{"id":26511,"date":"2023-05-02T18:12:36","date_gmt":"2023-05-02T11:12:36","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26511"},"modified":"2023-05-02T18:12:36","modified_gmt":"2023-05-02T11:12:36","slug":"hoi-chung-giam-hoat-giap-dinh-nghia-nguyen-nhan-co-che-benh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/02\/hoi-chung-giam-hoat-giap-dinh-nghia-nguyen-nhan-co-che-benh\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p: \u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n, c\u01a1 ch\u1ebf b\u1ec7nh"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p (hay c\u00f2n g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng m\u1ea5t ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tuy\u1ebfn gi\u00e1p) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn tuy\u1ebfn gi\u00e1p, tuy\u1ebfn n\u00e0y s\u1ea3n xu\u1ea5t c\u00e1c hormone gi\u00fap \u0111i\u1ec1u ch\u1ec9nh qu\u00e1 tr\u00ecnh trao \u0111\u1ed5i ch\u1ea5t trong c\u01a1 th\u1ec3. H\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p x\u1ea3y ra khi tuy\u1ebfn gi\u00e1p kh\u00f4ng s\u1ea3n xu\u1ea5t \u0111\u1ee7 l\u01b0\u1ee3ng hormone gi\u00e1p \u0111\u1ec3 \u0111\u00e1p \u1ee9ng nhu c\u1ea7u c\u1ee7a c\u01a1 th\u1ec3. Trong b\u00e0i n\u00e0y, ch\u00fang ta s\u1ebd \u0111i t\u00ecm hi\u1ec3u \u0111\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n, c\u01a1 ch\u1ebf b\u1ec7nh sinh d\u1ecbch t\u1ec5 v\u00e0 ch\u1ea9n \u0111o\u00e1n c\u1ee7a h\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p<\/strong><\/p>\n

\"Minh
Minh h\u1ecda h\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p (NGU\u1ed2N<\/strong>)<\/figcaption><\/figure>\n

1. \u0110\u1ecbnh ngh\u0129a: <\/strong><\/h2>\n

H\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 gi\u1ea3m tuy\u1ec7t \u0111\u1ed1i hay t\u01b0\u01a1ng \u0111\u1ed1i v\u1ec1 t\u1ed5ng h\u1ee3p v\u00e0\/ho\u1eb7c gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a hormone gi\u00e1p l\u00ean c\u01a1 quan \u0111\u00edch<\/p>\n

2. C\u01a1 ch\u1ebf b\u1ec7nh sinh:<\/strong><\/h2>\n

2.1. Qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p hormone gi\u00e1p<\/strong><\/h3>\n

2.1.1. V\u1eadn chuy\u1ec3n iode v\u00e0o trong t\u1ebf b\u00e0o gi\u00e1p th\u00f4ng qua b\u01a1m iode d\u01b0\u1edbi s\u1ef1 \u0111i\u1ec1u h\u00f2a c\u1ee7a TSH<\/p>\n

2.1.2. Oxy h\u00f3a ion iodua (I-) th\u00e0nh iodine (I2) nh\u1edd men Peroxidase. I2 k\u1ebft h\u1ee3p v\u1edbi Thyroglobulin nh\u1edd enzym iodinase t\u1ea1o th\u00e0nh MIT (T1) v\u00e0 DIT (T2)<\/p>\n

2.1.3. C\u00e1c DIT k\u1ebft h\u1ee3p v\u1edbi nhau t\u1ea1o th\u00e0nh thyrosine (T4) v\u00e0 1 MIT k\u1ebft h\u1ee3p v\u1edbi 1 DIT t\u1ea1o th\u00e0nh T3<\/p>\n

2.1.4. Th\u1ee7y ph\u00e2n thyroglobulin, ph\u00f3ng th\u00edch T3, T4 v\u00e0 MIT, DIT<\/p>\n

2.1.5. Kh\u1eed iode c\u1ee7a MIT v\u00e0 DIT d\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a Deiodinase<\/p>\n

2.1.6. Chuy\u1ec3n \u0111\u1ed5i T4 th\u00e0nh T3<\/p>\n

2.2. \u0110i\u1ec1u h\u00f2a b\u00e0i ti\u1ebft hormone gi\u00e1p<\/strong><\/h3>\n

– Tuy\u1ebfn gi\u00e1p \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1edfi TSH ti\u1ec1n y\u00ean, s\u1ef1 b\u00e0i ti\u1ebft TSH t\u0103ng d\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a TRH v\u00e0 l\u1ea1nh, gi\u1ea3m khi b\u1ecb stress, n\u00f3ng…T4,T3 t\u1ef1 do \u1ee9c ch\u1ebf ng\u01b0\u1ee3c s\u1ef1 b\u00e0i ti\u1ebft TSH, TSH b\u1ecb \u0111i\u1ec1u khi\u1ec3n b\u1edfi TRH.<\/p>\n

– Trong \u0111i\u1ec1u ki\u1ec7n sinh l\u00fd, ch\u1ec9 c\u1ea7n 55g iod\/ng\u00e0y v\u00e0o tuy\u1ebfn gi\u00e1p, n\u1ebfu s\u1ef1 cung c\u1ea5p gia t\u0103ng (10 gi\u1ecdt Lugol ch\u1ee9a 60.000(g iod) xu\u1ea5t hi\u1ec7n s\u1ef1 gi\u1ea3m thu nh\u1eadn iod h\u1eefu c\u01a1, c\u0169ng nh\u01b0 \u1ee9c ch\u1ebf gi\u1ea3i ph\u00f3ng hormon.<\/p>\n

3. D\u1ecbch t\u1ec5 h\u1ecdc h\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p<\/strong><\/h2>\n

– SG \u0111i\u1ec3n h\u00ecnh \u1edf ng\u01b0\u1eddi l\u1edbn: n\u1eef 2%, nam 0,2%; n\u1eef \/ nam: 10\/1.
\n– SG c\u1eadn l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi >60 tu\u1ed5i h\u01a1n: n\u1eef 6%, nam 2%.<\/p>\n\n\n\n\n\n\n\n\n
 <\/p>\n

\u0110\u1ed1i t\u01b0\u1ee3ng<\/td>\n

Nhu c\u1ea7u(\u00b5g\/ng\u00e0y)<\/td>\n<\/tr>\n
Tr\u1ebb em n\u0103m \u0111\u1ea7u ti\u00ean<\/td>\n50<\/td>\n<\/tr>\n
Tr\u1ebb 1-5 tu\u1ed5i<\/td>\n90<\/td>\n<\/tr>\n
Tr\u1ebb 6-11 tu\u1ed5i<\/td>\n120<\/td>\n<\/tr>\n
>12 tu\u1ed5i, ng\u01b0\u1eddi l\u1edbn<\/td>\n150<\/td>\n<\/tr>\n
Ph\u1ee5 n\u1eef c\u00f3 thai<\/td>\n250<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Iode \u0111\u00f3ng vai tr\u00f2 trong tr\u1ecdng trong vi\u1ec7c t\u1ed5ng h\u1ee3p hormon gi\u00e1p n\u00ean n\u1ebfu thi\u1ebfu iot s\u1ebd l\u00e0m \u1ea3nh h\u01b0\u1edfng t\u1edbi qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p hormon gi\u00e1p<\/a><\/p>\n

– Ph\u1ee5 n\u1eef c\u00f3 thai c\u00f3 nhu c\u1ea7u Iode cao h\u01a1n so v\u1edbi nh\u1eefng nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng kh\u00e1c do ngo\u00e0i nhu c\u1ea7u cho ch\u00ednh b\u1ea3n th\u00e2n m\u1eb9 c\u00f2n c\u00f3 thai nhi ch\u00ednh v\u00ec v\u1eady c\u1ea7n ch\u00fa \u00fd cho nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y<\/p>\n

– Ng\u01b0\u1eddi l\u1edbn \u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u1ee5 n\u1eef kho\u1ea3ng 60 tu\u1ed5i c\u00f3 nguy c\u01a1 cao b\u1ecb suy gi\u00e1p do nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i v\u1ec1 sinh l\u00fd v\u00e0 \u1ea3nh h\u01b0\u1edfng t\u1edbi hormon gi\u00e1p.
\n+ Ph\u1ee5 n\u1eef khi c\u00f3 kinh nguy\u1ec7t s\u1ebd m\u1ea5t m\u00e1u \u0111\u1ed3ng th\u1eddi m\u1ea5t c\u1ea3 hormon gi\u00e1p
\n+ Ph\u1ee5 n\u1eef m\u00e3n kinh c\u00e1c y\u1ebfu t\u1ed1 n\u1ed9i ti\u1ebft t\u1ed1 suy gi\u1ea3m, hormon gi\u00e1p gi\u1ea3m
\n+ M\u1eafc nhi\u1ec1u b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n
\n=> D\u1ec5 b\u1ecb suy gi\u00e1p<\/p>\n

4. Nguy\u00ean nh\u00e2n g\u00e2y gi\u1ea3m ho\u1ea1t gi\u00e1p<\/strong><\/h3>\n

4.1. Ti\u00ean ph\u00e1t<\/strong><\/h3>\n

Chi\u1ebfm 95% tr\u01b0\u1eddng h\u1ee3p.
\n– Vi\u00eam tuy\u1ebfn gi\u00e1p Hashimoto: th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. C\u00f3 s\u1ef1 t\u01b0\u01a1ng \u0111\u1ed3ng mi\u1ec5n d\u1ecbch v\u1edbi Basedow
\n– Vi\u00eam tuy\u1ebfn gi\u00e1p b\u00e1n c\u1ea5p De Quervain
\n– Do \u0111i\u1ec1u tr\u1ecb: thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p, ph\u1eabu thu\u1eadt tuy\u1ebfn gi\u00e1p, I131, interferon, x\u1ea1 tr\u1ecb v\u00f9ng c\u1ed5 v\u00e0 n\u00e1ch
\n– Do cung c\u1ea5p iode kh\u00f4ng h\u1ee3p l\u00fd (th\u1eeba ho\u1eb7c thi\u1ebfu iode)
\n– B\u1ea5t th\u01b0\u1eddng sinh t\u1ed5ng h\u1ee3p hormon gi\u00e1p
\n– Ch\u1ea5t kh\u00e1ng gi\u00e1p trong th\u1ee9c \u0103n
\n– Hi\u1ebfm h\u01a1n: nhi\u1ec5m s\u1eafc t\u1ed1 s\u1eaft, sarcoidosis, amyloidosis<\/p>\n

4.2. Th\u1ee9 ph\u00e1t<\/strong><\/h3>\n

\u00cdt g\u1eb7p h\u01a1n
\n– Suy tuy\u1ebfn y\u00ean do u tuy\u1ebfn y\u00ean, ho\u1ea1i t\u1eed tuy\u1ebfn y\u00ean; do ph\u1eabu thu\u1eadt, tia x\u1ea1
\n– X\u1ea1 tr\u1ecb v\u00f9ng \u0111\u1ea7u c\u1ed5 trong u tuy\u1ebfn y\u00ean
\n– Nhi\u1ec5m s\u1eafc t\u1ed1 s\u1eaft, Sarcoidosis
\n– R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i l\u00e0m gi\u1ea3m s\u1ea3n xu\u1ea5t v\u00e0\/ho\u1eb7c ph\u00f3ng th\u00edch TRH. Th\u01b0\u1eddng ph\u1ed1i h\u1ee3p v\u1edbi b\u1ec7nh l\u00fd tuy\u1ebfn y\u00ean<\/p>\n

4.3. Nguy\u00ean nh\u00e2n \u0111\u1eb7c bi\u1ec7t c\u1ee7a gi\u1ea3m ho\u1ea1t gi\u00e1p<\/strong><\/h3>\n

– \u0110\u1ec1 kh\u00e1ng ngo\u1ea1i bi\u00ean v\u1edbi t\u00e1c d\u1ee5ng hormone gi\u00e1p
\n– B\u1ea5t th\u01b0\u1eddng th\u1ee5 th\u1ec3 T4 \u1edf t\u1ebf b\u00e0o<\/p>\n

5. Ch\u1ea9n \u0111o\u00e1n<\/strong><\/h2>\n

5.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/h3>\n

*L\u00e2m s\u00e0ng<\/strong>
\nH\u1ed9i ch\u1ee9ng da, ni\u00eam m\u1ea1c
\nH\u1ed9i ch\u1ee9ng gi\u1ea3m chuy\u1ec3n h\u00f3a :m\u1ec7t m\u1ecfi, ng\u1ee7 li b\u00ec, s\u1ee3 l\u1ea1nh, r\u1ed1i lo\u1ea1n tr\u00ed nh\u1edb, t\u0103ng c\u00e2n, ch\u00e1n \u0103n<\/p>\n

\u1ede c\u1ed5:<\/strong>
\n– Kh\u00f4ng s\u1edd \u0111\u01b0\u1ee3c tuy\u1ebfn gi\u00e1p (vi\u00eam teo tuy\u1ebfn gi\u00e1p m\u1ea1n t\u00ednh)
\n– Tuy\u1ebfn gi\u00e1p lan t\u1ecfa trong vi\u00eam tuy\u1ebfn gi\u00e1p sau sinh v\u00e0 Hashimoto
\n– Lan t\u1ecfa \u0111\u00e0n h\u1ed3i trong gi\u1ea3m ho\u1ea1t tuy\u1ebfn gi\u00e1p do iode v\u00e0 r\u1ed1i lo\u1ea1n t\u1ed5ng h\u1ee3p hormone<\/p>\n

C\u1ea7n ngh\u0129 \u0111\u1ebfn suy gi\u00e1p khi:
\n– Tuy\u1ebfn gi\u00e1p l\u1edbn
\n– Ho\u1eb7c c\u00f3 \u0111i\u1ec1u tr\u1ecb iode ph\u00f3ng x\u1ea1 (\u0111i\u1ec1u tr\u1ecb tuy\u1ebfn gi\u00e1p v\u00e0 c\u1eadn gi\u00e1p tr\u01b0\u1edbc \u0111\u00f3)
\n– Ho\u1eb7c ph\u1eabu thu\u1eadt tuy\u1ebfn gi\u00e1p (ti\u1ec1n s\u1eed)<\/p>\n

* C\u1eadn l\u00e2m s\u00e0ng<\/strong>
\n– D\u1ec5 n\u1ebfu tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh, TSH t\u0103ng ho\u1eb7c b\u00ecnh th\u01b0\u1eddng, FT4 gi\u1ea3m
\n– TSH m\u00e1u > 20 \u00b5U\/ml: ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh suy gi\u00e1p ti\u00ean ph\u00e1t
\n– TSH t\u0103ng nh\u1eb9 (< 20 \u00b5U\/ml), c\u1ea7n \u0111\u1ecbnh l\u01b0\u1ee3ng FT4
\n+ N\u1ebfu FT4 th\u1ea5p: suy gi\u00e1p l\u00e2m s\u00e0ng
\n+ N\u1ebfu FT4 b\u00ecnh th\u01b0\u1eddng: suy gi\u00e1p d\u01b0\u1edbi l\u00e2m s\u00e0ng (subclinical), nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y gi\u00e1p suy nh\u1eb9, nh\u01b0ng TSH t\u0103ng gi\u00fap duy tr\u00ec T4 b\u00ecnh th\u01b0\u1eddng, tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00f4ng r\u00f5.<\/p>\n

Trong suy gi\u00e1p th\u1ee9 ph\u00e1t th\u00ec n\u1ed3ng \u0111\u1ed9 TSH th\u01b0\u1eddng gi\u1ea3m nh\u01b0ng c\u00f3 khi b\u00ecnh th\u01b0\u1eddng, do \u0111\u00f3 c\u1ea7n \u0111\u1ecbnh l\u01b0\u1ee3ng FT4, kh\u00f4ng n\u00ean ch\u1ec9 d\u1ef1a v\u00e0o \u0111\u1ecbnh l\u01b0\u1ee3ng TSH \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n suy gi\u00e1p th\u1ee9 ph\u00e1t. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y n\u00ean th\u0103m d\u00f2 th\u00eam tuy\u1ebfn y\u00ean, v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i.<\/p>\n

5.2. Ch\u1ea9n \u0111o\u00e1n gi\u00e1n bi\u1ec7t<\/strong><\/h3>\n

\u00b7 Suy tu\u1ea7n ho\u00e0n n\u00e3o \u1edf ng\u01b0\u1eddi gi\u00e0: Gi\u1ea3m tr\u00ed nh\u1edb, \u0111\u00f4i l\u00fac bu\u1ed3n r\u1ea7u, \u00edt n\u00f3i, \u00edt \u01b0a ti\u1ebfp x\u00fac, da b\u1ea1c, d\u1ec5 l\u1ea1nh. FT3, FT4 b\u00ecnh th\u01b0\u1eddng.
\n\u00b7 H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0: Ph\u00f9 m\u1ec1m, tr\u1eafng, l\u00f5m; n\u01b0\u1edbc ti\u1ec3u c\u00f3 protein ni\u1ec7u cao >3,5 g\/24 gi\u1edd, protein m\u00e1u gi\u1ea3m
\n\u00b7 H\u1ed9i ch\u1ee9ng Down: tr\u00ed tu\u1ec7, tay ch\u00e2n k\u00e9m ph\u00e1t tri\u1ec3n, l\u00f9n, m\u1eaft x\u1ebfch
\n\u00b7 Suy th\u1eadn m\u1ea1n: Ch\u00e1n \u0103n, ch\u1eadm ch\u1ea1p, ph\u00f9 nh\u1eb9, thi\u1ebfu m\u00e1u, huy\u1ebft \u00e1p t\u0103ng, ure, creatinin m\u00e1u t\u0103ng.
\n\u00b7 Thi\u1ebfu m\u00e1u, suy dinh d\u01b0\u1ee1ng: Da t\u00e1i, ph\u00f9 nh\u1eb9, l\u00f4ng t\u00f3c c\u00f3 th\u1ec3 r\u1ee5ng, cholesterol m\u00e1u kh\u00f4ng t\u0103ng, c\u1ea7n x\u00e9t nghi\u1ec7m sinh h\u00f3a, hormone \u0111\u1ec3 ph\u00e2n bi\u1ec7t<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>
\nGi\u00e1o tr\u00ecnh n\u1ed9i c\u01a1 s\u1edf 2018, NXB \u0110\u1ea1i h\u1ecdc Hu\u1ebf<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

H\u1ed9i ch\u1ee9ng gi\u1ea3m ho\u1ea1t gi\u00e1p (hay c\u00f2n g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng m\u1ea5t ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tuy\u1ebfn gi\u00e1p) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn tuy\u1ebfn gi\u00e1p, tuy\u1ebfn n\u00e0y s\u1ea3n xu\u1ea5t c\u00e1c hormone gi\u00fap \u0111i\u1ec1u ch\u1ec9nh qu\u00e1 tr\u00ecnh trao \u0111\u1ed5i ch\u1ea5t trong c\u01a1 th\u1ec3. 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