{"id":6098,"date":"2019-04-04T00:07:44","date_gmt":"2019-04-03T17:07:44","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=6098"},"modified":"2019-04-04T00:07:44","modified_gmt":"2019-04-03T17:07:44","slug":"ca-lam-sang-dieu-tri-benh-basedow","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/ca-lam-sang-dieu-tri-benh-basedow\/","title":{"rendered":"Ca l\u00e2m s\u00e0ng \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n m\u1edbi kh\u1edfi ph\u00e1t b\u1ec7nh Basedow"},"content":{"rendered":"<h2>\u0110\u00e2u l\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho m\u1ed9t b\u1ec7nh nh\u00e2n m\u1edbi kh\u1edfi ph\u00e1t b\u1ec7nh Basedow v\u1edbi bi\u1ec3u hi\u1ec7n s\u00fat c\u00e2n, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c m\u1ed7i ng\u00e0y trong su\u1ed1t 4 th\u00e1ng, nh\u1ecbp nhanh xoang v\u00e0 t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng?<\/h2>\n<p>A. Ch\u1ec9 d\u00f9ng propranolol<br \/>\nB. Ph\u1ed1i h\u1ee3p methimazole v\u00e0 propranolol<br \/>\nC. Ph\u1ed1i h\u1ee3p propylthiouracil v\u00e0 propranolol<br \/>\nD. Ch\u1ec9 d\u00f9ng methimazole<br \/>\nE. Ch\u1ec9 d\u00f9ng propylthiouracil<\/p>\n<p>\u0110\u00e1p \u00e1n: B.<\/p>\n<p>\u0110i\u1ec3m then ch\u1ed1t: \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u ph\u00f9 h\u1ee3p nh\u1ea5t cho m\u1ed9t b\u1ec7nh nh\u00e2n m\u1edbi kh\u1edfi ph\u00e1t b\u1ec7nh Basedow, bi\u1ec3u hi\u1ec7n s\u00fat c\u00e2n, nh\u1ecbp nhanh xoang v\u00e0 \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c l\u00e0 methimazole ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t thu\u1ed1c ch\u1eb9n beta.<\/p>\n<h2>Gi\u1ea3i th\u00edch chi ti\u1ebft:<\/h2>\n<p>B\u1ec7nh Basedow l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n t\u1ef1 mi\u1ec5n v\u1ec1 tuy\u1ebfn gi\u00e1p \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng gi\u00e1p. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 bao g\u1ed3m \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, \u0111i ngo\u00e0i nhi\u1ec1u, run, ch\u1ecbu nhi\u1ec7t k\u00e9m, s\u00fat c\u00e2n, m\u1ea5t ng\u1ee7 v\u00e0 v\u00e3 m\u1ed3 h\u00f4i. C\u00e1c d\u1ea5u hi\u1ec7u tr\u00ean x\u00e9t nghi\u1ec7m l\u00e0 suy gi\u1ea3m n\u1ed3ng \u0111\u1ed9 hormone k\u00edch th\u00edch tuy\u1ebfn gi\u00e1p (TSH) v\u00e0 t\u0103ng n\u1ed3ng \u0111\u1ed9 hormon gi\u00e1p ngo\u1ea1i vi, th\u00f4ng th\u01b0\u1eddng T3 t\u0103ng nhi\u1ec1u h\u01a1n T4. X\u00e9t nghi\u1ec7m kh\u00e1ng th\u1ec3 kh\u00e1ng th\u1ee5 th\u1ec3 thyrotroponin c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u v\u1edbi b\u1ec7nh Basedow. Ch\u1ee5p iod ph\u00f3ng x\u1ea1 24 gi\u1edd cho h\u00ecnh \u1ea3nh h\u1ea5p th\u1ee5 b\u00ecnh th\u01b0\u1eddng, lan to\u1ea3, \u0111\u1ed3ng nh\u1ea5t v\u1edbi t\u1ec9 l\u1ec7 &gt;10%. Kh\u00e1m th\u1ef1c th\u1ec3 th\u1ea5y nh\u1ecbp nhanh xoang, b\u01b0\u1edbu gi\u00e1p, l\u1ed3i m\u1eaft, d\u1ea5u hi\u1ec7u mi m\u1eaft ch\u1eadm ch\u1ea1p (lid lag), run t\u01b0 th\u1ebf v\u00e0 t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng.<\/p>\n<p>Tr\u00e1i v\u1edbi t\u00ecnh tr\u1ea1ng c\u01b0\u1eddng gi\u00e1p tri\u1ec7u ch\u1ee9ng, bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a c\u01a1n b\u00e3o gi\u00e1p bao g\u1ed3m s\u1ed1t r\u1ea5t cao, co gi\u1eadt, h\u00f4n m\u00ea, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, suy tim sung huy\u1ebft, \u0111au b\u1ee5ng v\u00e0 v\u00e0ng da kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.<\/p>\n<p>C\u1ea7n b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb n\u1ebfu b\u1ec7nh nh\u00e2n Basedow c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng. C\u00e1c thionamide, nh\u01b0 methimazole v\u00e0 propylthiouracil, c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p hormone tuy\u1ebfn gi\u00e1p v\u00e0 c\u00f2n c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u ho\u00e0 mi\u1ec5n d\u1ecbch. Propylthiouracil c\u0169ng \u1ee9c ch\u1ebf bi\u1ebfn \u0111\u1ed5i T4 th\u00e0nh T3, nh\u01b0ng c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n h\u01a1n (nh\u01b0 \u0111\u1ed9c v\u1edbi gan) v\u00e0 T1\/2 ng\u1eafn h\u01a1n methimazole; ngo\u00e0i ra, methimazole c\u00f3 th\u1ec3 d\u00f9ng 1 ho\u1eb7c 2 l\u1ea7n\/ng\u00e0y, trong khi propylthiouracil ph\u1ea3i d\u00f9ng \u00edt nh\u1ea5t 3 l\u1ea7n\/ng\u00e0y m\u1edbi c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3 s\u1ef1 t\u1ed5ng h\u1ee3p hormon gi\u00e1p. Do \u0111\u00f3, n\u00f3i chung methimazole \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb Basedow.<\/p>\n<p>C\u00e1c thu\u1ed1c ch\u1eb9n beta nh\u01b0 propanolol ch\u1ed1ng l\u1ea1i t\u00e1c d\u1ee5ng c\u1ee7a T3 tr\u00ean tim v\u00e0 h\u1ec7 th\u1ea7n kinh giao c\u1ea3m, \u1ee9c ch\u1ebf chuy\u1ec3n T4 th\u00e0nh T3. C\u00e1c thu\u1ed1c n\u00e0y gi\u1ea3m c\u00f3 hi\u1ec7u qu\u1ea3 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, lo \u00e2u v\u00e0 run \u1edf b\u1ec7nh nh\u00e2n c\u01b0\u1eddng gi\u00e1p, do v\u1eady c\u1ea7n d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi thionamide \u1edf b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5. Tuy c\u00f3 nhi\u1ec1u b\u00e1c s\u0129 l\u00e2m s\u00e0ng d\u00f9ng propanolol \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n c\u01b0\u1eddng gi\u00e1p nh\u01b0ng c\u00e1c thu\u1ed1c ch\u1eb9n beta ch\u1ecdn l\u1ecdc tr\u00ean tim nh\u01b0 atenolol v\u00e0 metoprolol c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 v\u1edbi s\u1ed1 l\u1ea7n d\u00f9ng \u00edt h\u01a1n so v\u1edbi propanolol.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p>1. Brent GA. Clinical practice. Graves&#8217; disease. N Engl J Med 2008 Jun 14; 358:2594. Link:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18550875\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18550875<\/a><\/p>\n<p>2. Ross DS et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016 Oct; 26:1343. Link:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27521067\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27521067<\/a><\/p>\n<p>Ngu\u1ed3n: NEJM.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110\u00e2u l\u00e0 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p nh\u1ea5t cho m\u1ed9t b\u1ec7nh nh\u00e2n m\u1edbi kh\u1edfi ph\u00e1t b\u1ec7nh Basedow v\u1edbi bi\u1ec3u hi\u1ec7n s\u00fat c\u00e2n, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c m\u1ed7i ng\u00e0y trong su\u1ed1t 4 th\u00e1ng, nh\u1ecbp nhanh xoang v\u00e0 t\u0103ng ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng? A. Ch\u1ec9 d\u00f9ng propranolol B. Ph\u1ed1i h\u1ee3p methimazole v\u00e0 propranolol C. Ph\u1ed1i h\u1ee3p propylthiouracil v\u00e0 propranolol [&#8230;]\n","protected":false},"author":1,"featured_media":6099,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6098","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6098","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=6098"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6098\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/6099"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=6098"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=6098"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=6098"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}