pū i ka puʻuwai puʻuwai, ka mahana o ke kino a me ke kahe koko. Hoʻokuʻu pololei ʻia nā hormones i loko o ke kahe koko, mai kahi e hele ai lākou i nā wahi like ʻole o ke kino.

Hōʻike ʻia ka maʻi o Graves e ka hoʻonui ʻia ʻana o ka thyroid gland (i kapa ʻia he goiter) a me ka hoʻonui ʻana i ka huna ʻana o ka hormone thyroid (hyperthyroidism). Hoʻokomo ʻia nā hormones thyroid i nā ʻōnaehana kino like ʻole, a ma muli o ka hopena, hiki ke ʻokoʻa nā hōʻailona kikoʻī a me nā hōʻailona o ka maʻi Graves i waena o nā poʻe o nā kāne like ʻole a me nā makahiki. ʻO nā hōʻailona maʻamau ʻo ia ka pohō kaumaha ʻole, ka hoʻomanawanui ʻole o ka wela me ka hoʻoluhi ʻana, nāwaliwali o ka ʻiʻo, ka luhi, a me ka puka ʻana o ka maka. ʻO ka maʻi o Graves kahi maʻi autoimmune.

Nā kiʻi ma mua a ma hope o ka maʻi o Graves

Nā kumu o ka maʻi o Basedow i nā mākua

Ua manaʻo ʻia ka maʻi ʻo Graves he maʻi autoimmune, akā ʻo nā kumu ʻē aʻe, e pili ana i ka genetic, environmental, a i ʻole nā ​​mea kūlohelohe, hiki ke kōkua i kona ulu ʻana. Loaʻa nā maʻi autoimmune i ka wā e hoʻouka hewa ai ke kino o ke kino i nā ʻiʻo olakino.

Hoʻopuka maʻamau ka ʻōnaehana pale i nā protein kūikawā i kapa ʻia nā antibodies. Hoʻopili kēia mau antibodies i nā mea ʻē aʻe (e laʻa i ka bacteria, virus, toxins) i loko o ke kino, no laila e luku ʻia lākou. Hiki i nā antibodies ke pepehi pololei i nā microorganism a i ʻole ke kāʻei iā lākou i mea maʻalahi e wāwahi ʻia lākou e nā keʻokeʻo keʻokeʻo. Hoʻokumu ʻia nā antibodies kūikawā i ka pane ʻana i kekahi mau mea a i ʻole nā ​​​​mea e hoʻoulu ai i ka hana ʻana o nā antibodies. Kapa ʻia lākou he antigens.

I ka maʻi Graves, hoʻopuka ka ʻōnaehana immune i kahi antibody ʻano ʻino i kapa ʻia ʻo thyroid-stimulating immunoglobulin. Hoʻohālike kēia antibody i ka hana o ka hormone hoʻoulu thyroid maʻamau (kahi i huna ʻia e ka pituitary gland). Hoʻopili ʻia kēia hormone mimic i ka ʻili o nā pūnaewele thyroid a hoʻoulu i nā cell e hana i nā hormones thyroid, e hopena i ka nui o ia mau mea i loko o ke koko. Aia ka hyperactivity o ka thyroid gland, kāna hoʻonui, hana nui. I loko o ka Graves' ophthalmopathy, hiki i kēia mau antibodies ke hoʻopilikia i nā pūnaewele e hoʻopuni ana i ka pōpō maka.

Loaʻa paha i ka poʻe i hoʻopilikia ʻia nā genes hemahema a i ʻole kahi predisposition genetic i ka maʻi Graves. ʻO ke kanaka i loaʻa i ka genetically predisposed i kahi maʻi e lawe i ka gene (a i ʻole genes) no kēlā maʻi, akā ʻaʻole hiki ke hōʻike ʻia ka pathology iā ia iho inā ʻaʻole i hoʻāla ʻia ka gene a i ʻole "hoʻoulu ʻia" ma lalo o kekahi mau kūlana, no ka laʻana, ma muli o ka hoʻololi wikiwiki ʻana i nā kumu kūlohelohe. (i kapa ʻia he multifactorial heredity).

Ua ʻike ʻia nā ʻano genes like ʻole e pili ana i ka maʻi Graves, e komo pū me nā mea:

• hoʻonāwaliwali a hoʻololi paha i ka pane o ka ʻōnaehana pale (immunomodulators),
• pili pono i ka hana thyroid, e like me thyroglobulin (Tg) a i ʻole thyroid stimulating hormone receptor (TSHR) genes.

ʻO Gene Tg hoʻopuka ʻo thyroglobulin, he pūmua i loaʻa i loko o ka ʻiʻo thyroid wale nō a hana i ka hana o kāna mau hormones.

Gene TSHR hoʻopuka i kahi pūmua i loaʻa a hoʻopaʻa i ka hormone hoʻoulu thyroid. ʻAʻole maopopo loa ke kumu kūpono o ka launa pū ʻana o nā ʻano genetic a me ke kaiapuni i kumu i ka maʻi Graves.

ʻO nā kumu genetic hou aʻe, i kapa ʻia ʻo modifier genes, hiki ke pāʻani i ka hoʻomohala ʻana a i ʻole ka hōʻike ʻana o ka maʻi. ʻO nā kumu kaiapuni e hiki ke hoʻoulu i ka ulu ʻana o ka hyperthyroidism e pili ana i ke koʻikoʻi o ka naʻau a i ʻole ke kino, ka maʻi, a i ʻole ka hāpai ʻana. ʻOi aku ka nui o ka pilikia o ka poʻe puhi puhi i ka maʻi Graves a me ka ophthalmopathy. ʻO ka poʻe i loaʻa i nā maʻi ʻē aʻe i hoʻokumu ʻia e ka hana ʻino o ka ʻōnaehana pale, e like me ka maʻi diabetes type 1 a i ʻole rheumatoid arthritis, ʻoi aku ka pilikia o ka hoʻomohala ʻana i ka maʻi Graves.

ʻO wai ka mea e loaʻa i ka maʻi Graves?

Hoʻopilikia pinepine ka maʻi Graves i nā wahine ma mua o nā kāne, ma ka ratio o 10: 1. Hoʻoulu pinepine ʻia ka maʻi i waena o nā makahiki me ka nui o ka maʻi ma waena o nā makahiki 40 a me 60, akā hiki ke hoʻopilikia i nā keiki, nā ʻōpio, a me nā ʻelemakule. Loaʻa ka maʻi Graves ma nā wahi āpau o ka honua. Ua manaʻo ʻia he 2-3% o ka heluna kanaka i loaʻa iā ia. Ma ke ala, ʻo ka maʻi Graves ke kumu maʻamau o ka hyperthyroidism.

He mea nui hoʻi nā pilikia olakino ʻē aʻe a me ka moʻolelo ʻohana. Loaʻa pinepine ka poʻe me ka maʻi Graves i ka moʻolelo o nā ʻohana ʻē aʻe me nā pilikia thyroid a i ʻole nā ​​maʻi autoimmune. Ua loaʻa paha i kekahi mau ʻohana ka hyperthyroidism a i ʻole ka thyroid underactive, ʻo nā mea ʻē aʻe he maʻi autoimmune ʻē aʻe, e komo pū ana i ka hina o ka lauoho (e hoʻomaka ana i ko lākou mau makahiki he 20). Ma ka hoʻohālikelike, pili paha ka mea maʻi i nā pilikia immune i loko o ka ʻohana, ʻo ia hoʻi ka maʻi diabetes ʻōpiopio, ka anemia pernicious (ma muli o ka nele o ka huaora B12), a i ʻole nā ​​ʻāpana keʻokeʻo ʻeha ʻole ma ka ʻili (vitiligo).

He mea nui e kāpae i nā kumu ʻē aʻe o ka hyperthyroidism. Hoʻopili lākou i ka nodular a i ʻole multinodular goiter, kahi i hōʻike ʻia e hoʻokahi a ʻoi aku paha nā nodules a i ʻole nā ​​puʻupuʻu i loko o ka thyroid gland e ulu mālie a hoʻonui i kā lākou hana i ʻoi aku ka nui o ka hopena o ka hormone thyroid i loko o ke koko ma mua o ka maʻamau.

Eia kekahi, hiki i nā kānaka ke hoʻomohala i nā hōʻailona o ka hyperthyroidism inā loaʻa iā lākou kahi maʻi i kapa ʻia ʻo thyroiditis. Hoʻokumu ʻia kēia maʻi ma muli o ka pilikia me ka ʻōnaehana immune a i ʻole kahi maʻi maʻi e hoʻoheheʻe ai ka gland i ka hormone thyroid i mālama ʻia. ʻO nā ʻano thyroiditis he subacute, leo, infectious, radiation therapy-induced, a me ka thyroiditis postpartum.

Kakaʻikahi, hiki i kekahi mau ʻano o ka maʻi maʻi thyroid a me kekahi mau maʻi koko, e like me ka TSH-producing pituitary adenomas, ke hoʻoulu i nā hōʻailona e like me nā mea i ʻike ʻia i ka maʻi Graves. ʻAʻole hiki ke loaʻa nā hōʻailona o ka hyperthyroidism ma muli o ka lawe nui ʻana i ka hormone thyroid i ke ʻano pila.

Nā hōʻailona o ka maʻi o Basedow i nā mākua

ʻO nā hōʻailona e pili ana i ka maʻi o Basedow e ʻike mālie ʻia, i kekahi manawa me ka ʻike ʻole ʻia e ke kanaka ponoʻī (ʻo lākou paha ka mea mua i ʻike i nā ʻohana). Lawe lākou i nā pule a i ʻole mau mahina e ulu ai. Hiki i nā hōʻailona ke hoʻololi i ke ʻano e like me ka makaʻu nui, ka huhū, ka hopohopo, ka hoʻomaha ʻole, a me ka paʻakikī o ka hiamoe (insomnia). ʻO nā hōʻailona ʻē aʻe e pili ana i ka pohō kaumaha ʻole (me ka hahai ʻole ʻana i nā meaʻai koʻikoʻi a me nā hoʻololi ʻana i ka meaʻai), nāwaliwali o ka ʻiʻo, ka hoʻomanawanui ʻole o ka wela, ka hoʻonui ʻana i ka wela, ka wikiwiki, ka puʻuwai puʻuwai ʻole (tachycardia), a me ka luhi.

Hoʻopili pinepine ʻia ka maʻi Graves me nā pathologies e pili ana i nā maka, i ʻōlelo pinepine ʻia he ophthalmopathy. Aia kekahi ʻano ophthalmopathy maʻalahi i ka hapa nui o ka poʻe i loaʻa i ka hyperthyroidism i kekahi manawa o ka maʻi, ʻoi aku ka liʻiliʻi o ka 10% o nā mea maʻi i komo nui i ka maka e pono ai ka mālama ʻana. Hiki ke ulu nā hōʻailona maka ma mua, i ka manawa like, a ma hope paha o ka ulu ʻana o ka hyperthyroidism. ʻAʻole loa e ulu ka poʻe me nā hōʻailona maka i ka hyperthyroidism. I kekahi mau hihia, ʻike mua ʻia ka pōʻino o ka maka ma hope o ka mālama ʻana i ka hyperthyroidism.

ʻO nā hoʻopiʻi i ka ophthalmopathy he loli loa. No kekahi poʻe, hiki ke hoʻololi ʻole ʻia lākou no nā makahiki he nui, a no nā mea ʻē aʻe, hiki ke hoʻomaikaʻi a ʻoi paha ka maʻi i loko o nā mahina ʻelua. Hiki i nā hoʻololi ke hahai i ke ʻano: kahi hōʻemi nui (exacerbation), a laila hoʻomaikaʻi nui (kala ʻia). I ka nui o nā kānaka, maʻalahi ka maʻi a ʻaʻole holomua.

ʻO nā hiʻohiʻona maʻamau o nā hōʻailona o ka maka, ʻo ia ka pehu ʻana o nā ʻiʻo e hoʻopuni ana i ka pōpō maka, a hiki ke hoʻokuʻu ʻia i waho o ka orbit, kahi maʻi i kapa ʻia he proptosis (nā maka bulging). Hiki i nā maʻi ke hoʻomaopopo i ka maloʻo nui o nā maka, ka pehu ʻana o nā lihilihi a me ko lākou pani piha ʻole ʻana, ka loli ʻana o nā lihilihi, ʻulaʻula, ʻulaʻula, ʻeha a me ka huhū o nā maka. Hōʻike kekahi poʻe i ke ʻano o ke one i ko lākou mau maka. ʻAʻohe mea maʻamau, hiki mai ka ʻike pōkā a i ʻole ka ʻike pālua, ka ʻike i ka mālamalama, a i ʻole ka ʻike makapō.

Kakaʻikahi loa, hoʻomohala ka poʻe me ka maʻi Graves i kahi ʻili ʻili i kapa ʻia ʻo pretibial dermopathy a i ʻole myxedema. Hōʻike ʻia kēia ʻano ma ke ʻano o ka ʻili mānoanoa, ʻulaʻula ma mua o nā wāwae. ʻO ka mea maʻamau, ua kaupalena ʻia i nā ʻili, akā i kekahi manawa hiki ke hana ma nā wāwae. ʻAʻole hiki ke loaʻa ka pehu e like me ka gel o nā ʻiʻo o nā lima a me ka pehu ʻana o nā manamana lima a me nā manamana wāwae (acropachia).

ʻO nā hōʻailona hou e pili ana i ka maʻi o Graves:

• cardiopalmus;
• haʻalulu iki o nā lima a me nā manamana lima;
• poho lauoho;
• kui kui palupalu;
• hoʻonui i nā reflexes (hyperreflexia);
• hoʻonui i ka ʻai a me ka hoʻonui ʻana i ka ʻōpū.

Hiki i nā wāhine me ka maʻi Graves ke loaʻa i nā loli i kā lākou kaʻina menstrual. Hiki i nā kāne ke loaʻa i ka erectile dysfunction (impotence).

I kekahi mau hihia, hiki i ka maʻi o Graves ke holomua, e hōʻeha ana i ka naʻau a i ʻole ka lahilahi ʻano a me ka nāwaliwali o nā iwi (osteoporosis), e hoʻowaliwali ai a haʻihaʻi mai ka ʻeha liʻiliʻi a i ʻole nā ​​​​neʻe ʻino.

Lapaʻau ʻana i ka maʻi o Basedow i nā pākeke

Hōʻike ʻia ka ʻike a me ka mālama ʻana i ka maʻi o Basedow i nā kuʻuna honua a me nā alakaʻi lapaʻau ʻāina. Hoʻolālā ʻia ka hoʻolālā hoʻokolokolo e like me ka maʻi i manaʻo ʻia a lawe ʻia i nā pae.

lapaʻau '

Hana ʻia ka ʻike o ka maʻi Graves ma ke kumu o ka moʻolelo kikoʻī o ka mea maʻi a me kona ʻohana (e ʻike inā loaʻa nā pilikia o nā ʻohana pili i ke ʻano like), kahi loiloi lapaʻau piha, ʻike ʻana i nā hōʻailona ʻano, etc. ua ʻike ʻia, ua kuhikuhi ʻia nā hoʻokolohua hoʻokolohua a me nā hoʻokolohua instrumental.

Hōʻike ʻia nā hoʻāʻo maʻamau (koko, mimi, biochemistry) a me nā hoʻokolohua kūikawā e like me nā hoʻāʻo koko e ana i nā kiʻekiʻe o ka hormone thyroid (T3 a me T4) a me ka hormone hoʻoikaika thyroid (nā pae TSH). No ka hōʻoia ʻana i ka maʻi maʻi, hiki ke hana ʻia nā hoʻāʻo koko e ʻike i ka loaʻa ʻana o nā antibodies kikoʻī i ka thyrogloulin a me ka thioperoxidase e kumu ai ka maʻi Graves, akā ʻaʻole pono kēia.

Nā lāʻau lapaʻau hou

ʻO ka hoʻomaʻamaʻa ʻana no ka maʻi Graves maʻamau e komo i kekahi o nā ʻano ʻekolu:

• nā lāʻau antithyroid (hoʻopau i ka hana o ka thyroid gland i ka synthesis o nā hormones);
• ka hoʻohana ʻana i ka iodine radioactive;
• ʻoki lāʻau lapaʻau.

ʻO ke ʻano kikoʻī o ka lāʻau i ʻōlelo ʻia ma muli o ka makahiki o ka mea maʻi a me ka nui o ka maʻi.

Nā alakaʻi lapaʻau

Hoʻokō ʻia nā pae āpau o ka mālama ʻana e like me nā ʻōlelo aʻoaʻo o nā protocol Clinical

ʻO ka lāʻau lapaʻau liʻiliʻi loa no ka maʻi Graves ʻo ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi i ka hoʻokuʻu ʻana o ka hormone thyroid (nā lāʻau antithyroid). Makemake nui ʻia lākou no ka mālama ʻana i nā wahine hāpai, ka poʻe me ka hyperthyroidism haʻahaʻa, a i ʻole nā ​​​​mea maʻi e koi ana i ka mālama wikiwiki ʻana no ka hyperthyroidism. Ua koho ʻia nā lāʻau lapaʻau kūikawā e ke kauka, e pili ana i ka makahiki o ka mea maʻi, kona kūlana a me nā kumu hou aʻe.

ʻO nā lāʻau lapaʻau paʻa no ka maʻi o Graves ka mea e hoʻopau ai i ka ʻili thyroid, e hopena i ka hypothyroidism. ʻO ka radioactive iodine therapy ka lapaʻau maʻamau no ka maʻi Graves ma nā ʻāina he nui. ʻO Iodine kahi mea kemika i hoʻohana ʻia e ka thyroid gland e hana (synthesize) thyroid hormones. ʻAneʻane pau nā iodine i loko o ke kino o ke kanaka e komo i nā ʻiʻo o ka thyroid gland. Ale ka poʻe maʻi i kahi hopena i loaʻa i ka iodine radioactive, e hele ana ma ke kahe koko a hōʻiliʻili i loko o ka thyroid gland, kahi e hōʻino a luku ai i ka ʻiʻo thyroid. ʻO kēia ka mea e hōʻemi ai i ka thyroid gland a hoʻemi i ka hana nui o nā hormones. Inā hāʻule haʻahaʻa loa ka nui o ka hormone thyroid, pono paha ka hormone therapy e hoʻihoʻi i nā pae hormone thyroid kūpono.

ʻO kekahi lāʻau lapaʻau ʻē aʻe he ʻokiʻoki e wehe i nā ʻāpana āpau a i ʻole kekahi o ka thyroid gland (thyroidectomy). Mālama ʻia kēia ʻano o ka mālama ʻana i ka maʻi no ka poʻe i loaʻa ʻole nā ​​​​ʻano lapaʻau ʻē aʻe i kūleʻa ʻole ʻia a i ʻole i contraindicated, a i ʻole ma mua o ka ulu ʻana o ka ʻiʻo gland i kahi nui nui. Ma hope o ka ʻoki ʻana, hiki pinepine ka hypothyroidism - ʻo ia ka hopena i makemake ʻia, i hoʻoponopono ʻia e ka nui o nā hormones i hoʻoponopono ʻia mai waho.

Ma waho aʻe o nā lāʻau lapaʻau ʻekolu i ʻōlelo ʻia ma luna nei, hiki ke kuhikuhi ʻia nā lāʻau lapaʻau e pale ai i ka hormone thyroid e holo mua nei i loko o ke koko (beta-blockers) mai ka hana ʻana i kāna hana. Hiki ke hoʻohana ʻia nā beta blockers e like me propranolol, atenolol, a i ʻole metoprolol. Ke maʻamau ka pae o nā hormones thyroid, hiki ke hoʻopau ʻia ka lāʻau me nā beta-blockers.

I nā hihia he nui, pono ka hahai ʻana i ke ola a me nā noiʻi hoʻokolohua. I kekahi mau hihia, pono paha ke ola ʻana o ka hormone replacement therapy.

Hiki ke mālama ʻia nā maʻi maʻalahi o ka ophthalmopathy me nā aniani, ka ʻaila, nā waimaka artificial. Hiki ke mālama ʻia nā maʻi koʻikoʻi me nā corticosteroids e like me prednisone e hōʻemi i ka pehu ʻana o nā ʻiʻo e puni ana i nā maka.

I nā hihia koʻikoʻi, koi ʻia ke ʻoki decompression orbital a me ka radiation radiation orbital. I ka wā o ka orbital decompression surgery, wehe ke kauka lapaʻau i ka iwi ma waena o ka maka (orbit) a me nā sinuses. ʻAe kēia i ka maka e hoʻi i kona kūlana kūlohelohe i ke kumu. Mālama ʻia kēia ʻokiʻoki no ka poʻe i pilikia i ka nalo ʻana o ka ʻike ma muli o ke kaomi ʻana i ke aʻalolo optic a i ʻole nā ​​​​mea lapaʻau ʻē aʻe i hana ʻole.

Ka pale ʻana i ka maʻi o Basedow i nā pākeke ma ka home

He mea paʻakikī ke wānana i ka ulu ʻana o ka maʻi ma mua. Akā aia kekahi mau hana e hōʻemi i nā pilikia o ka hoʻopiʻi a me ka holomua o ka hyperthyroidism.

Inā ʻike ʻia ka maʻi o Graves, e hoʻoholo i ka pono o ka noʻonoʻo a me ke kino.

ʻO ka meaʻai kūpono a me ka hoʻoikaika kino hiki ke hoʻomaikaʻi i kekahi mau hōʻailona i ka wā o ka mālama ʻana a kōkua iā ʻoe e ʻoi aku ka maikaʻi ma ka holoʻokoʻa. No ka laʻana, no ka mālama ʻana o ka thyroid gland i ka metabolism, hiki i ka hyperthyroidism ke lilo i piha a palupalu ma hope o ka hoʻoponopono ʻana i ka hyperthyroidism, a hiki i ka hoʻoikaika kino ke kōkua i ka mālama ʻana i ka nui o ka iwi a me ke kaumaha.

ʻO ka hōʻemi kaumaha He mea maikaʻi paha ia no ka mea hiki ke hoʻonui a hoʻonui paha i ka maʻi Graves. ʻO nā mele leʻaleʻa, kahi ʻauʻau mehana a i ʻole ka hele wāwae e kōkua iā ʻoe e hoʻomaha a hoʻomaikaʻi i kou ʻano.

Hoole i na hana ino – mai puhi. Hoʻonui ka puhi paka i ka ophthalmopathy o Graves. Inā pili ka maʻi i kou ʻili (dermopathy), e hoʻohana i ka ʻaila a i ʻole ka ʻaila i loaʻa ka hydrocortisone e hoʻomaha ai i ka pehu a me ka ʻulaʻula. Eia kekahi, hiki ke kōkua i ka hoʻopili ʻana i nā wāwae.

Nā nīnau a me nā pane kaulana

Nā nīnau e pili ana i ka maʻi o Basedow, ua kūkākūkā mākou me ke kauka maʻamau, endoscopist, ke poʻo o ke keʻena hoʻonohonoho a me ke ʻano hana ʻo Lidia Golubenko.