Tap 5-so 4/2010 TAP CHi Y pgOC LAM SANG 108
N g h i e n c i r u d a c d i e m l a m s a n g , c a n l a m s a n g c u a b e n h n h a n s u y giap tai tuyen
Clinical and laboratory features of primary hypothyroidism Hoang Tien Hirng, Nguyen Khoa Dieu Van Benh vien Bach Mai Tom tat
Suy giap, dac biet la suy giap tai tuyen ngay nay dang la mdt van de dang quan tam. Vdi muc tieu md ta dac diem lam sang,can lam sang cua benh nhan suy giap tai tuyen, bang phUdng phap dieu tra cat ngang, tac gia da nghien ctfu 80 benh nhan suy giap tai tuyen phat hien lan dau tien va dUdc dieu tri ndi tru tai khoa Ndi tiet- dai thao dUdng Benh vien Bach Mai. Ket qua nghien ctfu cho thay: trieu chtfng hay gap cua suy giap tai tuyen la met mdi, chiem 85%, bieu hien da niem mac chiem 72,1%, cham chap 63,8%; sd lanh chiem 61,3%; cac trieu chtfng ve tim mach va HA it gap nhat (mach cham 3,8; HA thap 12,5%). Cac TC can lam sang ndi bat la FT4 giam va TSH tang dac biet nong do anti-TPO tang cao d nhdm suy giap do viem tuyen giap man tinh Hashimoto. Ket luan: Trieu chtfng lam sang cua benh thudng da dang va khdng dac hieu. Chan doan benh chu yeu dtfa vao cac xet nghiem can lam sang.
Summary
Backgrounds: Hypothyroidism, especially primary hypothyroidism is subtle disease but it can affect much to quality of life. All clinicians should know clinical and laboratory features of hypothyroidism to recognize this disease at earlier stage. Objectives: Describe clinical and laboratory features of primary hypothyroidism. Methods: This cross-sectional study was carried out in 80 patients who have been diagnosed as primary hypothyroidism for the first time, and managed at Department of Endocrinology, Bach Mai hospital from Oct 2008 to Oct 2009. Results: Fatigue is present in 85% patients. Other common symptoms of primary hypothyroidism are dry and yellow skin; sluggishness; and cold intolerance (72.1%; 63.8% and 61.3% respectively). Cardiovascular symptoms are rare (bradycardia is in 3.8% and hypotension is in 12.5%
patients). Remarkable laboratory features are low FT4 and high TSH level, especially great increase Anti-TPO level in group of patients suffer from Hashimoto's (chronic) thyroiditis. Conclusions: Clinical signs and symptoms of primary hypothyroidism are variable and atypical. The specific diagnosis is confirmed by laboratory tests.
1. Oat van de
Suy giap la hdi chtfng dac trUng bang tinh trang suy giam chtfc nang tuyen giap, san xuat hormon tuyen giap khdng day du so vdi nhu cau cua cd the, gay nen td'n thUdng d cac md, cd quan, cac rdi loan chuye'n hda tren lam sang, xet nghiem.
Suy giap gay ra cac rdi loan chuye'n hda d moi cd quan va to chtfc trong cd the vdi dac diem xuat hien cac trieu chtfng lam sang ttf ttf so vdi bien ddi ndng do hormon tuyen giap trong mau. Chinh vi vay chan doan benh thudng mudn, khi benh nhan da cd cac bien chtfng nang de doa tinh mang ngUdi benh. Tuy vay, neu nam vtfng cac trieu chtfng lam sang cua benh, cd the phat hien sdm dtfdc benh, dieu tri rat hieu qua, ddn gian, chi phi dieu tri thap, benh nhan
cd the nhanh chdng hdi phuc. Do vay chung tdi nghien ctfu de tai nay vdi muc tieu sau: Nghien cuv dac diem lam sang, can lam sang d benh nhan suy giap tai tuyen.
2. Ooi ttfdng va phtfdng phap nghien ciru - Ddi tUdng nghien ctfu: Tat ca benh nhan dUdc chan doan suy giap tai tuyen (SGTT) lan dau tien va dieu tri ndi tru tai khoa Ndi tiet - Dai thao dUdng Benh vien Bach Mai. Loai trtf khdi nghien ctfu nhtfng benh nhan da dtfdc chan doan suy giap va dang dieu tri hormon tuyen giap thay the, suy giap do nguyen nhan ngoai tuyen giap, suy giap do nguyen nhan tren cao, suy da tuyen va benh nhan khdng ddng y iham gia vao nghien ctfu.
Phan bien khoa hgc: PGS.TS. PHAM NGUYEN SON
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.5-N°4/2010 - Thdi gian nghien ctfu: ttf thang 10/2008 den - PhUdng phap nghien ctfu: Stf dung phUdng thang 10/2009. phap nghien ctfu mo ta cat ngang.
- C3 mau: Chpn mau khong xac suat.
3. Ket qua nghien ctfu Nhip tim cham
Tang HA B0 mat tho a Tao bon Dau ngyc Tang can Giong khan Rung long toe
So lanh Cham chap Bieu hien da
Met moi o%
7J 12.50%
-ZTJ16
10%
30%
22.50°/
j23.80p/o I7J26 20%
]46.20%
146.20%
I 61.30%
Z]63.8C ] 71.20%
20% 30% 40% 50% 60% 70%
I 85%
80% 90%
Bieu dd 1. Trieu chtfng lam sang Met moi la trieu chtfng thudng gap nhat, chiem ty le 85%.
anti-TPO Ul/ml 1000 800 600 400 300 200 100
34 ••• •
• •
• 9 0
Nguyen nhan SGTT VTG Hashimoto Sau dieu tri Sau phau thuat Cac nguyen
1-131 tuyen giap nhan khac
Bieu dd 2. Nong dp anti-TPO d cac nhdm nguyen nhan gay suy giap tai tuyen.
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Tap 5 - so 4/2010 TAP CHI Y DUOC LAM SANG 108 Nhan xet: Anti-TPO tang cao d cac benh nhan SGTT do viem tuyen giap man ti'nh Hashimoto, trung binh la 357,08 Ul/ml.
TSH
O Observed Linear
Bieu do 3. TUdng quan giira FT3-TSH d benh nhan suy giap tai tuyen
TSH
CO o
o o o
O Observed Linear
FT4
Bieu do 4. TUOng quan giiia FT4-TSH d benh nhan suy giap tai tuyen
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.5 - NM/2010 4. Ban luan
4.1. Lam sang
Met moi la trieu chu'ng thifdng gap nhat song lai khong phai la trieu chirng dac hieu. Cung do khong phai la trieu chu'ng dac hieu cua benh nen benh nhan thUdng khdng di kham benh hoac cd di kham benh thi thudng kham d rat nhieu chuyen khoa khac nhau nen phat hien benh thudng mudn.
Cac trieu chdng khac cung chi gap vdi ty le nhd hdn 71%. Khdng cd trieu chdng nao dac hieu cho benh.
4.2. Can lam sang
Trong nghien ciru cua chung tdi tat ca cac benh nhan deu cd FT3 giam, mffc dd giam khdng cd sif khac biet giffa cac nhdm nguyen nhan khac nhau, vdi p>0.05. Ndng dd FT4 d nhdm nguyen nhan SGTT do viem tuyen giap man tinh Hashimoto giam thap nhat so vdi cac nhdm nguyen nhan khac. Chung tdi nhan thay ty le cac trieu chffng va bien chffng cung gap cao nhat d cac nhdm cd ndng dp FT4 thap, cao hdn han so vdi cac nhdm. Cd sff tffdng quan ty le nghich chat che giffa ndng dp FT3, FT4 va TSH d benh nhan suy giap tai tuyen.
Trpng nghien effu cua chung tdi, Iffdng anti-TPO cac nhat d nhdm SGTT dp viem tuyen giap man tinh Hashimoto.Cac benh nhan viem tuyen giap man ti'nh Hashimctp cd suy giap can lam sang thi chae chan se chuyen thanh suy giap thffc sif. Thee nghien effu Whichkham, trong 20 nam, ve lam sang va sinh hoa, ty le chuye'n thanh suy giap la 55% d phu nff neu cd ndng dp anti-TPO tang cao. Cd sff lien quan mat thiet giffa tang cao ndng dp anti-TPO d benh nhan SGTT dp viem tuyen giap man tinh Hashimpto va cac bien chffng ciia benh. Do dd neu benh nhan cd ndng dp anti-TPO tang cac ma chua cd suy giap thi can theo ddi va xet nghiem hormon tuyen giap dinh
ky hang nam de phat hien sdm suy giap va dieu tri kjp thdi.
5. Ke't luan
- Trieu chffng lam sang hay gap cua SGTT la met mdi 85%.
- 100% benh nhan SGTT cd FT3, FT4 thap va TSH tang cao: ndng dp FT3 trung binh la 2,33 ±
l,40pmpl/l, ndng dp FT4 trung binh la 5,85 ± 5,33 pmol/1.
- Ndng dp anti -TPO tang cao nhat d nhdm SGTT do viem tuyen giap man tinh Hashimoto, trung binh la 357,08 Ul/ml.
Tai lieu tham khao
1. Mai The Trach, Nguyen Thy Khue (2003), "Suy giap", Ndi tiet hpc dai cUdng, Nha xuat ban Y hpc Thanh phd HP Chi Minh, tr. 163-171.
2. Evans, Timothy C, M.D (2003), "Thyroid disease", Primary Care: Clinics in Office Practice, p. 625-640.
3. Janet E.Hall and Lynnette K.Nieman (2003),
"Evaluation of Thyroid Function", Handbook of Diagnostic Endocrinology, p. 107-119.
4. Ladenson, Paul W., M.D. et al. (2000), "American Thyroid Association Guidelines for Detection of Thyroid Dysfunction", Archives of Internal
Medeccine, p. 1573-1575.
5. Surks, Martin I., MD. (1990), "American Thyroid Association Guidelines for Use of Laboratory Test in Thyroid Disorders", Journal of the American Medical Association, p. 1529-1532.
6. Toft AD, Beckett GJ. (2003), "Thyroid function tests and hypothyroidism", JAMA, 326: p. 295-296.
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