{"id":20888,"date":"2023-04-18T14:03:43","date_gmt":"2023-04-18T07:03:43","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20888"},"modified":"2023-04-18T14:34:35","modified_gmt":"2023-04-18T07:34:35","slug":"cac-phuong-phap-dieu-tri-benh-basedow","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/cac-phuong-phap-dieu-tri-benh-basedow\/","title":{"rendered":"C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh basedow"},"content":{"rendered":"<p><strong>B\u1ec7nh Basedow, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 b\u1ec7nh Graves, l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tuy\u1ebfn gi\u00e1p t\u1ef1 mi\u1ec5n, trong \u0111\u00f3 tuy\u1ebfn gi\u00e1p s\u1ea3n xu\u1ea5t qu\u00e1 nhi\u1ec1u hormone gi\u00e1p. B\u1ec7nh c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea3 nam v\u00e0 n\u1eef, nh\u01b0ng ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ph\u1ee5 n\u1eef. B\u1ec7nh n\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 20 \u0111\u1ebfn 40 v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n k\u1ecbp th\u1eddi. Trong b\u00e0i vi\u1ebft n\u00e0y, ch\u00fang ta s\u1ebd t\u00ecm hi\u1ec3u ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh Basedow. Vi\u1ec7c hi\u1ec3u r\u00f5 v\u1ec1 b\u1ec7nh n\u00e0y s\u1ebd gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u00ecm ki\u1ebfm s\u1ef1 h\u1ed7 tr\u1ee3 y t\u1ebf k\u1ecbp th\u1eddi v\u00e0 qu\u1ea3n l\u00fd b\u1ec7nh t\u1ed1t h\u01a1n.<\/strong><\/p>\n<figure style=\"width: 777px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/i.imgur.com\/Rg5Ukjq.png\" alt=\"Minh ho\u1ea1 b\u1ec7nh Basedow\" width=\"777\" height=\"619\" \/><figcaption class=\"wp-caption-text\">Minh ho\u1ea1 b\u1ec7nh Basedow<\/figcaption><\/figure>\n<h2><strong>1. T\u1ed5ng quan c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb basedow<\/strong><\/h2>\n<p><strong>1.1. Thu\u1ed1c kh\u00e1ng gi\u00e1p (ATD)<\/strong><\/p>\n<ul>\n<li>Nh\u00f3m Thiouracil<\/li>\n<li>Nh\u00f3m Imidazole<\/li>\n<\/ul>\n<p><strong>1.2. Iode ph\u00f3ng x\u1ea1 (RAI)<\/strong><\/p>\n<p>IODE 131<\/p>\n<p><strong>1.3. Ph\u1eabu thu\u1eadt (Tx)<\/strong><\/p>\n<p><strong>2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/strong><\/p>\n<p><strong>2.1. Thu\u1ed1c kh\u00e1ng gi\u00e1p (thionamides)\u00a0<\/strong><\/p>\n<ul>\n<li><strong>C\u01a1 ch\u1ebf<\/strong>: \u1ee8c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng peroxidase tuy\u1ebfn gi\u00e1p, l\u00e0m gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh iodide. Propylthiouracil (PTU) li\u1ec1u cao c\u0169ng \u1ee9c ch\u1ebf chuy\u1ec3n \u0111\u1ed5i T4 th\u00e0nh T3 \u1edf ngo\u1ea1i vi th\u00edch h\u1ee3p \u0111\u1ec3 gi\u1ea3m nhanh hormone gi\u00e1p.<\/li>\n<\/ul>\n<p>\u0110\u00e2y l\u00e0 <strong><u>ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean<\/u><\/strong> c\u1ee7a Graves disease (GD), \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng tr\u1ebb tu\u1ed5i v\u00e0 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb GD ng\u1eafn h\u1ea1n <strong><u>tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng RAI ho\u1eb7c <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/anh-huong-co-gap-sau-khi-cat-bo-tuyen-giap\/\">c\u1eaft b\u1ecf tuy\u1ebfn gi\u00e1p<\/a><\/u><\/strong><\/p>\n<ul>\n<li><strong>\u01afu \u0111i\u1ec3m:\u00a0<\/strong><\/li>\n<\/ul>\n<p>Tr\u00e1nh \u0111\u01b0\u1ee3c nguy c\u01a1 suy gi\u00e1p v\u0129nh vi\u1ec5n<\/p>\n<p>Kh\u00f4ng c\u00f3 nguy c\u01a1 ti\u1ebfp x\u00fac tia x\u1ea1<\/p>\n<ul>\n<li><strong>Nh\u01b0\u1ee3c \u0111i\u1ec3m:\u00a0<\/strong><\/li>\n<\/ul>\n<p>T\u1ef7 l\u1ec7 t\u00e1i ph\u00e1t cao: T\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t r\u1ea5t cao sau khi ng\u1eebng thu\u1ed1c: 50-60% trong v\u00f2ng 1 n\u0103m.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb t\u1ea1m th\u1eddi tr\u01b0\u1edbc ph\u1eabu thu\u1eadt<\/p>\n<p><strong>&#8211; C\u00e1c thu\u1ed1c d\u00f9ng c\u1ee5 th\u1ec3<\/strong><\/p>\n<p><strong><u>Methimazole (MMI) &amp; Carbimazole (CBZ)<\/u><\/strong><\/p>\n<ul>\n<li>MMI (CBZ) <strong>n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho m\u1ecdi b\u1ec7nh nh\u00e2n kh\u00f4ng mang thai\u00a0<\/strong><\/li>\n<li>Ch\u1ec9 c\u1ea7n u\u1ed1ng<strong> m\u1ed9t l\u1ea7n\/ng\u00e0y<\/strong><\/li>\n<li>Khi methimazole \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u &lt; 20 mg\/ng\u00e0y, <strong>m\u1ea5t b\u1ea1ch c\u1ea7u trung t\u00ednh \u00edt g\u1eb7p h\u01a1n<\/strong><\/li>\n<\/ul>\n<p>L\u01b0u \u00fd: M\u1ed9t s\u1ed1 hi\u1ebfm c\u00e1c tr\u01b0\u1eddng h\u1ee3p methimazole c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c d\u1ecb t\u1eadt tr\u00ean da \u0111\u1ea7u v\u00e0 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 v\u1edbi b\u1ec7nh ph\u00f4i thai hi\u1ebfm. N\u00ean <strong>kh\u00f4ng d\u00f9ng MMI trong 3 th\u00e1ng \u0111\u1ea7u thai k\u1ef3<\/strong><\/p>\n<p><strong><u>Propylthiouracil (PTU)<\/u><\/strong><\/p>\n<ul>\n<li>Hi\u1ec7n nay ch\u1ec9 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t (v\u00ed d\u1ee5 nh\u01b0 <strong>trong ba th\u00e1ng th\u1ee9 nh\u1ea5t c\u1ee7a thai k\u1ef3, trong c\u01a1n b\u00e3o gi\u00e1p<\/strong>)<\/li>\n<li>PTU ph\u1ea3i d\u00f9ng <strong>2-3 l\u1ea7n\/ng\u00e0y<\/strong><\/li>\n<li><strong>S\u1ef1 m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ea5t k\u1ef3 li\u1ec1u l\u01b0\u1ee3ng n\u00e0o<\/strong><\/li>\n<\/ul>\n<p>Propylthiouracil \u0111\u01b0\u1ee3c \u01b0u ti\u00ean d\u00f9ng \u0111\u1ec3 <strong>\u0111i\u1ec1u tr\u1ecb c\u01a1n b\u00e3o gi\u00e1p<\/strong><\/p>\n<p><strong>T\u00e1c d\u1ee5ng ph\u1ee5<\/strong><\/p>\n<ul>\n<li>1-5%: <strong>m\u1ec1 \u0111ay (th\u01b0\u1eddng g\u1eb7p nh\u1ea5t)<\/strong>, n\u1ed5i ban, \u0111au kh\u1edbp, vi\u00eam \u0111a kh\u1edbp, s\u1ed1t, gi\u1ea3m BC nh\u1eb9 tho\u00e1ng qua -&gt; T\u1ef1 bi\u1ebfn m\u1ea5t d\u00f9 ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb, c\u00f3 th\u1ec3 d\u00f9ng th\u00eam kh\u00e1ng histamin<\/li>\n<\/ul>\n<ul>\n<li>R\u1ea5t hi\u1ebfm (&lt;0,1%)<\/li>\n<li>Thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n (<strong>PTU<\/strong>, CBZ)<\/li>\n<li>Gi\u1ea3m ti\u1ec3u c\u1ea7u (<strong>PTU<\/strong>, CBZ)<\/li>\n<li>Vi\u00eam m\u1ea1ch gi\u1ed1ng lupus (<strong>PTU<\/strong>)<\/li>\n<li>Vi\u00eam gan (<strong>PTU<\/strong>)<\/li>\n<li>H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft (kh\u00e1ng insulin; <strong>PTU<\/strong>)<\/li>\n<li>V\u00e0ng da \u1ee9 m\u1eadt (CBZ\/MMI)<\/li>\n<li><strong>Gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t trung t\u00ednh<\/strong> (&lt;500\/mm3) (n\u1eb7ng nh\u1ea5t) . H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u1ea5t BC h\u1ea1t \u0111\u1ec1u x\u1ea3y ra trong v\u00f2ng <strong>90 ng\u00e0y \u0111\u1ea7u<\/strong>, m\u1eb7c d\u00f9 bi\u1ebfn ch\u1ee9ng n\u00e0y v\u1eabn c\u00f3 th\u1ec3 x\u1ea3y ra sau 1 n\u0103m ho\u1eb7c h\u01a1n n\u1eefa.\u00a0 Th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i. Bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p c\u1ee7a bi\u1ebfn ch\u1ee9ng n\u00e0y l\u00e0 <strong>s\u1ed1t v\u00e0 \u0111au h\u1ecdng, lo\u00e9t mi\u1ec7ng<\/strong><\/li>\n<\/ul>\n<p>-&gt; C\u1ea7n ng\u01b0ng thu\u1ed1c kh\u00e1ng gi\u00e1p v\u00e0 d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng nh\u01b0 thu\u1ed1c k\u00edch th\u00edch t\u1ee7y x\u01b0\u01a1ng h\u1ed3i ph\u1ee5c.<\/p>\n<p>-&gt; B\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 chuy\u1ec3n sang c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng gi\u00e1p kh\u00e1c; c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c li\u1ec7u ph\u00e1p kh\u00e1c (nh\u01b0 i\u1ed1t ph\u00f3ng x\u1ea1, ph\u1eabu thu\u1eadt).<\/p>\n<p><strong>2.2. Iode ph\u00f3ng x\u1ea1 (RAI)<\/strong><\/p>\n<ul>\n<li><strong>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng iod ph\u00f3ng x\u1ea1 (I 131) nh\u1eb1m m\u1ee5c \u0111\u00edch ph\u00e1 h\u1ee7y nhu m\u00f4 gi\u00e1p ho\u1eb7c nh\u1eefng v\u00f9ng tuy\u1ebfn gi\u00e1p t\u0103ng ho\u1ea1t\u00a0<\/strong><\/li>\n<\/ul>\n<table style=\"height: 335px;\" width=\"944\">\n<tbody>\n<tr>\n<td>&nbsp;<\/p>\n<p><strong>\u01afu \u0111i\u1ec3m<\/strong><\/td>\n<td><strong>Nh\u01b0\u1ee3c \u0111i\u1ec3m<\/strong><\/td>\n<\/tr>\n<tr>\n<td>-L\u00e0nh b\u1ec7nh m\u1ed9t c\u00e1ch ho\u00e0n to\u00e0n<\/td>\n<td>-C\u00f3 th\u1ec3 b\u1ecb suy gi\u00e1p m\u1ed9t c\u00e1ch v\u0129nh vi\u1ec5n<\/p>\n<p>-B\u1ec7nh nh\u00e2n ph\u1ea3i u\u1ed1ng ph\u00f3ng x\u1ea1, ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e1ch ly m\u1ed9t v\u00e0i ng\u00e0y sau \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>-Kh\u00f4ng d\u00f9ng cho tr\u1ebb nh\u1ecf v\u00e0 ph\u1ee5 n\u1eef c\u00f3 thai<\/p>\n<p>-C\u00f3 nguy c\u01a1 nhi\u1ec5m ph\u00f3ng x\u1ea1\u2026<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>*Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 tai bi\u1ebfn c\u1ee7a \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa (ATD), t\u00e1i ph\u00e1t sau \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa, c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa (v\u00ed d\u1ee5 suy tim n\u1eb7ng)<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 b\u01b0\u1edbu nh\u00e2n \u0111\u1ed9c tuy\u1ebfn gi\u00e1p.<\/p>\n<p><strong>*Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n<p>Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 \u0111ang cho con b\u00fa<\/p>\n<p>B\u1ec7nh l\u00fd m\u1eaft m\u1ee9c \u0111\u1ed9 n\u1eb7ng l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a Iod ph\u00f3ng x\u1ea1<\/p>\n<p><strong>*Chu\u1ea9n b\u1ecb ng\u01b0\u1eddi b\u1ec7nh<\/strong><\/p>\n<ul>\n<li>C\u00e2n nh\u1eafc s\u1eed d\u1ee5ng ch\u1eb9n \u03b2 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c gi\u00e1p (l\u1edbn tu\u1ed5i ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed1i h\u1ee3p) m\u1eb7c d\u00f9 kh\u00f4ng tri\u1ec7u ch\u1ee9ng, v\u00ec RAI c\u00f3 th\u1ec3 g\u00e2y b\u1ed9c ph\u00e1t c\u01a1n c\u01b0\u1eddng gi\u00e1p c\u1ea5p tho\u00e1ng qua<\/li>\n<li>Nh\u1eefng ph\u1ee5 n\u1eef nghi c\u00f3 thai n\u00ean th\u1eed thai trong v\u00f2ng 48h tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb RAI.<\/li>\n<li>C\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u c\u00e1c b\u1ec7nh l\u00fd k\u00e8m tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb RAI<\/li>\n<li>S\u1eed d\u1ee5ng thu\u1ed1c ATD \u0111\u1ec3 b\u1ec7nh gi\u1ea3m ho\u1eb7c \u0111\u1ea1t b\u00ecnh gi\u00e1p<\/li>\n<li>Ng\u1eebng ATD 5-7 ng\u00e0y, sau \u0111\u00f3 \u0111o \u0111\u1ed9 t\u1eadp trung Iod \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec1u x\u1ea1.<\/li>\n<li>Ng\u1eebng s\u1eed d\u1ee5ng lod ho\u1eb7c c\u00e1c d\u1eabn ch\u1ea5t lod tr\u01b0\u1edbc 2-3 tu\u1ea7n.<\/li>\n<\/ul>\n<p><strong>Li\u1ec1u l\u01b0\u1ee3ng, c\u00e1ch d\u00f9ng:<\/strong> T\u00f9y thu\u1ed9c k\u00edch th\u01b0\u1edbc tuy\u1ebfn gi\u00e1p, kh\u1ea3 n\u0103ng b\u1eaft gi\u1eef Iod ph\u00f3ng x\u1ea1 24h<\/p>\n<p><strong>Li\u1ec1u (mCi)=Tr\u1ecdng l\u01b0\u1ee3ng TG (g) x li\u1ec1u d\u1ef1 tr\u00f9 (\u00b5Ci\/g)\/\u0111\u1ed9 t\u1eadp trung ph\u00f3ng x\u1ea1 24h<\/strong><\/p>\n<p><em>*L\u01b0u \u00fd:<\/em><\/p>\n<ul>\n<li>Li\u1ec1u d\u1ef1 tr\u00f9 thay \u0111\u1ed5i t\u1eeb 150 &#8211; 200 \u00b5Ci\/g tuy\u1ebfn gi\u00e1p.<\/li>\n<li>Hi\u1ec7u qu\u1ea3 c\u1ee7a Iod ph\u00f3ng x\u1ea1 ch\u1ec9 xu\u1ea5t hi\u1ec7n sau v\u00e0i th\u00e1ng do \u0111\u00f3 d\u00f9ng kh\u00e1ng gi\u00e1p 2 tu\u1ea7n sau \u0111i\u1ec1u tr\u1ecb r\u1ed3i gi\u1ea3m li\u1ec1u d\u1ea7n.<\/li>\n<\/ul>\n<p><strong>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n:<\/strong><\/p>\n<ul>\n<li>L\u00e0m tr\u1ea7m tr\u1ecdng b\u1ec7nh l\u00fd m\u1eaft m\u1ee9c \u0111\u1ed9 nh\u1eb9, v\u1eeba: x\u1ea3y ra sau v\u00e0i th\u00e1ng, c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid ng\u1eafn h\u1ea1n<\/li>\n<li>Vi\u00eam tuy\u1ebfn gi\u00e1p c\u1ea5p do ph\u00f3ng x\u1ea1: Th\u01b0\u1eddng t\u1ef1 gi\u1edbi h\u1ea1n, x\u1ea3y ra trong v\u00f2ng 3-4 ng\u00e0y sau u\u1ed1ng thu\u1ed1c ph\u00f3ng x\u1ea1, c\u00f3 th\u1ec3 d\u00f9ng kh\u00e1ng vi\u00eam.<\/li>\n<li>B\u1ed9c ph\u00e1t nhi\u1ec5m \u0111\u1ed9c gi\u00e1p sau v\u00e0i tu\u1ea7n \u0111i\u1ec1u tri do nhu m\u00f4 b\u1ecb ph\u00e1 h\u1ee7y, do ph\u00f3ng th\u00edch hormon gi\u00e1p d\u1ef1 tr\u1eef. Ng\u0103n ng\u1eeba c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Thionamid v\u00e0i th\u00e1ng tr\u01b0\u1edbc v\u00e0 ng\u1eebng 3-8 ng\u00e0y\u00a0 tr\u01b0\u1edbc s\u1eed d\u1ee5ng ph\u00f3ng x\u1ea1.<\/li>\n<li>C\u00f3 th\u1ec3 g\u00e2y ung th\u01b0<\/li>\n<\/ul>\n<p><strong>2.3. Ph\u1eabu thu\u1eadt<\/strong><\/p>\n<p><strong>Chu\u1ea9n b\u1ecb ng\u01b0\u1eddi b\u1ec7nh<\/strong><\/p>\n<ul>\n<li><strong>\u0110i\u1ec1u tr\u1ecb Thionamid sau 2-3 th\u00e1ng \u0111\u01b0a v\u1ec1 b\u00ecnh gi\u00e1p<\/strong><\/li>\n<\/ul>\n<p>Iod: dung d\u1ecbch Lugon 1% li\u1ec1u 30-60 gi\u1ecdt\/ ng\u00e0y, 2-3 tu\u1ea7n tr\u01b0\u1edbc m\u1ed5<\/p>\n<p>Corticoid 20-30mg\/ng\u00e0y tr\u01b0\u1edbc ph\u1eabu thu\u1eadt 1-2 tu\u1ea7n<\/p>\n<p>D\u1eebng propranolol 7-10 ng\u00e0y<\/p>\n<p>\u0110\u00e1nh gi\u00e1 Calci v\u00e0 25-hydroxy vitamin D tr\u01b0\u1edbc ph\u1eabu thu\u1eadt v\u00e0 x\u00e9t nghi\u1ec7m d\u1ef1 ph\u00f2ng h\u1ea1 Ca-vitD<\/p>\n<p>C\u00e2n nh\u1eafc b\u1ed5 sung Calcitriol tr\u01b0\u1edbc ph\u1eabu thu\u1eadt.<\/p>\n<ul>\n<li><strong>Tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt kh\u1ea9n c\u1ea5p:<\/strong> \u0111i\u1ec1u tr\u1ecb nh\u01b0 v\u1edbi c\u01a1n b\u00e3o gi\u00e1p tr\u01b0\u1edbc ph\u1eabu thu\u1eadt<\/li>\n<\/ul>\n<p><strong>C\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng th\u1ee9c th\u1ef1c hi\u1ec7n:<\/strong><\/p>\n<ul>\n<li>C\u1eaft tuy\u1ebfn gi\u00e1p b\u00e1n ph\u1ea7n: D\u1ec5 t\u00e1i ph\u00e1t, v\u1eabn c\u00f3 t\u1ec9 l\u1ec7 suy gi\u00e1p. C\u1ea7n theo d\u00f5i l\u00e2u d\u00e0i<\/li>\n<li>C\u1eaft tuy\u1ebfn gi\u00e1p g\u1ea7n to\u00e0n ph\u1ea7n: Kh\u00f4ng can thi\u1ec7p v\u00e0o v\u00f9ng nhu m\u00f4 quanh d\u00e2y th\u1ea7n kinh qu\u1eb7t ng\u01b0\u1ee3c v\u00e0 tuy\u1ebfn c\u1eadn gi\u00e1p. Nguy c\u01a1 t\u00e1i ph\u00e1t nhi\u1ec5m \u0111\u1ed9c gi\u00e1p th\u1ea5p h\u01a1n, t\u1ec9 l\u1ec7 suy gi\u00e1p cao h\u01a1n.<\/li>\n<li>C\u1eaft tuy\u1ebfn gi\u00e1p to\u00e0n ph\u1ea7n: Suy gi\u00e1p v\u0129nh vi\u1ec5n, lo\u1ea1i b\u1ecf \u0111\u01b0\u1ee3c c\u00e1c kh\u00e1ng nguy\u00ean.<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td>&nbsp;<\/p>\n<p><strong>Ph\u01b0\u01a1ng ph\u00e1p<\/strong><\/td>\n<td><strong>D\u00f9ng thu\u1ed1c Thionamides<\/strong><\/td>\n<td><strong>D\u00f9ng iod ph\u00f3ng x\u1ea1<\/strong><\/td>\n<td><strong>Ph\u1eabu thu\u1eadt<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>\u01afu \u0111i\u1ec3m<\/strong><\/td>\n<td>-Chi ph\u00ed ban \u0111\u1ea7u r\u1ebb<\/p>\n<p>-Tr\u00e1nh \u0111\u01b0\u1ee3c nguy c\u01a1 suy gi\u00e1p v\u0129nh vi\u1ec5n<\/p>\n<p>-40% b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 tho\u00e1i tri\u1ec3n b\u1ec7nh ho\u00e0n to\u00e0n sau 1-2 n\u0103m u\u1ed1ng thu\u1ed1c<\/td>\n<td>-B\u1ec7nh nh\u00e2n s\u1ebd l\u00e0nh b\u1ec7nh m\u1ed9t c\u00e1ch ho\u00e0n to\u00e0n<\/td>\n<td>-L\u00e0nh b\u1ec7nh nhanh<\/td>\n<\/tr>\n<tr>\n<td><strong>Nh\u01b0\u1ee3c \u0111i\u1ec3m<\/strong><\/td>\n<td>-T\u1ed5ng chi ph\u00ed cao<\/p>\n<p>-Nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5:Gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t, vi\u00eam gan, d\u1ecb \u1ee9ng d\u01b0\u1edbi da<\/td>\n<td>-C\u00f3 th\u1ec3 b\u1ecb suy gi\u00e1p m\u1ed9t c\u00e1ch v\u0129nh vi\u1ec5n<\/p>\n<p>-B\u1ec7nh nh\u00e2n ph\u1ea3i u\u1ed1ng ph\u00f3ng x\u1ea1, ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e1ch ly m\u1ed9t v\u00e0i ng\u00e0y sau \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>-Kh\u00f4ng d\u00f9ng cho tr\u1ebb nh\u1ecf v\u00e0 ph\u1ee5 n\u1eef c\u00f3 thai<\/p>\n<p>-C\u00f3 nguy c\u01a1 nhi\u1ec5m ph\u00f3ng x\u1ea1\u2026<\/td>\n<td>-C\u00f3 nguy c\u01a1 suy gi\u00e1p v\u0129nh vi\u1ec5n<\/p>\n<p>-C\u1eaft nh\u1ea7m tuy\u1ebfn c\u1eadn gi\u00e1p, d\u00e2y th\u1ea7n kinh thanh qu\u1ea3n qu\u1eb7t ng\u01b0\u1ee3c<\/p>\n<p>-Chi ph\u00ed cao<\/p>\n<p>-T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c g\u00e2y m\u00ea<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Ngu\u1ed3n tham kh\u1ea3o:<\/strong><\/p>\n<ul>\n<li>Grave\u2019s Disease \u2013 MIMS<\/li>\n<li>H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh n\u1ed9i ti\u1ebft chuy\u1ec3n h\u00f3a B\u1ed9 Y T\u1ebf 2015<\/li>\n<li>2018 European Thyroid Association Guideline for the Management of Graves Hyperthyroidism<\/li>\n<li>Gi\u00e1o tr\u00ecnh n\u1ed9i b\u1ec7nh l\u00fd \u0110\u1ea1i h\u1ecdc Y d\u01b0\u1ee3c Hu\u1ebf<\/li>\n<li>C\u1eadp nh\u1eadt ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ed9i khoa 2022<\/li>\n<li>2022 European Thyroid Association Guideline for the management of pediatric Graves\u2019 disease<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh Basedow, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 b\u1ec7nh Graves, l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tuy\u1ebfn gi\u00e1p t\u1ef1 mi\u1ec5n, trong \u0111\u00f3 tuy\u1ebfn gi\u00e1p s\u1ea3n xu\u1ea5t qu\u00e1 nhi\u1ec1u hormone gi\u00e1p. B\u1ec7nh c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u1ea3 nam v\u00e0 n\u1eef, nh\u01b0ng ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ph\u1ee5 n\u1eef. B\u1ec7nh n\u00e0y th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 20 \u0111\u1ebfn 40 [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh basedow - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh Basedow, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 b\u1ec7nh Graves, l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd tuy\u1ebfn gi\u00e1p t\u1ef1 mi\u1ec5n, trong \u0111\u00f3 tuy\u1ebfn gi\u00e1p s\u1ea3n xu\u1ea5t qu\u00e1 nhi\u1ec1u hormone gi\u00e1p.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh basedow - 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