{"id":2616,"date":"2023-04-09T15:16:28","date_gmt":"2023-04-09T08:16:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=2616"},"modified":"2023-04-17T10:04:06","modified_gmt":"2023-04-17T03:04:06","slug":"cuong-giap-va-nhiem-doc-giap-chan-doan-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/09\/cuong-giap-va-nhiem-doc-giap-chan-doan-dieu-tri\/","title":{"rendered":"C\u01b0\u1eddng gi\u00e1p v\u00e0 nhi\u1ec5m \u0111\u1ed9c gi\u00e1p: ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb."},"content":{"rendered":"

Ti\u1ebfp c\u1eadn nhi\u1ec5m \u0111\u1ed9c gi\u00e1p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n ng\u01b0\u1eddi ta chia ra 2 nh\u00f3m: nguy\u00ean nh\u00e2n t\u1ea1i tuy\u1ebfn gi\u00e1p v\u00e0 ngo\u00e0i tuy\u1ebfn gi\u00e1p. Nh\u00f3m t\u1ea1i tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 do t\u0103ng b\u00e0i ti\u1ebft hormon gi\u00e1p (c\u01b0\u1eddng gi\u00e1p) ho\u1eb7c gi\u1ea3i ph\u00f3ng c\u00e1c hormon \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t do ph\u00e1 h\u1ee7y m\u00f4 tuy\u1ebfn gi\u00e1p (nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do ph\u00e1 h\u1ee7y). Nh\u00f3m th\u1ee9 2 g\u1ed3m nhi\u1ec1u r\u1ed1i lo\u1ea1n kh\u00e1c nhau, tuy\u1ebfn gi\u00e1p kh\u00f4ng ph\u1ea3i nguy\u00ean nh\u00e2n. \u0110\u1ec3 ph\u00e2n bi\u1ec7t, ng\u01b0\u1eddi ta d\u1ef1a v\u00e0o \u0111o h\u1ea5p th\u1ee5 iod ph\u00f3ng x\u1ea1 (RAIU), h\u1ea5p th\u1ee5 cao trong c\u01b0\u1eddng gi\u00e1p v\u00e0 th\u1ea5p trong nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do ph\u00e1 h\u1ee7y ho\u1eb7c ngo\u00e0i tuy\u1ebfn gi\u00e1p.<\/strong><\/p>\n

1. T\u1ed5ng quan v\u1ec1 nhi\u1ec5m \u0111\u1ed9c gi\u00e1p v\u00e0 c\u01b0\u1eddng gi\u00e1p.<\/strong><\/h2>\n

Theo Oxford textbook of endocrinology, thu\u1eadt ng\u1eef nhi\u1ec5m \u0111\u1ed9c gi\u00e1p l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng g\u00e2y ra do t\u0103ng n\u1ed3ng \u0111\u1ed9 free thyroxine(fT4), free triiodothyronine (fT3), ho\u1eb7c c\u1ea3 hai. Thu\u1eadt ng\u1eef c\u01b0\u1eddng gi\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ec9 s\u1ef1 t\u0103ng t\u1ed5ng h\u1ee3p v\u00e0 b\u00e0i ti\u1ebft hormon gi\u00e1p t\u1ea1i tuy\u1ebfn gi\u00e1p, trong \u0111\u00f3 Basedow (b\u1ec7nh Grave\u2019s) l\u00e0 b\u1ec7nh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y nhi\u1ec5m \u0111\u1ed9c gi\u00e1p nh\u01b0 vi\u00eam gi\u00e1p (ph\u00e1 h\u1ee7y m\u00f4 tuy\u1ebfn gi\u00e1p), d\u00f9ng qu\u00e1 li\u1ec1u hormon gi\u00e1p ho\u1eb7c b\u00e0i ti\u1ebft hormon gi\u00e1p ngo\u00e0i tuy\u1ebfn gi\u00e1p.
\nTi\u1ebfp c\u1eadn nhi\u1ec5m \u0111\u1ed9c gi\u00e1p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n ng\u01b0\u1eddi ta chia ra 2 nh\u00f3m: nguy\u00ean nh\u00e2n t\u1ea1i tuy\u1ebfn gi\u00e1p v\u00e0 ngo\u00e0i tuy\u1ebfn gi\u00e1p. Nh\u00f3m t\u1ea1i tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 do t\u0103ng b\u00e0i ti\u1ebft hormon gi\u00e1p (c\u01b0\u1eddng gi\u00e1p) ho\u1eb7c gi\u1ea3i ph\u00f3ng c\u00e1c hormon \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t do ph\u00e1 h\u1ee7y m\u00f4 tuy\u1ebfn gi\u00e1p (nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do ph\u00e1 h\u1ee7y). Nh\u00f3m th\u1ee9 2 g\u1ed3m nhi\u1ec1u r\u1ed1i lo\u1ea1n kh\u00e1c nhau, tuy\u1ebfn gi\u00e1p kh\u00f4ng ph\u1ea3i nguy\u00ean nh\u00e2n. \u0110\u1ec3 ph\u00e2n bi\u1ec7t, ng\u01b0\u1eddi ta d\u1ef1a v\u00e0o \u0111o h\u1ea5p th\u1ee5 iod ph\u00f3ng x\u1ea1 (RAIU), h\u1ea5p th\u1ee5 cao trong c\u01b0\u1eddng gi\u00e1p v\u00e0 th\u1ea5p trong nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do ph\u00e1 h\u1ee7y ho\u1eb7c ngo\u00e0i tuy\u1ebfn gi\u00e1p.<\/p>\n

2. L\u00e2m s\u00e0ng<\/strong><\/h2>\n

2.1. Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p d\u1ef1a v\u00e0o bi\u1ec3u hi\u1ec7n t\u1ea1i c\u00e1c c\u01a1 quan<\/strong><\/h2>\n

– To\u00e0n th\u00e2n: kh\u00f4ng ch\u1ecbu \u0111\u01b0\u1ee3c n\u00f3ng, s\u1ee5t c\u00e2n, m\u1ec7t m\u1ecfi, m\u1ea5t ng\u1ee7, lo l\u1eafng, run tay.
\n– Da: m\u1ecfng, \u1ea5m, \u1ea9m \u01b0\u1edbt, t\u0103ng s\u1eafc t\u1ed1, t\u0103ng ti\u1ebft m\u1ed3 h\u00f4i. M\u00f3ng: d\u1ea5u hi\u1ec7u t\u00e1ch m\u00f3ng. T\u00f3c: m\u1ecbn, th\u1eb3ng, ng\u1ee9a.
\n– M\u1eaft: l\u1ed3i m\u1eaft, ph\u00f9 mi, d\u1ea5u lid lag, globe lag, ph\u00f9 k\u1ebft m\u1ea1c, li\u1ec7t v\u1eadn nh\u00e3n, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh th\u1ecb.
\n– T\u00e2m th\u1ea7n: k\u00edch th\u00edch, b\u1ed3n ch\u1ed3n, lo l\u1eafng, m\u1ea5t t\u1eadp trung, tr\u1ea7m c\u1ea3m.
\n– Th\u1ea7n kinh: ng\u1ea5t, s\u1ea3ng, l\u01a1 m\u01a1, h\u00f4n m\u00ea, m\u00faa gi\u1eadt \u2013 m\u00faa v\u1eddn.
\n– Tim m\u1ea1ch: nh\u1ecbp tim nhanh, hi\u1ec7u \u00e1p t\u00e2m thu t\u00e2m tr\u01b0\u01a1ng l\u1edbn,<\/strong> m\u1ea1ch d\u1ed9i. \u0110\u00f4i khi c\u00f3 tim to, tri\u1ec7u ch\u1ee9ng suy tim sung huy\u1ebft, \u0111au th\u1eaft ng\u1ef1c, nhanh k\u1ecbch ph\u00e1t ho\u1eb7c rung nh\u0129.
\n– H\u00f4 h\u1ea5p: kh\u00f3 th\u1edf.
\n– Ti\u00eau h\u00f3a: \u0103n nhi\u1ec1u, kh\u00e1t nhi\u1ec1u, ti\u00eau ch\u1ea3y\/\u0111i ti\u00eau nhi\u1ec1u l\u1ea7n.
\n– Th\u1ea7n kinh c\u01a1: run tay, t\u0103ng ph\u1ea3n x\u1ea1, y\u1ebfu c\u01a1 g\u1ed1c chi, teo c\u01a1, b\u1ec7nh c\u01a1, li\u1ec7t chu k\u1ef3.
\n– Chuy\u1ec3n h\u00f3a: t\u0103ng calci m\u00e1u, gi\u1ea3m magnesium, t\u0103ng alkaline phosphotase, calci ni\u1ec7u.
\n– X\u01b0\u01a1ng: thi\u1ebfu x\u01b0\u01a1ng, lo\u00e3ng x\u01b0\u01a1ng.
\n– Sinh d\u1ee5c: kinh kh\u00f4ng \u0111\u1ec1u, v\u00f4 kinh, v\u00fa to \u1edf nam, gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ee5 tinh.
\n– Huy\u1ebft h\u1ecdc: thi\u1ebfu m\u00e1u (th\u01b0\u1eddng \u0111\u1eb3ng s\u1eafc, \u0111\u1eb3ng b\u00e0o), t\u0103ng lympho, l\u00e1ch to, h\u1ea1ch to.
\nNg\u01b0\u1eddi cao tu\u1ed5i th\u01b0\u1eddng c\u00f3 \u00edt tri\u1ec7u ch\u1ee9ng do t\u0103ng ho\u1ea1t giao c\u1ea3m m\u00e0 c\u00f3 nhi\u1ec1u tri\u1ec7u ch\u1ee9ng suy ch\u1ee9c n\u0103ng h\u1ec7 tim m\u1ea1ch h\u01a1n. B\u1ec7nh nh\u00e2n c\u01b0\u1eddng gi\u00e1p th\u1ec3 th\u1edd \u01a1 (apathetic hyperthyroidism) kh\u00f4ng c\u00f3 h\u1ea7u h\u1ebft c\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p.
\nNhi\u1ec5m \u0111\u1ed9c gi\u00e1p c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi r\u1ed1i lo\u1ea1n lo \u1ea5u, u t\u1ee7y th\u01b0\u1ee3ng th\u1eadn, lo\u1ea1n sinh t\u1ee7y v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.
\n\u0110\u1ee9ng tr\u01b0\u1edbc m\u1ed9t b\u1ec7nh nh\u00e2n nhi\u1ec5m \u0111\u1ed9c gi\u00e1p c\u1ea7n \u0111\u00e1nh gi\u00e1 nguy c\u01a1 xu\u1ea5t hi\u1ec7n m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa \u2013 c\u01a1n b\u00e3o gi\u00e1p<\/a>, d\u1ef1a v\u00e0o thang \u0111i\u1ec3m Burch \u2013 Wartofsky 1993.<\/p>\n

2.2. Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng c\u01b0\u1eddng gi\u00e1p:<\/strong><\/h2>\n

2.2.1. B\u1ec7nh Basedow:<\/strong><\/em><\/p>\n

– L\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a c\u01b0\u1eddng gi\u00e1p, chi\u1ebfm 70% \u1edf ra kh\u00e1ng th\u1ec3 kh\u00e1ng receptor TSH, t\u1ef1 kh\u00e1ng th\u1ec3 n\u00e0y g\u00e2y ho\u1ea1t t\u00ednh gi\u1ed1ng TSH l\u00ean th\u1ee5 th\u1ec3 c\u1ee7a t\u1ebf n\u00e0o nang (TSHR) g\u00e2y c\u01b0\u1eddng gi\u00e1p.<\/p>\n

– Do ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ef1 kh\u00e1ng th\u1ec3, tuy\u1ebfn gi\u00e1p to (b\u01b0\u1edbu gi\u00e1p) l\u00e0 bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng c\u1ee7a c\u01b0\u1eddng b\u1ec7nh. C\u00f3 \u1edf kho\u1ea3ng 80% c\u00e1c BN Basedow, th\u01b0\u1eddng l\u00e0 b\u01b0\u1edbu \u0111\u1ed9 II, lan to\u1ea3, m\u1eadt \u0111\u1ed9\u00a0\u00a0c\u00e1c v\u00f9ng \u0111\u1ee7 iod, t\u1ec9 l\u1ec7 m\u1eafc c\u00f3 th\u1ec3 t\u1edbi 2% \u1edf ph\u1ee5 n\u1eef.<\/p>\n

– Trong b\u1ec7nh Basedow, ph\u1ea3n \u1ee9ng t\u1ef1 mi\u1ec5n t\u1ea1i tuy\u1ebfn gi\u00e1p t\u1ea1om\u1ec1m ho\u1eb7c ch\u1eafc, di \u0111\u1ed9ng khi nu\u1ed1t. B\u01b0\u1edbu gi\u00e1p trong Basedow l\u00e0 b\u01b0\u1edbu m\u1ea1ch n\u00ean c\u00f3 th\u1ec3 s\u1edd th\u1ea5y rung miu v\u00e0\/ ho\u1eb7c nghe th\u1ea5y ti\u1ebfng th\u1ed5i t\u00e2m thu ho\u1eb7c th\u1ed5i li\u00ean t\u1ee5c.<\/p>\n

– B\u1ec7nh m\u1eaft n\u1ed9i ti\u1ebft: chi\u1ebfm 30 \u2013 45% b\u1ec7nh nh\u00e2n basedow, Th\u01b0\u1eddng t\u1ed5n th\u01b0\u01a1ng xu\u1ea5t hi\u1ec7n \u1edf c\u1ea3 2 m\u1eaft nh\u01b0ng c\u00f3 10% tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 b\u1ecb \u1edf 1 b\u00ean. D\u1ea5u hi\u1ec7u \u0111i\u1ec3n h\u00ecnh: mi m\u1eaft nh\u1eafm kh\u00f4ng k\u00edn, co c\u01a1 mi tr\u00ean g\u00e2y h\u1edf khe mi, m\u1ea5t \u0111\u1ed3ng t\u00e1c gi\u1eefa nh\u00e3n c\u1ea7u v\u00e0 mi tr\u00ean (co c\u01a1 mi tr\u00ean khi m\u1eaft nh\u00ecn \u0111\u01b0a xu\u1ed1ng d\u01b0\u1edbi) v\u00e0 gi\u1ea3m h\u1ed9i t\u1ee5 nh\u00e3n c\u1ea7u g\u00e2y nh\u00ecn \u0111\u00f4i do li\u1ec7t c\u01a1 v\u1eadn nh\u00e3n.<\/p>\n

Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n:<\/em>
\n– Ph\u00e2n \u0111\u1ed9 NOSPECS c\u1ee7a ATA.
\n– Ti\u00eau chu\u1ea9n c\u1ee7a EUGOGO: thang \u0111i\u1ec3m TES g\u1ed3m CAS+SS, 0 \u2013 18 \u0111i\u1ec3m.
\n– Ti\u00eau chu\u1ea9n VISA: d\u1ef1a tr\u00ean 4 ti\u00eau ch\u00ed: V (vision), I (inflammation), S (strabimus), A (appearance).
\n+ Ph\u00f9 ni\u00eam tr\u01b0\u1edbc x\u01b0\u01a1ng ch\u00e0y: d\u1ea5u hi\u1ec7u hi\u1ebfm c\u00f3 th\u1ec3 g\u1eb7p trong basedow.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh basedow:<\/em>
\n\u2013 L\u00e2m s\u00e0ng: C\u00f3 h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p. N\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a nhi\u1ec5m \u0111\u1ed9c gi\u00e1p v\u00e0 \u00edt nh\u1ea5t 1 trong 3 tri\u1ec7u ch\u1ee9ng b\u01b0\u1edbu m\u1ea1ch, l\u1ed3i m\u1eaft v\u00e0 ph\u00f9 ni\u00eam tr\u01b0\u1edbc x\u01b0\u01a1ng ch\u00e0y th\u00ec cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh
\n\u2013 X\u00e9t nghi\u1ec7m: FT4 t\u0103ng v\u00e0 TSH gi\u1ea3m (<0.01mU\/mL). N\u1ebfu fT4 b\u00ecnh th\u01b0\u1eddng, th\u1eed fT3, fT3 t\u0103ng -> c\u01b0\u1eddng gi\u00e1p th\u1ec3 t\u0103ng T3.
\n\u2013 N\u1ed3ng \u0111\u1ed9 TSH-RAb t\u0103ng.
\n\u2013 X\u1ea1 h\u00ecnh: Tuy\u1ebfn gi\u00e1p t\u0103ng b\u1eaft gi\u1eef Iode ph\u00f3ng x\u1ea1 ho\u1eb7c Technitium.<\/p>\n

 <\/p>\n

2.2.2. B\u01b0\u1edbu gi\u00e1p \u0111a nh\u00e2n \u0111\u1ed9c v\u00e0 adenoma tuy\u1ebfn (\u0111\u01a1n nh\u00e2n) \u0111\u1ed9c:<\/em><\/strong><\/p>\n

– L\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a t\u00ecnh tr\u1ea1ng t\u1ef1 ch\u1ee7 tuy\u1ebfn gi\u00e1p: t\u1ebf b\u00e0o tuy\u1ebfn ti\u1ebft hormon kh\u00f4ng ph\u1ee5 thu\u1ed9c TSH v\u00e0 kh\u00f4ng c\u00f3 TRAb. Th\u01b0\u1eddng g\u1eb7p \u1edf v\u00f9ng thi\u1ebfu iod, chi\u1ebfm 60% tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m \u0111\u1ed9c gi\u00e1p (50% \u0111a nh\u00e2n \u0111\u1ed9c, 10% adenoma \u0111\u1ed9c), hi\u1ebfm (10%) \u1edf v\u00f9ng \u0111\u1ee7 iod.<\/p>\n

– Adenoma \u0111\u1ed9c: nh\u00e2n gi\u00e1p \u0111\u1ed9c t\u0103ng ho\u1ea1t \u0111\u1ed9ng th\u1ec3 hi\u1ec7n qua h\u1ea5p thu iod ph\u00f3ng x\u1ea1 ho\u1eb7c Tc99m khu tr\u00fa t\u1ea1i nh\u00e2n v\u00e0 gi\u1ea3m h\u1ea5p th\u1ee5 ngo\u00e0i nh\u00e2n.<\/p>\n

– \u0110a nh\u00e2n \u0111\u1ed9c: c\u00f3 nhi\u1ec1u nh\u00e2n t\u0103ng ho\u1ea1t \u0111\u1ed9ng, c\u00f3 th\u1ec3 k\u00e8m theo c\u00e1c nh\u00e2n b\u00ecnh th\u01b0\u1eddng (nh\u00e2n l\u1ea1nh tr\u00ean x\u1ea1 h\u00ecnh). Th\u01b0\u1eddng g\u1eb7p h\u01a1n adenoma \u0111\u1ed9c.<\/p>\n

– L\u00e2m s\u00e0ng: c\u00f3 bi\u1ec3u hi\u1ec7n c\u01b0\u1eddng gi\u00e1p v\u00e0\/ho\u1eb7c tri\u1ec7u ch\u1ee9ng ch\u00e8n \u00e9p do b\u01b0\u1edbu gi\u00e1p to. C\u00e1c bi\u1ec3u hi\u1ec7n kinh \u0111i\u1ec3n c\u01b0\u1eddng gi\u00e1p nh\u01b0 run tay, \u0111\u1ed5 m\u1ed3 h\u00f4i, t\u0103ng nhu \u0111\u1ed9ng g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u1ebb nhi\u1ec1u h\u01a1n; ng\u01b0\u1eddi l\u1edbn tu\u1ed5i th\u01b0\u1eddng \u00edt tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00f3 th\u1ec3 g\u1eb7p: rung nh\u0129, suy tim, ch\u00e1n \u0103n, c\u01b0\u1eddng gi\u00e1p d\u01b0\u1edbi l\u00e2m s\u00e0ng (TSH gi\u1ea3m, fT3 v\u00e0 fT4 b\u00ecnh th\u01b0\u1eddng).<\/p>\n

– TSH gi\u1ea3m, fT4, fT3 t\u0103ng ho\u1eb7c b\u00ecnh th\u01b0\u1eddng (trong c\u01b0\u1eddng gi\u00e1p d\u01b0\u1edbi l\u00e2m s\u00e0ng).
\n– Si\u00eau \u00e2m: \u0111\u00e1nh gi\u00e1 v\u1ecb tr\u00ed, k\u00edch th\u01b0\u1edbc, s\u1ed1 l\u01b0\u1ee3ng nh\u00e2n n\u00f3ng v\u00e0 h\u1ea1ch c\u1ed5 k\u00e8m theo.
\n– X\u1ea1 h\u00ecnh: nh\u00e2n n\u00f3ng t\u0103ng b\u1eaft ph\u00f3ng x\u1ea1, gi\u1ea3m \u1edf xung quanh.<\/p>\n

2.2.3 Nhi\u1ec5m \u0111\u1ed9c gi\u00e1p kh\u00f4ng c\u01b0\u1eddng gi\u00e1p:<\/strong><\/em><\/p>\n

– Vi\u00eam gi\u00e1p do ph\u00e1 h\u1ee7y, g\u1ed3m: vi\u00eam gi\u00e1p b\u00e1n c\u1ea5p De Quervain, vi\u00eam gi\u00e1p kh\u00f4ng \u0111au, vi\u00eam gi\u00e1p h\u1eadu s\u1ea3n, vi\u00eam gi\u00e1p do ph\u00f3ng x\u1ea1, vi\u00eam gi\u00e1p do cytokine. Vi\u00eam gi\u00e1p b\u00e1n c\u1ea5p, kh\u00f4ng \u0111au v\u00e0 h\u1eadu s\u1ea3n th\u01b0\u1eddng t\u1ef1 kh\u1ecfi, tri\u1ec7u ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p nh\u1eb9 trong v\u00e0i tu\u1ea7n. Kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb ho\u1eb7c ch\u1ec9 c\u1ea7n ch\u1eb9n beta l\u00e0 \u0111\u1ee7.<\/p>\n

– Nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do iod. Th\u01b0\u1eddng g\u1eb7p v\u00f9ng thi\u1ebfu oxy. Y\u1ebfu t\u1ed1 nguy c\u01a1: tu\u1ed5i cao, b\u01b0\u1edbu gi\u00e1p nh\u00e2n, TSH th\u1ea5p.
\n– Nhi\u1ec5m \u0111\u1ed9c gi\u00e1p nguy\u00ean nh\u00e2n ngo\u00e0i tuy\u1ebfn gi\u00e1p. Qu\u00e1 li\u1ec1u hormon gi\u00e1p, u qu\u00e1i struma ovarii,\u2026<\/p>\n

3. \u0110i\u1ec1u tr\u1ecb:<\/strong><\/h2>\n

3.1 Basedow<\/strong><\/em><\/p>\n

M\u1ed9t s\u1ed1t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng g\u1ee3i \u00fd \u0111i\u1ec1u tr\u1ecb basedow theo ATA 2016.<\/p>\n

    \n
  • Mang thai: ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh iod ph\u00f3ng x\u1ea1 (RAI), c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p (ATD) > ph\u1eabu thu\u1eadt.<\/li>\n
  • Nhi\u1ec1u b\u1ec7nh n\u1ec1n, nguy c\u01a1 ph\u1eabu thu\u1eadt cao, k\u00ec v\u1ecdng s\u1ed1ng th\u1ea5p: khuy\u1ebfn c\u00e1o RAI, c\u00f3 th\u1ec3 d\u00f9ng ATD, kh\u00f4ng khuy\u1ebfn c\u00e1o ph\u1eabu thu\u1eadt.<\/li>\n
  • Basedow kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng: RAI, ATD, ph\u1eabu thu\u1eadt \u0111\u1ec1u c\u00f3 gi\u00e1 tr\u1ecb nh\u01b0 nhau.<\/li>\n
  • Basedow ho\u1ea1t \u0111\u1ed9ng: c\u1ea3 RAI, ATD, ph\u1eabu thu\u1eadt \u0111\u1ec1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o m\u1ea1nh.<\/li>\n
  • B\u1ec7nh gan: RAI \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o m\u1ea1nh h\u01a1n ph\u1eabu thu\u1eadt, c\u00e2n nh\u1eafc ATD.<\/li>\n
  • T\u00e1c d\u1ee5ng ph\u1ee5 nghi\u1ec7m tr\u1ecdng do ATD: khuy\u1ebfn c\u00e1o RAI, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ATD, c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt.<\/li>\n
  • \u00cdt ph\u1eabu thu\u1eadt vi\u00ean kinh nghi\u1ec7m: RAI > ATD, ph\u1eabu thu\u1eadt c\u1ea7n th\u1eadn tr\u1ecdng c\u00e2n nh\u1eafc.<\/li>\n
  • Kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c cao (n\u1eef, b\u1ec7nh nh\u1eb9, b\u01b0\u1edbu nh\u1ecf, TRAb d\u01b0\u01a1ng t\u00ednh th\u1ea5p): ATD \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o m\u1ea1nh, RAI v\u00e0 ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 l\u1ef1a.<\/li>\n
  • C\u00f3 li\u1ec7t chu k\u00ec do nhi\u1ec5m \u0111\u1ed9c gi\u00e1p: khuy\u1ebfn c\u00e1o m\u1ea1nh RAI v\u00e0 ph\u1eabu thu\u1eadt, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn ATD.<\/li>\n
  • C\u00f3 t\u0103ng \u00e1p ph\u1ed5i, suy tim sung huy\u1ebft: khuy\u1ebfn c\u00e1o m\u1ea1nh RAI, c\u00f3 th\u1ec3 ch\u1ecdn ATD, th\u1eadn tr\u1ecdng v\u1edbi ph\u1eabu thu\u1eadt.<\/li>\n
  • Cao tu\u1ed5i nhi\u1ec1u b\u1ec7nh n\u1ec1n: c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn RAI ho\u1eb7c ATD, th\u1eadn tr\u1ecdng v\u1edbi ph\u1eabu thu\u1eadt,<\/li>\n
  • Nghi ng\u1edd\/x\u00e1c \u0111\u1ecbnh ung th\u01b0 gi\u00e1p: ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh RAI, ATD c\u00f3 th\u1ec3 d\u00f9ng t\u00f9y t\u00ecnh hu\u1ed1ng, khuy\u1ebfn c\u00e1o ph\u1eabu thu\u1eadt.<\/li>\n
  • M\u1ed9t ho\u1eb7c nhi\u1ec1u nh\u00e2n gi\u00e1p to: khuy\u1ebfn c\u00e1o ph\u1eabu thu\u1eadt, c\u00f3 th\u1ec3 d\u00f9ng ATD.<\/li>\n
  • K\u00e8m c\u01b0\u1eddng c\u1eadn gi\u00e1p nguy\u00ean ph\u00e1t c\u1ea7n ph\u1eabu thu\u1eadt: ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/li>\n<\/ul>\n

    3.2 Li\u1ec1u thu\u1ed1c kh\u00e1ng gi\u00e1p theo BTA:<\/strong><\/p>\n

    PTU: Li\u1ec1u kh\u1edfi \u0111\u1ea7u 300-450 mg m\u1ed9t l\u1ea7n\/ng\u00e0y ho\u1eb7c 50-150 mg m\u1ed7i ng\u00e0y
    \nMMI: Li\u1ec1u kh\u1edfi \u0111\u1ea7u 10-20 mg m\u1ed7i ng\u00e0y ho\u1eb7c 5-10 mg hai l\u1ea7n\/ng\u00e0y.
    \nT\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n: gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t, vi\u00eam m\u1ea1ch m\u00e1u, t\u1ed5n th\u01b0\u01a1ng gan.
    \n\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng: \u0111\u1ea7u tay l\u00e0 ch\u1eb9n beta, verapamil\/diltiazem n\u1ebfu kh\u00f4ng dung n\u1ea1p.
    \nLi\u1ec1u: propanolol 10 \u2013 40 mg (3-4 l\u1ea7n\/ ng\u00e0y), metoprolol 25 \u2013 50 mg (2-3 l\u1ea7n\/ng\u00e0y), esmolol IV 50 \u2013 100mcg\/kg\/p.
    \nIod (lugol): cho m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n basedow, c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng do ATD, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh\/ kh\u00f4ng \u0111\u1ed3ng \u00fd d\u00f9ng RAI\/ ph\u1eabu thu\u1eadt. \u0110i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 cho RAI, ph\u1eabu thu\u1eadt.<\/p>\n

    3.3 B\u01b0\u1edbu \u0111a nh\u00e2n \u0111\u1ed9c v\u00e0 adenoma tuy\u1ebfn:<\/strong><\/em><\/p>\n

    – \u0110i\u1ec1u tr\u1ecb ATD, RAI, ph\u1eabu thu\u1eadt t\u00f9y thu\u1ed9c tu\u1ed5i, m\u1ee9c \u0111\u1ed9 c\u01b0\u1eddng gi\u00e1p, k\u00edch th\u01b0\u1edbc b\u01b0\u1edbu v\u00e0 b\u1ec7nh n\u1ec1n.
    \n– ATD l\u00e0 \u0111\u1ea7u tay n\u1ebfu c\u01b0\u1eddng gi\u00e1p r\u00f5. Li\u1ec1u khuy\u1ebfn c\u00e1o 10\u201320 mg\/d v\u1edbi methimazole v\u00e0 15\u201330 mg\/d v\u1edbi carbimazole.
    \n– \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng: d\u00f9ng ch\u1eb9n beta cho \u0111\u1ebfn khi b\u00ecnh gi\u00e1p.
    \n– Ph\u1eabu thu\u1eadt th\u01b0\u1eddng khuy\u1ebfn c\u00e1o trong b\u01b0\u1edbu \u0111a nh\u00e2n to (>100mL), ch\u1ec9 \u0111\u1ecbnh trong nghi ng\u1edd ung th\u01b0 gi\u00e1p. Ph\u1eabu thu\u1eadt n\u00ean xem x\u00e9t n\u1ebfu c\u01b0\u1eddng gi\u00e1p r\u00f5 v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a ATD c\u0169ng nh\u01b0 x\u1eed tr\u00ed kh\u1ea9n c\u1ea5p c\u01a1n b\u00e3o gi\u00e1p.<\/p>\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n

    Oxford textbook of endocrinology, 3e.
    \n2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Ti\u1ebfp c\u1eadn nhi\u1ec5m \u0111\u1ed9c gi\u00e1p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1ec3 t\u00ecm nguy\u00ean nh\u00e2n ng\u01b0\u1eddi ta chia ra 2 nh\u00f3m: nguy\u00ean nh\u00e2n t\u1ea1i tuy\u1ebfn gi\u00e1p v\u00e0 ngo\u00e0i tuy\u1ebfn gi\u00e1p. Nh\u00f3m t\u1ea1i tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 do t\u0103ng b\u00e0i ti\u1ebft hormon gi\u00e1p (c\u01b0\u1eddng gi\u00e1p) ho\u1eb7c gi\u1ea3i ph\u00f3ng c\u00e1c hormon \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t do ph\u00e1 h\u1ee7y m\u00f4 tuy\u1ebfn […]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[3],"yoast_head":"\nC\u01b0\u1eddng gi\u00e1p v\u00e0 nhi\u1ec5m \u0111\u1ed9c gi\u00e1p: ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb. - Vinmec<\/title>\n<meta name=\"description\" content=\"Nhi\u1ec5m \u0111\u1ed9c gi\u00e1p, h\u1ed9i ch\u1ee9ng do t\u0103ng n\u1ed3ng \u0111\u1ed9 fT4, fT3 ho\u1eb7c c\u1ea3 hai. C\u01b0\u1eddng gi\u00e1p l\u00e0 s\u1ef1 t\u0103ng t\u1ed5ng h\u1ee3p, ti\u1ebft hormon gi\u00e1p t\u1eeb tuy\u1ebfn gi\u00e1p. 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