{"id":32718,"date":"2023-05-09T15:05:01","date_gmt":"2023-05-09T08:05:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32718"},"modified":"2023-05-09T15:05:01","modified_gmt":"2023-05-09T08:05:01","slug":"gioi-thieu-ve-cuong-giap-trong-thai-ky","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/09\/gioi-thieu-ve-cuong-giap-trong-thai-ky\/","title":{"rendered":"Gi\u1edbi thi\u1ec7u v\u1ec1 c\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3"},"content":{"rendered":"

C\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3 chi\u1ebfm t\u1ef7 l\u1ec7 0,1 \u2013 1% (0,4% l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng 0,65%) v\u00e0 ph\u1ea7n l\u1edbn l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a b\u1ec7nh Graves. C\u01b0\u1eddng gi\u00e1p \u1ea3nh h\u01b0\u1edfng l\u00ean qu\u00e1 tr\u00ecnh mang thai, k\u1ebft qu\u1ea3 thai k\u1ef3 v\u00e0 bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 thai ch\u1eadm ph\u00e1t tri\u1ec3n trong t\u1eed cung, ng\u01b0\u1ee3c l\u1ea1i qu\u00e1 tr\u00ecnh mang thai l\u00e0m th\u00fac \u0111\u1ea9y c\u00e1c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p.<\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u v\u1ec1 c\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3<\/h2>\n

C\u01b0\u1eddng gi\u00e1p<\/a> trong th\u1eddi k\u1ef3 mang thai l\u00e0 b\u1ec7nh l\u00fd kh\u00f4ng ph\u1ed5 bi\u1ebfn v\u00e0 ghi nh\u1eadn v\u1edbi t\u1ef7 l\u1ec7 th\u1ea5p trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p mang thai. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 ph\u00e2n bi\u1ec7t nguy\u00ean nh\u00e2n c\u01b0\u1eddng gi\u00e1p c\u00f3 th\u1ec3 g\u1eb7p kh\u00f3 kh\u0103n \u1edf ph\u1ee5 n\u1eef mang thai, do c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u c\u01b0\u1eddng gi\u00e1p nh\u01b0 c\u0103ng th\u1eb3ng, \u0111\u1ed5 m\u1ed3 h\u00f4i, kh\u00f3 th\u1edf, nh\u1ecbp tim nhanh v\u00e0 ti\u1ebfng th\u1ed5i t\u00e2m thu \u1edf tim c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn trong h\u1ea7u h\u1ebft c\u00e1c s\u1ea3n ph\u1ee5 b\u00ecnh th\u01b0\u1eddng. Tuy nhi\u00ean c\u00e1c d\u1ea5u ch\u1ee9ng c\u1ee5 th\u1ec3 h\u01a1n nh\u01b0 gi\u1ea3m c\u00e2n, b\u01b0\u1edbu gi\u00e1p v\u00e0 l\u1ed3i m\u1eaft c\u00f3 th\u1ec3 g\u1ee3i \u00fd c\u01b0\u1eddng gi\u00e1p Graves. Ngo\u00e0i ra, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u01b0\u1eddng gi\u00e1p tho\u00e1ng qua c\u1ee7a ch\u1ee9ng n\u00f4n ngh\u00e9n \u1edf s\u1ea3n ph\u1ee5 c\u00f3 th\u1ec3 l\u00e0m ph\u1ee9c t\u1ea1p cho ch\u1ea9n \u0111o\u00e1n. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n c\u01b0\u1eddng gi\u00e1p lu\u00f4n lu\u00f4n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1ch \u0111o n\u1ed3ng \u0111\u1ed9 FT4 v\u00e0 TSH. N\u1ed3ng \u0111\u1ed9 FT3 v\u00e0 FT4 th\u01b0\u1eddng thay \u0111\u1ed5i trong th\u1eddi gian mang thai b\u00ecnh th\u01b0\u1eddng v\u00e0 gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a n\u1ed3ng \u0111\u1ed9 FT4, FT4 v\u00e0 T3 c\u0169ng nh\u01b0 TSH c\u1ea7n \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t cho m\u1ed7i qu\u00fd thai. Kh\u1eb3ng \u0111\u1ecbnh b\u1ec7nh c\u00f3 \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng thai k\u1ef3. V\u00ec v\u1eady, m\u1eb7c d\u00f9 hi\u1ebfm g\u1eb7p b\u1ec7nh, vi\u1ec7c nh\u1eadn bi\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u c\u1ee7a b\u1ec7nh trong th\u1eddi k\u1ef3 mang thai l\u00e0 quan tr\u1ecdng.<\/p>\n

\"C\u01b0\u1eddng<\/p>\n

2. Nguy\u00ean nh\u00e2n c\u1ee7a nhi\u1ec5m \u0111\u1ed9c gi\u00e1p trong thai k\u1ef3<\/strong><\/h2>\n

Nhi\u1ec5m \u0111\u1ed9c gi\u00e1p \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 \u201ch\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a t\u0103ng chuy\u1ec3n h\u00f3a v\u00e0 t\u0103ng ho\u1ea1t \u0111\u1ed9ng qu\u00e1 m\u1ee9c khi gia t\u0103ng n\u1ed3ng \u0111\u1ed9 FT4 v\u00e0\/ho\u1eb7c FT3\u201d. B\u1ec7nh Graves l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a c\u01b0\u1eddng gi\u00e1p t\u1ef1 mi\u1ec5n d\u1ecbch trong th\u1eddi k\u1ef3 mang thai, x\u1ea3y ra \u1edf 0,1% -1% (0,4% l\u00e2m s\u00e0ng v\u00e0 0,65% c\u1eadn l\u00e2m s\u00e0ng) c\u1ee7a t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p mang thai. B\u1ec7nh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u1ea7n \u0111\u1ea7u ti\u00ean trong th\u1eddi k\u1ef3 mang thai ho\u1eb7c c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n nh\u01b0 l\u00e0 m\u1ed9t giai \u0111o\u1ea1n t\u00e1i ph\u00e1t \u1edf s\u1ea3n ph\u1ee5 c\u00f3 ti\u1ec1n s\u1eed c\u01b0\u1eddng gi\u00e1p.<\/p>\n

Nguy\u00ean nh\u00e2n nhi\u1ec5m \u0111\u1ed9c gi\u00e1p kh\u00f4ng do b\u1ec7nh t\u1ef1 mi\u1ec5n th\u01b0\u1eddng \u00edt ph\u1ed5 bi\u1ebfn bao g\u1ed3m b\u01b0\u1edbu gi\u00e1p \u0111\u1ed9c \u0111a nh\u00e2n, u tuy\u1ebfn \u0111\u1ed9c, nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do thu\u1ed1c. Vi\u00eam gi\u00e1p b\u00e1n c\u1ea5p \u0111au ho\u1eb7c vi\u00eam gi\u00e1p im l\u1eb7ng ho\u1eb7c u qu\u00e1i bu\u1ed3ng tr\u1ee9ng l\u00e0 nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p c\u1ee7a nhi\u1ec5m \u0111\u1ed9c gi\u00e1p trong thai k\u1ef3.<\/p>\n

M\u1ed9t nguy\u00ean nh\u00e2n c\u01b0\u1eddng gi\u00e1p trong th\u1eddi k\u1ef3 mang thai th\u01b0\u1eddng g\u1eb7p h\u01a1n so v\u1edbi b\u1ec7nh Graves l\u00e0 h\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p do thai (gestational hyperthyroidism syndrome) \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 c\u01b0\u1eddng gi\u00e1p tho\u00e1ng qua, x\u1ea3y ra trong n\u1eeda \u0111\u1ea7u thai k\u1ef3, \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 gia t\u0103ng FT4 ho\u1eb7c FT3 v\u00e0 n\u1ed3ng \u0111\u1ed9 TSH huy\u1ebft thanh gi\u1ea3m ho\u1eb7c kh\u00f4ng \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c nh\u01b0ng kh\u00f4ng c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u00e1c d\u1ea5u ch\u1ec9 \u0111i\u1ec3m huy\u1ebft thanh c\u1ee7a b\u1ec7nh t\u1ef1 mi\u1ec5n tuy\u1ebfn gi\u00e1p. T\u1ef7 l\u1ec7 h\u1ed9i ch\u1ee9ng n\u00e0y t\u1eeb 1-3% c\u1ee7a ng\u01b0\u1eddi mang thai, t\u00f9y thu\u1ed9c v\u00e0o v\u00f9ng \u0111\u1ecba l\u00fd v\u00e0 th\u1ee9 ph\u00e1t do t\u0103ng n\u1ed3ng \u0111\u1ed9 hCG.<\/p>\n

B\u00ean c\u1ea1nh \u0111\u00f3 h\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi ch\u1ee9ng \u1ed1m ngh\u00e9n v\u1edbi \u0111\u1eb7c tr\u01b0ng nh\u01b0 bu\u1ed3n n\u00f4n v\u00e0 \u00f3i m\u1eeda nghi\u00eam tr\u1ecdng trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a thai k\u1ef3, s\u1ea3n ph\u1ee5 c\u00f3 th\u1ec3 gi\u1ea3m c\u00e2n tr\u00ean 5%, m\u1ea5t n\u01b0\u1edbc v\u00e0 xu\u1ea5t hi\u1ec7n ceton ni\u1ec7u. Ch\u1ee9ng \u1ed1m ngh\u00e9n x\u1ea3y ra trong 0,5-10 tr\u00ean 1000 ph\u1ee5 n\u1eef mang thai.<\/p>\n

Nguy\u00ean nh\u00e2n kh\u00e1c li\u00ean quan v\u1edbi nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do hCG bao g\u1ed3m \u0111a thai, thai tr\u1ee9ng ho\u1eb7c ung th\u01b0 t\u1ebf b\u00e0o nu\u00f4i. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p hi\u1ec7n nay c\u00f3 t\u0103ng n\u1ed3ng \u0111\u1ed9 hCG huy\u1ebft thanh \u0111\u00e1ng k\u1ec3. Ngo\u00e0i ra m\u1ed9t s\u1ef1 \u0111\u1ed9t bi\u1ebfn th\u1ee5 th\u1ec3 TSH d\u1eabn \u0111\u1ebfn t\u0103ng nh\u1ea1y c\u1ea3m ch\u1ee9c n\u0103ng \u0111\u1ed1i v\u1edbi hCG c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n hi\u1ebfm g\u1eb7p c\u1ee7a c\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3.<\/p>\n

3. Ph\u00e2n bi\u1ec7t h\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p do thai (gestational hyperthyroidism) v\u00e0 c\u01b0\u1eddng gi\u00e1p do b\u1ec7nh Graves\u2019 trong thai k\u1ef3<\/strong><\/h2>\n

Khi n\u1ed3ng \u0111\u1ed9 TSH huy\u1ebft thanh th\u1ea5p ho\u1eb7c kh\u00f4ng \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c v\u00e0 n\u1ed3ng \u0111\u1ed9 FT4 huy\u1ebft thanh cao, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t trong \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p l\u00e0 gi\u1eefa c\u01b0\u1eddng gi\u00e1p Graves v\u00e0 c\u01b0\u1eddng gi\u00e1p thai k\u1ef3. Trong c\u1ea3 hai tr\u01b0\u1eddng h\u1ee3p, bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ph\u1ed5 bi\u1ebfn bao g\u1ed3m h\u1ed3i h\u1ed9p, lo \u00e2u, run tay v\u00e0 k\u00e9m ch\u1ecbu n\u00f3ng. H\u1ecfi b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng c\u1ea9n th\u1eadn r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c t\u00ecm ki\u1ebfm b\u1ec7nh nguy\u00ean. S\u1ea3n ph\u1ee5 kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed v\u1ec1 b\u1ec7nh tuy\u1ebfn gi\u00e1p tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh Graves (b\u01b0\u1edbu c\u1ed5, b\u1ec7nh m\u1eaft n\u1ed9i ti\u1ebft) c\u1ea7n \u01b0u ti\u00ean ch\u1ea9n \u0111o\u00e1n c\u01b0\u1eddng gi\u00e1p thai k\u1ef3. Trong t\u00ecnh hu\u1ed1ng nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, c\u1ea7n x\u00e1c \u0111\u1ecbnh b\u1eb1ng TSHR-Ab.<\/p>\n

Khi hi\u1ec7n di\u1ec7n m\u1ed9t b\u01b0\u1edbu gi\u00e1p nh\u00e2n, FT3 huy\u1ebft thanh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 h\u1eefu \u00edch trong vi\u1ec7c th\u0103m d\u00f2 kh\u1ea3 n\u0103ng c\u1ee7a h\u1ed9i ch\u1ee9ng \u201cnhi\u1ec5m \u0111\u1ed9c T3\u2019\u2019. X\u00e1c \u0111\u1ecbnh FT3 c\u0169ng c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m \u0111\u1ed9c gi\u00e1p T3 g\u00e2y ra b\u1edfi b\u1ec7nh Graves\u2019.<\/p>\n

Theo khuy\u1ebfn c\u00e1o \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo h\u01b0\u1edbng d\u1eabn c\u1ee7a Ban c\u00f4ng t\u00e1c c\u00e1c d\u1ecbch v\u1ee5 y t\u1ebf d\u1ef1 ph\u00f2ng Hoa K\u1ef3 (United States Preventive Services Task Force= USPSTF), n\u1ebfu TSH huy\u1ebft thanh th\u1ea5p trong thai k\u1ef3 \u0111\u1ea7u ti\u00ean (TSH < 0.1 mIU\/L), c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 h\u1ecfi ti\u1ec1n s\u1eed. \u0110\u1ecbnh l\u01b0\u1ee3ng FT4 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n. \u0110\u1ecbnh l\u01b0\u1ee3ng TT3 v\u00e0 TSHR-Ab c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c thi\u1ebft l\u1eadp m\u1ed9t ch\u1ea9n \u0111o\u00e1n c\u01b0\u1eddng gi\u00e1p (m\u1ee9c B-USPSTF).<\/p>\n

Hi\u1ec7n kh\u00f4ng c\u00f3 \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 khuy\u1ebfn c\u00e1o hay ch\u1ed1ng l\u1ea1i vi\u1ec7c s\u1eed d\u1ee5ng c\u1ee7a si\u00eau \u00e2m tuy\u1ebfn gi\u00e1p ph\u00e2n bi\u1ec7t nguy\u00ean nh\u00e2n g\u00e2y ra c\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3 (m\u1ee9c I-USPSTF).<\/p>\n

Kh\u00f4ng n\u00ean th\u1ef1c hi\u1ec7n x\u1ea1 h\u00ecnh iod ph\u00f3ng x\u1ea1 (RAI) v\u00e0 x\u00e1c \u0111\u1ecbnh s\u1ef1 h\u1ea5p thu iode ph\u00f3ng x\u1ea1 trong th\u1eddi k\u1ef3 mang thai (m\u1ee9c D-USPSTF).<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: T\u1ea1p ch\u00ed ph\u1ee5 s\u1ea3n<\/p>\n","protected":false},"excerpt":{"rendered":"

C\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3 chi\u1ebfm t\u1ef7 l\u1ec7 0,1 \u2013 1% (0,4% l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng 0,65%) v\u00e0 ph\u1ea7n l\u1edbn l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a b\u1ec7nh Graves. C\u01b0\u1eddng gi\u00e1p \u1ea3nh h\u01b0\u1edfng l\u00ean qu\u00e1 tr\u00ecnh mang thai, k\u1ebft qu\u1ea3 thai k\u1ef3 v\u00e0 bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 thai ch\u1eadm ph\u00e1t tri\u1ec3n trong t\u1eed cung, […]<\/p>\n","protected":false},"author":49,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,33],"tags":[],"yoast_head":"\nGi\u1edbi thi\u1ec7u v\u1ec1 c\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3 - Vinmec<\/title>\n<meta name=\"description\" content=\"C\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3 chi\u1ebfm t\u1ef7 l\u1ec7 0,1 \u2013 1% (0,4% l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng 0,65%) v\u00e0 ph\u1ea7n l\u1edbn l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a b\u1ec7nh Graves.\" \/>\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=\"Gi\u1edbi thi\u1ec7u v\u1ec1 c\u01b0\u1eddng gi\u00e1p trong thai k\u1ef3 - 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