Rima K. Dhillon-Smith, Lee J. Middleton, Kirandeep K. Sunner, Versha Cheed v\u00e0 c\u1ed9ng s\u1ef1.<\/p>\n
\u0110\u0103ng tr\u00ean NEJM ng\u00e0y 23\/3\/2019. DOI: 10.1056\/NEJMoa1812537<\/p>\n
Kh\u00e1ng th\u1ec3 kh\u00e1ng peroxidase tuy\u1ebfn gi\u00e1p c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 s\u1ea3y thai v\u00e0 \u0111\u1ebb non, ngay c\u1ea3 khi ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p b\u00ecnh th\u01b0\u1eddng. M\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m c\u1ee1 m\u1eabu nh\u1ecf g\u1ee3i \u00fd r\u1eb1ng s\u1eed d\u1ee5ng levothyroxine<\/strong> c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ea7n su\u1ea5t m\u1eafc m\u1edbi c\u00e1c bi\u1ebfn c\u1ed1 kh\u00f4ng mong mu\u1ed1n n\u00f3i tr\u00ean. Th\u1ef1c t\u1ebf, c\u00e1c b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng levothyroxine nh\u01b0 v\u1eady v\u1eabn c\u00f2n ch\u01b0a c\u00f3 t\u00ednh k\u1ebft lu\u1eadn ch\u1eafc ch\u1eafn.<\/p>\n Do \u0111\u00f3, c\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 ti\u1ebfn h\u00e0nh th\u1eed nghi\u1ec7m m\u00f9 \u0111\u00f4i, so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c nh\u1eb1m nghi\u00ean c\u1ee9u xem levothyroxine<\/strong> c\u00f3 l\u00e0m t\u0103ng t\u1ec9 l\u1ec7 tr\u1ebb \u0111\u1ebb s\u1ed1ng \u1edf ph\u1ee5 n\u1eef b\u00ecnh gi\u00e1p c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng peroxidase tuy\u1ebfn gi\u00e1p v\u00e0 ti\u1ec1n s\u1eed s\u1ea3y thai ho\u1eb7c v\u00f4 sinh. C\u00f3 t\u1ed5ng c\u1ed9ng 19.585 ph\u1ee5 n\u1eef \u0111\u1ebfn t\u1eeb 49 b\u1ec7nh vi\u1ec7n \u1edf v\u01b0\u01a1ng qu\u1ed1c Anh \u0111\u01b0\u1ee3c ki\u1ec3m tra kh\u00e1ng th\u1ec3 kh\u00e1ng peroxidase v\u00e0 ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p. Trong \u0111\u00f3 952 ph\u1ee5 n\u1eef \u0111\u01b0\u1ee3c ng\u1eabu nhi\u00ean ho\u00e1 v\u00e0o m\u1ed9t trong hai nh\u00f3m d\u00f9ng 50 mcg levothyroxine 1 l\u1ea7n\/ ng\u00e0y (n=476) ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c (n=476) tr\u01b0\u1edbc khi mang thai cho \u0111\u1ebfn khi k\u1ebft th\u00fac thai k\u00ec. Ch\u1ec9 s\u1ed1 \u0111\u1ea7u ra ch\u00ednh l\u00e0 t\u1ec9 l\u1ec7 tr\u1ebb \u0111\u1ebb s\u1ed1ng sau \u00edt nh\u1ea5t 34 tu\u1ea7n thai.<\/p>\n K\u1ebft qu\u1ea3 cho th\u1ea5y t\u1ec9 l\u1ec7 theo d\u00f5i \u0111\u1ebfn h\u1ebft th\u1eddi gian ch\u1ec9 s\u1ed1 \u0111\u1ea7u ra ch\u00ednh l\u00e0 98,7% (940\/952 ph\u1ee5 n\u1eef tham gia). C\u00f3 t\u1ed5ng c\u1ed9ng 266 tr\u00ean 470 ph\u1ee5 n\u1eef \u1edf nh\u00f3m levothyroxine (56,6%) v\u00e0 274 tr\u00ean 470 ph\u1ee5 n\u1eef \u1edf nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (58,3%) \u0111\u00e3 mang thai. T\u1ec9 l\u1ec7 tr\u1ebb \u0111\u1ebb s\u1ed1ng l\u00e0 37,4% (176 tr\u00ean 470 ph\u1ee5 n\u1eef) \u1edf nh\u00f3m levothyroxine v\u00e0 37,9% (178 tr\u00ean 470 ph\u1ee5 n\u1eef) \u1edf nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i l\u00e0 0,97; kho\u1ea3ng tin c\u1eady 95% [95% CI] l\u00e0 0,83 \u0111\u1ebfn 1,14, P=0,74; \u0111\u1ed9 ch\u00eanh tuy\u1ec7t \u0111\u1ed1i l\u00e0 \u22120,4 % \u0111i\u1ec3m; 95% CI l\u00e0 \u22126,6 \u0111\u1ebfn 5,8). Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1ec1 c\u00e1c ch\u1ec9 s\u1ed1 thai ngh\u00e9n kh\u00e1c, bao g\u1ed3m s\u1ea3y thai ho\u1eb7c sinh non, hay v\u1ec1 c\u00e1c ch\u1ec9 s\u1ed1 \u0111\u1ea7u ra c\u1ee7a s\u01a1 sinh. Bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i x\u1ea3y ra \u1edf 5,9% s\u1ed1 ph\u1ee5 n\u1eef c\u1ee7a nh\u00f3m levothyroxine v\u00e0 3,8% c\u1ee7a nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (P=0,14).<\/p>\n T\u1eeb \u0111\u00f3 \u0111i \u0111\u1ebfn k\u1ebft lu\u1eadn s\u1eed d\u1ee5ng levothyroxine \u1edf ph\u1ee5 n\u1eef b\u00ecnh gi\u00e1p c\u00f3 kh\u00e1ng th\u1ec3 kh\u00e1ng peroxidase kh\u00f4ng l\u00e0m t\u0103ng t\u1ec9 l\u1ec7 tr\u1ebb \u0111\u1ebb s\u1ed1ng so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c.<\/p>\n