{"id":34834,"date":"2023-06-10T12:11:06","date_gmt":"2023-06-10T05:11:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34834"},"modified":"2023-06-10T13:14:41","modified_gmt":"2023-06-10T06:14:41","slug":"dieu-tri-cuong-giap-phuong-phap-hieu-qua-de-kiem-soat-roi-loan-giap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/10\/dieu-tri-cuong-giap-phuong-phap-hieu-qua-de-kiem-soat-roi-loan-giap\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p: Ph\u01b0\u01a1ng ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 ki\u1ec3m so\u00e1t r\u1ed1i lo\u1ea1n gi\u00e1p"},"content":{"rendered":"<p><strong>\u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1ea7u ti\u00ean tr\u01b0\u1edbc khi b\u1eaft tay v\u00e0o \u0111i\u1ec1u tr\u1ecb ph\u1ea3i x\u00e1c \u0111\u1ecbnh \u0111\u00e2y l\u00e0 h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do c\u01b0\u1eddng gi\u00e1p hay nhi\u1ec5m \u0111\u1ed9c gi\u00e1p kh\u00f4ng do c\u01b0\u1eddng gi\u00e1p. \u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p d\u00f9 cho b\u1ea5t k\u00ec nguy\u00ean nh\u00e2n g\u00ec c\u0169ng lu\u00f4n b\u1eaft \u0111\u1ea7u b\u1eb1ng \u0111i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p cho \u0111\u1ebfn khi kh\u00f4ng c\u00f2n tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p, ngh\u0129a l\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i b\u00ecnh gi\u00e1p. Sau khi \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i b\u00ecnh gi\u00e1p r\u1ed3i th\u00ec m\u1edbi x\u00e9t t\u1edbi \u0111i\u1ec1u tr\u1ecb ti\u1ec7t c\u0103n nguy\u00ean nh\u00e2n. C\u00f3 th\u1ec3 ch\u00ednh \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n c\u0169ng ch\u00ednh l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng, tuy nhi\u00ean khi \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n th\u00f4ng th\u01b0\u1eddng ph\u1ea3i c\u00f3 tr\u1ea1ng th\u00e1i b\u00ecnh gi\u00e1p tr\u01b0\u1edbc. \u1ede b\u00e0i vi\u1ebft n\u00e0y n\u00e0y ch\u1ee7 y\u1ebfu n\u00f3i t\u1edbi c\u00e1c b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do c\u01b0\u1eddng gi\u00e1p.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-34835 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/cd7561ec-24eb-4408-8743-a8b4f93427f1-300x300.jpg\" alt=\"\u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/cd7561ec-24eb-4408-8743-a8b4f93427f1-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/cd7561ec-24eb-4408-8743-a8b4f93427f1-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/cd7561ec-24eb-4408-8743-a8b4f93427f1-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/cd7561ec-24eb-4408-8743-a8b4f93427f1.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2>1. \u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p n\u1ed9i khoa:<\/h2>\n<p><strong>1.1 Thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p:<\/strong><br \/>\n\uf0b6C\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p:<br \/>\nC\u00f3 hai nh\u00f3m thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p:<br \/>\n\u2665 Nh\u00f3m thiouracil: bao g\u1ed3m hai thu\u1ed1c ch\u00ednh:<br \/>\n\uf02dPropyl \u2013 thiouracil (PTU) bi\u1ec7t d\u01b0\u1ee3c l\u00e0 Propacyl vi\u00ean 50 mg.<br \/>\n\uf02dBenzyl \u2013 thiouracil (BTU) bi\u1ec7t d\u01b0\u1ee3c l\u00e0 Basdene vi\u00ean 25 mg.<br \/>\n\u2665 Nh\u00f3m imidazole:<br \/>\n\uf02dMethimazole bi\u1ec7t d\u01b0\u1ee3c l\u00e0 Tapazole ho\u1eb7c Thyrozole vi\u00ean 5 mg.<br \/>\n\uf02dCarbimazole bi\u1ec7t d\u01b0\u1ee3c l\u00e0 anti \u2013 Thyrox ho\u1eb7c Neomercarzole vi\u00ean 5 mg. Sau khi u\u1ed1ng trong c\u01a1 th\u1ec3 carbimazole \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00e0nh methimazole l\u00e0 d\u1ea1ng c\u00f3 ho\u1ea1t t\u00ednh.<br \/>\n\uf0b6C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p:<br \/>\n\uf02d\u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p hormone gi\u00e1p \u1edf c\u00e1c t\u1ebf b\u00e0o nang tuy\u1ebfn gi\u00e1p.<br \/>\n\uf02dCarbamin li\u1ec1u cao 60 mg\/ng\u00e0y c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf kh\u00e1ng th\u1ec3 kh\u00e1ng gi\u00e1p (TSI).<br \/>\n\uf02dPTU c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n c\u1ea3n kh\u00f4ng cho T4 chuy\u1ec3n th\u00e0nh T3 \u1edf m\u00f4 ngo\u1ea1i bi\u00ean.<br \/>\n\uf0b6Hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c kh\u00e1ng gi\u00e1p t\u1ed5ng h\u1ee3p:<br \/>\n\uf02dHi\u1ec7u qu\u1ea3 t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u th\u1ea5y \u0111\u01b0\u1ee3c sau khi d\u00f9ng thu\u1ed1c 1 \u2013 2 tu\u1ea7n, r\u00f5 r\u00e0ng nh\u1ea5t l\u00e0 sau 3 \u2013 6 tu\u1ea7n d\u00f9ng thu\u1ed1c.<br \/>\n\uf02dHi\u1ec7u qu\u1ea3 thu\u1ed1c \u0111\u1ec3 ki\u1ec3m so\u00e1t b\u1ec7nh (ki\u1ec3m so\u00e1t ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p) k\u00e9o d\u00e0i ch\u1ec9 th\u1ea5y \u0111\u01b0\u1ee3c \u1edf &lt; 50% tr\u01b0\u1eddng h\u1ee3p. Do \u0111\u00f3, \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh Basedow c\u00f3 th\u1ec3 t\u00e1i ph\u00e1t sau 6 th\u00e1ng ng\u01b0ng \u0111i\u1ec1u tr\u1ecb kh\u00e1ng gi\u00e1p.<br \/>\n\uf0b6C\u00e1ch d\u00f9ng thu\u1ed1c \u2013 Li\u1ec1u l\u01b0\u1ee3ng:<br \/>\nD\u00f9ng thu\u1ed1c bao g\u1ed3m 2 giai \u0111o\u1ea1n:<br \/>\n\u2665 Giai \u0111o\u1ea1n kh\u1edfi tr\u1ecb:<br \/>\n\uf02dGiai \u0111o\u1ea1n n\u00e0y t\u00ednh t\u1eeb l\u00fac b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i b\u00ecnh gi\u00e1p.<br \/>\n\uf02dLi\u1ec1u l\u01b0\u1ee3ng trong giai \u0111o\u1ea1n n\u00e0y:<br \/>\nPTU: 6 \u2013 12 vi\u00ean chia 2 \u2013 3 l\u1ea7n\/ng\u00e0y (li\u1ec1u 300 \u2013 600 mg chia 2 \u2013 3 l\u1ea7n\/ng\u00e0y).<br \/>\nImidazole: 4 \u2013 8 vi\u00ean\/ng\u00e0y u\u1ed1ng 1 l\u1ea7n trong ng\u00e0y v\u00e0o bu\u1ed5i s\u00e1ng (li\u1ec1u 20 \u2013 40 mg\/ng\u00e0y).<br \/>\n\uf02dTrong giai \u0111o\u1ea1n n\u00e0y ph\u1ea3i cho b\u1ec7nh nh\u00e2n t\u00e1i kh\u00e1m m\u1ed7i tu\u1ea7n \u0111\u1ec3 quan s\u00e1t v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng do \u0111i\u1ec1u tr\u1ecb. \u0110\u1ed3ng th\u1eddi m\u1ed7i 4 \u2013 6 tu\u1ea7n ph\u1ea3i cho b\u1ec7nh nh\u00e2n x\u00e9t nghi\u1ec7m l\u1ea1i TSH v\u00e0 FT3 v\u00e0 FT4 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<br \/>\n\u2665 Giai \u0111o\u1ea1n duy tr\u00ec:<br \/>\n\uf02dT\u00ednh t\u1eeb khi b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u00ecnh gi\u00e1p cho t\u1edbi khi b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 nh\u1eefng ti\u00eau chu\u1ea9n \u0111\u1ec3 ng\u1eebng thu\u1ed1c kh\u00e1ng gi\u00e1p.<br \/>\n\uf02dLi\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c trong giai \u0111o\u1ea1n duy tr\u00ec: \u0111\u1ed1i v\u1edbi c\u1ea3 hai nh\u00f3m thu\u1ed1c PTU v\u00e0 Imidazole l\u00e0 1 \u2013 2 vi\u00ean\/ng\u00e0y.<br \/>\n\uf02dTh\u1eddi gian duy tr\u00ec th\u01b0\u1eddng t\u00f9y v\u00e0o nguy\u00ean nh\u00e2n v\u00e0 m\u1ee5c \u0111\u00edch, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1eeb 6 th\u00e1ng \u0111\u1ebfn 20 n\u0103m ho\u1eb7c h\u01a1n.<br \/>\nTi\u00eau chu\u1ea9n c\u00f3 th\u1ec3 ng\u1eebng thu\u1ed1c kh\u00e1ng gi\u00e1p:<\/p>\n<ul>\n<li>D\u00f9ng thu\u1ed1c kh\u00e1ng gi\u00e1p li\u1ec1u th\u1ea5p sau m\u1ed9t th\u1eddi gian nh\u01b0ng kh\u00f4ng th\u1ea5y b\u1ec7nh t\u00e1i ph\u00e1t<\/li>\n<li>Th\u1ec3 t\u00edch tuy\u1ebfn gi\u00e1p tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng (18 \u2013 20 cm3) tr\u00ean si\u00eau \u00e2m tuy\u1ebfn gi\u00e1p.<\/li>\n<li>Kh\u00e1ng th\u1ec3 TR-Ab trong m\u00e1u \u00e2m t\u00ednh.<\/li>\n<\/ul>\n<p>T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c:<br \/>\n\uf02dR\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a.<br \/>\n\uf02dPh\u00e1t ban, n\u1ed5i m\u1ec1 \u0111ay.<br \/>\n\uf02d\u0110au kh\u1edbp.<br \/>\n\uf02dM\u1ea5t v\u1ecb gi\u00e1c.<br \/>\n\uf02dV\u00e0ng da t\u1eafc m\u1eadt.<br \/>\n\uf02dR\u1ee5ng t\u00f3c.<br \/>\n\uf02dGi\u1ea3m b\u1ea1ch c\u1ea7u tho\u00e1ng qua.<\/p>\n<p>\uf020M\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t.<br \/>\n\uf02dLupus ban \u0111\u1ecf do thu\u1ed1c.<br \/>\n\uf02dVi\u00eam gan.<br \/>\n\uf02dH\u1ed9i ch\u1ee9ng Lyel.<br \/>\n\uf02dH\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<br \/>\n\uf02dThi\u1ebfu m\u00e1u.<br \/>\n\uf02d\u0110au \u0111a kh\u1edbp.<br \/>\n\uf02dVi\u00eam m\u1ea1ch<br \/>\n<strong>1.2 Iode v\u00f4 c\u01a1:<\/strong><br \/>\n<strong>\u00a0C\u00e1c d\u1ea1ng ch\u1ebf ph\u1ea9m iode v\u00f4 c\u01a1:<\/strong><br \/>\n\uf02d dd Lugol 1% (1ml c\u00f3 25mg iod); li\u1ec1u 20-60 gi\u1ecdt\/ng\u00e0y (25-75mg).<br \/>\n\uf02d dd Lugol 5% (1ml c\u00f3 125mg iod); li\u1ec1u 10-20 gi\u1ecdt\/ng\u00e0y (63-125mg).<br \/>\n\uf02d dd IK b\u00e3o ho\u00e0 (SSKI);1gi\u1ecdt c\u00f3 50mg iod), li\u1ec1u 1-4 gi\u1ecdt\/ng\u00e0y<br \/>\n\uf02d vi\u00ean KI, d\u00f9ng 300 &#8211; 600mg m\u1ed7i ng\u00e0y.<br \/>\n<strong>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a iode v\u00f4 c\u01a1:<\/strong><br \/>\n\u1ee8c ch\u1ebf nhanh s\u1ef1 gi\u1ea3i ph\u00f3ng hormone gi\u00e1p, l\u00e0m t\u1ebf b\u00e0o gi\u00e1p tr\u1edf l\u1ea1i k\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng. Kh\u00f4ng s\u1eed d\u1ee5ng iod v\u00f4 c\u01a1 \u0111\u01a1n \u0111\u1ed9c m\u00e0 c\u1ea7n ph\u1ed1i h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng gi\u00e1p \u0111\u1ec1 ph\u00f2ng hi\u1ec7n t\u01b0\u1ee3ng tho\u00e1t \u1ee9c ch\u1ebf. C\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng gi\u00e1p tr\u01b0\u1edbc khi d\u00f9ng iode 1-2 gi\u1edd.<br \/>\n<strong>Ch\u1ec9 \u0111\u1ecbnh c\u1ee7a iode v\u00f4 c\u01a1:<\/strong><br \/>\n\uf02d \u0110i\u1ec1u tr\u1ecb c\u01a1n b\u00e3o gi\u00e1p<br \/>\n\uf02d Chu\u1ea9n b\u1ecb ti\u1ec1n ph\u1eabu c\u1eaft tuy\u1ebfn gi\u00e1p ho\u1eb7c c\u00e1c ph\u1eabu thu\u1eadt kh\u00e1c \u1edf BN c\u01b0\u1eddng gi\u00e1p ch\u01b0a \u1ed5n.<br \/>\n\uf02d \u0110i\u1ec1u tr\u1ecb thay th\u1ebf thu\u1ed1c kh\u00e1ng gi\u00e1p khi b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 n\u1eb7ng ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng, li\u1ec7u tr\u00ecnh s\u1eed d\u1ee5ng trung b\u00ecnh 10-15 ng\u00e0y.<br \/>\n<strong>1.3 Thu\u1ed1c \u1ee9c ch\u1ebf beta giao c\u1ea3m:<\/strong><br \/>\nD\u00f9ng \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u0111\u1ebfn b\u00ecnh gi\u00e1p th\u00ec gi\u1ea3m li\u1ec1u. C\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m d\u1ea7n n\u1ed3ng \u0111\u1ed9 thyroxine m\u00e1u n\u00ean gi\u1ea3m h\u1ed3i h\u1ed9p, run, lo \u00e2u, \u0111\u1ed5 m\u1ed3 h\u00f4i, ti\u00eau ch\u1ea3y v\u00e0 b\u1ec7nh l\u00fd c\u01a1 g\u1ed1c chi.<br \/>\n\uf02d C\u00e1c thu\u1ed1c v\u00e0 li\u1ec1u l\u01b0\u1ee3ng: Ch\u1ec9nh li\u1ec1u theo t\u1ea7n s\u1ed1 tim v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng.<br \/>\n\uf0a7 Propranolol 60-160mg\/ng\u00e0y, chia 3\u20134 l\u1ea7n. N\u00ean d\u00f9ng TM khi x\u1eed tr\u00ed c\u01a1n b\u00e3o gi\u00e1p.<br \/>\n\uf0a7 Atenolol 25-100mg\/ng\u00e0y.<br \/>\nKh\u1edfi d\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p sau \u0111\u00f3 t\u0103ng d\u1ea7n li\u1ec1u.<br \/>\n\uf02d N\u1ebfu ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1ee9c ch\u1ebf beta th\u00ec c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng Verapamil, Diltiazem \u0111\u1ec3 gi\u1ea3m t\u1ea7n s\u1ed1 tim.<\/p>\n<h2>2. \u0110i\u1ec1u tr\u1ecb iode \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1:<\/h2>\n<p><strong>2.1 C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng:<\/strong><br \/>\n&#8211; 131I t\u1eadp trung t\u1ea1i tuy\u1ebfn gi\u00e1p s\u1ebd ph\u00e1 h\u1ee7y nhu m\u00f4 tuy\u1ebfn t\u1ea1i ch\u1ed7. Tia ph\u00f3ng x\u1ea1 s\u1ebd g\u00e2y m\u1ed9t vi\u00eam gi\u00e1p m\u1ea1nh do nhi\u1ec5m x\u1ea1, ti\u1ebfp sau \u0111\u00f3 l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh x\u01a1 ho\u00e1 m\u00f4 k\u1ebd v\u00e0 teo t\u1ebf b\u00e0o tuy\u1ebfn gi\u00e1p t\u0103ng d\u1ea7n, l\u00e0m gi\u1ea3m t\u1ed5ng h\u1ee3p hormone gi\u00e1p.<br \/>\n&#8211; Sau khi cho li\u1ec1u \u0111i\u1ec1u tr\u1ecb, tuy\u1ebfn gi\u00e1p s\u1ebd gi\u1ea3m th\u1ec3 t\u00edch v\u00e0 \u0111\u1ea1t b\u00ecnh gi\u00e1p sau 6 &#8211; 12 tu\u1ea7n.<br \/>\n&#8211; Hi\u1ec7n nay, \u0111\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c ch\u1ecdn l\u1ef1a do hi\u1ec7u qu\u1ea3 cao, kinh t\u1ebf v\u00e0 kh\u00f4ng c\u00f3 ph\u1ea3n \u1ee9ng ph\u1ee5 nghi\u00eam tr\u1ecdng.<br \/>\n<strong>2.2 Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb iode \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1:<\/strong><br \/>\nC\u00f3 th\u1ec3 \u00e1p d\u1ee5ng cho \u0111a s\u1ed1 BN tr\u00ean 20 tu\u1ed5i.<br \/>\n&#8211; B\u1ec7nh t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n, kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c.<br \/>\n&#8211; Kh\u00f3 kh\u0103n trong theo d\u00f5i (ng\u01b0\u1eddi l\u1edbn tu\u1ed5i).<br \/>\n&#8211; Kh\u00f4ng dung n\u1ea1p c\u00e1c thu\u1ed1c kh\u00e1ng gi\u00e1p.<br \/>\n<strong>2.3 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh iode ph\u00f3ng x\u1ea1:<\/strong><br \/>\nCh\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i: ph\u1ee5 n\u1eef c\u00f3 thai.<br \/>\n<strong>2.4 Li\u1ec1u s\u1eed d\u1ee5ng:<\/strong><br \/>\nLi\u1ec1u trung b\u00ecnh 80-150 pCi\/gam kh\u1ed1i l\u01b0\u1ee3ng m\u00f4 tuy\u1ebfn gi\u00e1p \u01b0\u1edbc t\u00ednh.<br \/>\n<strong>2.5 C\u00e1ch s\u1eed d\u1ee5ng:<\/strong><br \/>\n\u1ede nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n gi\u00e0, suy tim, nhi\u1ec5m \u0111\u1ed9c gi\u00e1p n\u1eb7ng, tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 t\u00edch l\u1edbn (&gt;100 gam), n\u00ean \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c KGTH (\u01b0u ti\u00ean ch\u1ecdn Carbimazole h\u01a1n PTU) \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u00ecnh gi\u00e1p v\u00e0 ng\u01b0ng 1 tu\u1ea7n tr\u01b0\u1edbc tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb iod ph\u00f3ng x\u1ea1.<\/p>\n<h2>3. \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1ead t c\u1eaft gi\u1ea3m tuy\u1ebfn gi\u00e1p g\u1ea7n to\u00e0n ph\u1ea7n<\/h2>\n<p><strong>3.1 Ch\u1ec9 \u0111inh:<\/strong><br \/>\n&#8211; B\u1ec7nh t\u00e1i ph\u00e1t sau nhi\u1ec1u l\u1ea7n sau \u0111i\u1ec1u tr\u1ecb thu\u1ed1c.<br \/>\n&#8211; B\u01b0\u1edbu gi\u00e1p qu\u00e1 to (&gt;150gam).<br \/>\n&#8211; C\u01b0\u1eddng gi\u00e1p \u1edf ph\u1ee5 n\u1eef c\u00f3 thai \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<br \/>\n&#8211; Kh\u00f4ng dung n\u1ea1p ho\u1eb7c b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 n\u1eb7ng v\u1edbi c\u00e1c thionamides.<br \/>\n<strong>3.2 Chu\u1ea9n b\u1ecb:<\/strong><br \/>\n&#8211; T\u1ed1t nh\u1ea5t n\u00ean \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u1ea1t b\u00ecnh gi\u00e1p tr\u01b0\u1edbc khi m\u1ed5.<br \/>\n&#8211; B\u1ed5 sung iode v\u00f4 c\u01a1 kho\u1ea3ng 2 tu\u1ea7n tr\u01b0\u1edbc PT (SSKI 5gi\u1ecdt, 2l\u1ea7n\/ng\u00e0y).<br \/>\n<strong>3.3 Theo d\u00f5i sau m\u1ed5:<\/strong><br \/>\nX\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gi\u00e1p \u0111\u1ec3 ph\u00e1t hi\u1ec7n suy gi\u00e1p ho\u1eb7c c\u01b0\u1eddng gi\u00e1p t\u00e1i ph\u00e1t.<br \/>\n<strong>3.4 Tai bi\u1ebfn do ph\u1eabu thu\u1eadt:<\/strong><br \/>\n&#8211; C\u00f3 th\u1ec3 c\u00f3 suy gi\u00e1p nh\u1eb9 t\u1ef1 h\u1ed3i ph\u1ee5c trong v\u00f2ng 4-6 tu\u1ea7n.<br \/>\n&#8211; Suy ph\u00f3 gi\u00e1p kho\u1ea3ng 3%.<br \/>\n&#8211; Li\u1ec7t d\u00e2y th\u1ea7n kinh qu\u1eb7t ng\u01b0\u1ee3c.<br \/>\nNh\u1eadn th\u1ea5y: \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 n\u00f3i l\u00e0 second line n\u1ebfu nh\u01b0 \u0111i\u1ec1u tr\u1ecb iode ph\u00f3ng x\u1ea1 c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00ec b\u1ec7nh nh\u00e2n c\u00f3 thai ho\u1eb7c b\u01b0\u1edbu gi\u00e1p qu\u00e1 to l\u00e0m b\u1ec7nh nh\u00e2n ph\u1ea3i ch\u1ecbu m\u1ed9t li\u1ec1u ph\u00f3ng x\u1ea1 qu\u00e1 l\u1edbn. Tuy nhi\u00ean \u1edf Vi\u1ec7t Nam \u01b0u ti\u00ean l\u1ea1i l\u00e0 ph\u1eabu thu\u1eadt v\u00ec r\u1eb1ng kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n \u0111\u1ec3 th\u1ef1c hi\u1ec7n li\u1ec7u ph\u00e1p ph\u00f3ng x\u1ea1 nh\u01b0 \u1edf n\u01b0\u1edbc ngo\u00e0i.<\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/docs.google.com\/document\/d\/1W1zyq8ZN9oeUPM7tS0JxmTkk3PTR60vzz0NffYoxQxc\/edit?usp=sharing\">C\u01b0\u1eddng gi\u00e1p &#8211; Kh\u00e1m ph\u00e1 kh\u00e1i ni\u1ec7m v\u00e0 tri\u1ec7u ch\u1ee9ng trong l\u0129nh v\u1ef1c y h\u1ecdc<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p tr\u00ean l\u00e2m s\u00e0ng, \u0111\u1ea7u ti\u00ean tr\u01b0\u1edbc khi b\u1eaft tay v\u00e0o \u0111i\u1ec1u tr\u1ecb ph\u1ea3i x\u00e1c \u0111\u1ecbnh \u0111\u00e2y l\u00e0 h\u1ed9i ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c gi\u00e1p do c\u01b0\u1eddng gi\u00e1p hay nhi\u1ec5m \u0111\u1ed9c gi\u00e1p kh\u00f4ng do c\u01b0\u1eddng gi\u00e1p. \u0110i\u1ec1u tr\u1ecb c\u01b0\u1eddng gi\u00e1p d\u00f9 cho b\u1ea5t k\u00ec nguy\u00ean nh\u00e2n g\u00ec c\u0169ng lu\u00f4n b\u1eaft \u0111\u1ea7u b\u1eb1ng \u0111i\u1ec1u tr\u1ecb [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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