Tweak Thyroid 052014

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    CC BC KHO ST TUYN GIP (*)- Ct ngang mi thy t cc trncc di- Ct dc mi thy vi chiu cao ln nht- o th tich TG, bnh thng 7-11cm/thy.

    - Eo gip ct ngang v dc vi k trc-sau ln nht.- C T, c P: hch, M cnh, TM hu.- TG bnh thng: Khng thy bnh l 2 mt ct khc nhau, bao gmc hi m, s o, phn b mch mu.

    TG BNH THNG (**): Kch thc, hnh thi v th tch thay itheo tui v gii.-18-20mm chiu cao v 8-9mm b dy (AP) lc mi sanh.-25 mm chiu cao v 12-15 mm AP lc 1 tui.

    - 40-60 mm chiu cao v 13-18 mm AP lc trng thnh.Th tch bnh thng (khng k eo gip) 10-15ml/n v 12-18ml/nam.

    (*) ULTRASOUND OF THE THYROIDNormal http://www.ultrasoundpaedia.com/normal-thyroid

    (**) Thyroid ultrasound. Vikas Chaudhary, Shahina Bano. Indian Journal of Endocrinology andMetabolism / Mar-Apr 2013 / Vol 17 | Issue 2

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    ULTRASOUND OF THE THYROIDNormal http://www.ultrasoundpaedia.com/normal-thyroid/

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    1,2,3: ct ngang thy P,eo gip, thy T.4: ct dc eo gip.5: ct dc mi thy gip

    Tuyn c tr nh

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    1- Tuyn gip; 2- Kh qun; 3- Tuyn cn gip; 4- Tnh mch hu trong;5- ng mch cnh gc; 6- TK hu qut ngc; 7- M gip di

    8- C c gip; 9- C vai mng; 10- C c mng; 11- C c n chm;13- Thc qun; 14- C di c; 15- Ct sng.

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    910

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    1314

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    KHO ST MCH MU TG- TG c phn b bi M gip trn v di.- Bnh thng RI thp v PSV cao 15-30cm/s cho m trong nhu m gip.a. TG bnh thng, b. M gip di (), c. Ph M vi RI thp, PSVca

    a

    bc

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    - Th tch tuyn gip o c hai thy 8,53cm1,82, trung bnh n7,58cm3 v nam 9,72cm3 ,th tch thy P thng > T (4,48cm3so vi4,07 cm3). V= ngang x dy x cao x 0,49

    The Internet Journal of Radiology,Volume 4, Number 2Ultrasound Determination Of Thyroid Gland Volume Among Adult Nigerians

    A Ahidjo, A Tahir, M Tukur

    TNHTH TCH TUYN GIPCch tnh th tch tuyn gip cha c nht qun, nn c nhiu cch tnty theo trng phi:

    - Th tch tuyn gip = tng th tch hai thy, khng bao gm eo gipVthy= ngang x dy x cao x 0,479

    Method for determining thyroid size by ultrasonographyhttp://www.iccidd.org/cm_data/thyroid_size.pdf

    - Th tch ca mi thy v eo gip tnh theo cng thc hnh bu dc(ngang x dy x cao x /6)Thyroid Volumetric Quantification. J Ultrasound Med 2008; 27:17271733

    http://ispub.com/IJRAhttp://ispub.com/IJRA/4http://ispub.com/IJRA/4/2http://ispub.com/IJRA/4/2/8932http://ispub.com/IJRA/4/2/8932http://ispub.com/IJRA/4/2http://ispub.com/IJRA/4http://ispub.com/IJRA
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    VAI TR C A SI U M- Xc nh khi s thy c/LS nm trong hay ngoi tuyn gip.- phn loi khi s c/LS: nang, c hay hn hp- nh gi cu trc m cn li ca tuyn gip

    -Nhn nh nguyn nhn cng gip, suy gip.- Bin chng sau phu thut: p-xe, ph n- Phnh gip a ht: theo di nhn- Hng dn chc ht t bo, rt dch, sinh thit

    CHN ON PHN BiTNu bnh nhn c khi c v di ng theo nut, cc chn on ngoituyn gip c th c:- Cun m phn y ca c.

    - Hch- Nang khe mang-Nang gip thit (ng gia trn xng mng)- Khi ca tuyn cn gip

    ULTRASOUND OF THE THYROIDNormalhttp://www.ultrasoundpaedia.com/normal-thyroid/

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    CH NH SIU M TG (Theo AACE v AME*)1. Xc nhc nhn gip khi khm lm sng nghi ng.2. Tnh chtca(1 hay nhiu) nhn gip, kch thc, him v phn

    bmchmu.

    3. Phnbitnhn gip lnhc datrn cimSA.4. Phnbitnhn gip vicc khingoi TG: hch, nang gip thit,

    nang mchbchhuyt.5. nhgi thay ilan tatrong nhu m gip.

    6. nhgi m gip cn lisauphuthut, ti pht gingTG, dicnhchc.7. Theo di nhngBN nguy cK gip: tincngia nh, au nitit

    nhm II (multiple endocrine neoplasia (MEN) type II ), xtrvngc.

    8. HngdnFNA.

    (*) American Association of Clinical Endocrinologists (AACE) and Associazione MediciEndocrinologi (AME)

    Thyroid ultrasound. Vikas Chaudhary, Shahina Bano. Indian Journal of Endocrinology andMetabolism / Mar-Apr 2013 / Vol 17 | Issue 2

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    Bnhl lan ta Bnhl khu tr ChcnngTG

    Phnh gip

    Bulnhgip

    K gip

    Vim gip

    Basedow

    Phnh gip lan ta,

    1 hay 2 thy

    -----

    K gip lan ta

    1 hay 2 thy

    2 thy

    -Phnh gip n(a) nhn.

    - 1 hay nhiunang gipkeo/ 1 hay 2 thy.

    1bu/ 1 thyNhn c(ngnhthay

    khng)

    Nhn cecho km (ccnhn lnc hoitbntrong)

    Vim toht: 1 haynhiuht/ 1 hay 2 thy

    --------

    Bnh gip +++

    Cnggip +

    Bnh gip +++Cnggip + (c

    tnh)

    Bnh gip

    Bnh gipCnggip (thongqua)Suy gip

    Cnggip

    BNH HC TUYN GIP

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    NANG

    GIAP

    KEO +++

    NANG DO

    K hiem)

    PGH

    +++)

    BU LANH

    ADENOMA)

    hiem

    K GIAP VIEM

    CNG GIAP

    BASEDOW

    THUOC

    SUY GIAP

    BNH GIAP

    NHN GIP(LS HAY DI LS)

    NHN GIP DNG NANG# NANG GIP

    NHN GIP DNG C

    SAU T LM GiM THTCH TUYN GAP

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    NHN GIP(LS HAY DI LS)

    NHN GIP DNG NANG# NANG GIP

    NHN GIP DNG C

    NANGGIP

    KEO+++

    NANGDO K

    (him)

    PGH

    +++)

    BU LNH(ADENOMA)

    (him)K GIP

    VIEM

    Bnhl khu trPhnh gip

    Bulnhgip

    Phnh gip n(a)nhn. Nang gip keo/1 hay 2 thy.1bu/ 1 thy

    Nhn c(ngnht

    hay khng)

    Bnhl khu trK gip

    Vim gip

    Nhn cecho km(cc nhn lnc hoitbn trong)

    Vim toht

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    M t v tr, s lng, hnhthi, kch thc ca 1 haynhiu nhn

    B h h i

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    Benh hocac iem

    Lanh Ac

    1. Cau truc echo

    ac

    Nang

    Hon hp

    2. oecho

    Kem

    ong

    Day

    3. Gii han

    Gii han ro

    Gii han khong ro4. Halo

    Day / khong toan ven

    Mong / toan ven

    5. Voi hoa **

    Ngoai bien (voso)

    Ben trongTo

    Nho

    (1)

    (2)

    (2)

    (1)

    (3)

    (4)

    (2)

    (2)

    (4)

    (3)

    (1)

    (1)*

    (3)

    (2)

    (2)

    (3)

    (2)

    (1): Kh xc nh, c th gp. (2): c th, thng gp.(3): Kh xc nh, t gp. (4): c th.xc sut xy ra >85%.

    (*): mc d hu ht nhn c u echo km, phn ln cc nhn echo km l lnh tnh.(**): Vi ha: 13% vi ha i km vi nhn, s phn b & kiu vi ha rt quan trng.

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    1/. HT GIP DNG NANG = NANG GIP KEO:Phnlnnang gip thunggpl nang keo do kttdchkeo

    trong cc ti nang, dchstvng (Lugol). C thc 1 haynhiunang

    Lu : K gp khng bao gi biu hin di dng nang han tan

    Nang echo trng ngnht hoc c th vi

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    Nang nh, trong gii hn bnh thng, cth vi dng ui sao chi, rt hay gp

    Nang to, i khi cn thy c mt phn m gip vch nang (), c rt nhiu th vi dng ui saochi, rt hay gp

    Nhn gipdng nang#Nang gip

    keo

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    Nang gip keo xut huyt: dch echo km, c cn, vch ngn trong nang.

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    Nang gip keo xut huyt: cc mu ngc (A) v khng c (B) th vi.

    Nang gip keo xut huyt: th vi trini khp nangCPB vi vi vi ha.

    A B

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    2/. HT GIP DNG C :

    SA nh gi v tr, kch thc, hi m, cu trc echo, b vin, halo, vi ha

    v phn b mch mu

    -Nhn di v bao khi khng c m gip bao chung quanh.- Cc nhnphn bit r vi m gip cn li s c hi m: echo dy, ngecho, echo km hay echo hn hp.

    - ng vin b: u hay khng u.- Cu trc echo: ng nht hay khng ng nht.- Halo l ng vin echo trng hay echo km bao quanh nhn- Vi ha to hay nh nm trong nhn, ra nhn hay c hai- Phn tch cng v loi mch mu phn b cho cc nhn gm: loi I: khngc tn hiu mch mu; loi II: c mch mu quanh nhn, loi III: tng mch mutrong v ngoi nhn.

    Diagnosis of Thyroid Cancer in Children: Value of Gray- Scale and Power DopplerUS. Andrej Lyshchik, MD. Radiology 2005; 235:604613

    BNH HC

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    BNH HCNhn gip : thng gp l PHNH GIP A HT (PGH) nhng c tnh vs lnh tnh: khng c 1 c im SA no gip phn bit bnh l lnh hay cnn cn kt hp nhiu c im :

    -Nang vs c- n c hay a nhn- Echo km vs cc hi m khc- Halo- Vi ha to vs vi vi ha- Phn b mch mu

    TUY N GIP C TNH :- Chim 1% trong cc nhn gip, thng gp l carcinm dng nh hay nh-nang.-T l k gip gia tng khi c iu tr tia x vo vng u c.- K biu m dng nh 78%, K biu m cc tn thng dng nang 17%, K biu m dngty 4%, K biu m dng khng bit ha 1%, lymphm v di cn TG him gp.

    ULTRASOUND OF THE THYROIDNormal http://www.ultrasoundpaedia.com/normal-thyroid

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    Do tnh trng thiu it , l tn thng tng sn lnh tnh.

    PG n ht hay a ht (nodular goiter): Ht c cu trc echo rt a dng

    (tui): echo dy, ng echo, hi km hay rt km so vi ch m gip. Gii

    hn ro hay khng r khu tr 1 hay 2 thy. ng nht hay khng do ckm theo tnh trng vi ha (to trong nhn hay ngoi bin) hay ha nangtrong nhn.

    Chn an phn bit PG tuyn (adenomatous goiter) vi bu lnh TG

    hay k gip da va hnh nh SA nhiu khi khng th c.

    PG A (N) HT.

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    PG ht:ha nangt ong

    vc th

    vi

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    PG ht:khng hanang tong

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    PGH:nhn vi

    ha

    PG tuyn Ad t it

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    PG tuyn Adenomatous goiter

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    B i l h t h

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    Bu gip lnh tnhGm bu tuyn nang (Follicular adenomas) thng gp v bu tuyn nh(papillary adenomas) t gp. Bu tuyn nang gm nhiu dang m hc: dng c timnng vi xm ln: dng phi (microfollicular), dng thai (atypical), bu t bo

    Hurthle: v dng khng c xm lm: dng keo (macrofollicular), dng b trong sut(Hyalinizing trabecular).Kho CPB ton thng lanh tnh nay vi ung th giap dang nang.

    Go lbu chc nng(c tnh) # nhn nng khi bu tng chuyn ha lm tngtit hormone TG, gy hi chng cng gip.

    N,hn c n c, ng nht, c halo u quanh nhn l do v bao x, b uhnh bu dc # gi tinh hon, t l nhn echo km, hay echo dy nhiu>> nhn ngecho vi ch m gip.

    Khi cc nhn ln thng ckm theo vng ha nang bn trong: nu th tch phn

    nang < 2/3 th tch ca phn c (c > nang) #nhn gip hoa t; ngc li nu >2/3 # nang gip c chi.

    Bu nm trong nhm TN THNG DNG NANG, bao gm PG tuyn, butuyn nang, Car. dng nang, Car. dng nh bin th nang.

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    Bu tuyn nang khng hot ng

    Bu tuyn nang c tnh: ln nhanh c ha nang nh bn trong tng sinh mch mu

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    Nhn nng # bu lnh c tnh: nhn tng sinh mch mu nhiu vng ngoi bin: vntc M gip di ca thy coa nhn l 50cm/s, so vi bn bnh thng l 20cm/s

    a. Nhn echo dy,

    halo du, vi chha nang nh.b. Tng sinh mchmu ngoi bin vtrung tm hnh nan

    hoa

    Bu tuyn nang c tnh: ln nhanh, c ha nang nh bn trong, tng sinh mch munhiu.

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    Bu t bo Hurtle

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    Tn thng c tnh:

    Carcinm:Dng xut pht t biu m nang gipgm k gip dng nh, dngnang, v dng khng bit ha. Dng xut pht t t bo cnh tuyn gip:k gipdng ty.

    a/. Car. dng nh:75-90%, tin lng tt,mt hay a , nhn pht trin rt

    chm, di cn xa him v di cn hch sm (i hch). L ung th gip duy nht tr em, n > nam. 1 s trng hp c hch c di cn do ung th gip nhngkhng thy nhn gip trn i th v SA.Khi nhn kch thc ln, thy cn lid b ung th nn cn ct gip gn trn.

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    86,7% la nhan ac echo kem,khi ln hn 1 cm nhan tr nen khong ong

    nhat, gii han khong ro, 50% co vi voi hoa, t thay c hnh dang nhu trong

    nang.

    a nhn echo km 2 thy, gii hn khng r khng ng nht c

    nhng chm echo dy bn trong tng ng vi cc nt vi vi ha

    K gip dng nh c vi vi ha

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    Cc nhn echo km, gii hn khng r khngng nht c nhng chm echo dy bn trongtng ng vi cc nt vi vi ha

    K gip dng nh c vi vi ha

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    Nhn echo km, gii hn khng r kh ng nht, xm ln cn mc trc (A,C), cbao bc hon ton bi m gip (B), hay nm ngay st cn mc nhng cha xm ln (D)

    A B

    C

    K gipdng nhkhng vivi ha

    D

    K gip dng nh xm ln

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    Nhn echo dy bng m gipchim ht b dy ca thy, gii hn

    khng r xm ln cn mc truc vsau, khng ng nht c nhngchm ecgo dy () bn trongtng ng vi cc nt vi vi ha

    Nhn echo km, gii hn khng r,khng ng nht c nhng vnghoi t echo rt km bn trong vnhiu chm echo dy ri rc tngng vi cc nt vi vi ha, c dut on do xm ln cn mc vm chung quanh

    K gip dng nh xm ln

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    K gip dng nh hoi tto nang nhiu, trongphn m bu c vi viha to thnh cc vng

    echo rt dy (A,C) haykhng co vi vi ha (B)d lm vi nang gip keo

    A

    B

    C

    ac iem hach di can: mat hnh bau duc, thng hnh tron, khong con ron

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    g g

    hach echo day vung trung tam du hach kch thc nho.oi khi hach co cau truc

    echo day hn c, ong nhat, hay hoai t, co the co vi voi hoa trong hach. oi khi

    hach mang hnh anh giong nh nhan ung th nguyen phat cua TG.

    Hch di cn c vi ha t k gip dng nh

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    Hch di cn khngc vi ha, +/- c hoi t tk gip dng nh

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    Hch dicn choi tt k gipdng nh

    K giplan ta 2

    thy:nhnecho dydo vi viha

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    Phn bit cc chm echo dy trong nhn c tuyn gip: A. Cc chm echo dt trongnhn khng c du ui sao chinghi ng c tnh. B. Nhn c ch ha nang vicc chm echo dy c du ui sao chinhn lnh tnh.

    Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference

    Statement. Published online 10.1148/radiol.2373050220 Radiology 2005; 237:794800

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    b/. Car. dang nang:5-15%, ve mat hnh anh va te bao hoc kho phan biet vi cac

    u tuyen dang nang lanh tnh, PG tuyen, ung th giap dang nhu bien the nang;ch

    phan biet c bu lanh hay ac da tren vi the nh hnh anh xam lan vo bao

    va mach mau cua cac te bao nang giap.U phat trien cham, di can en phoi va

    xng nhieu hn hach co. Tien lng xau hn.

    2/3 trng hp kem theo PGnen can SA mau trong PG a hat e loai tr ung th.

    Nhan thng to, ong echohay gap hn echo kem, b halo khong eu,khong co

    vi voi hoa i kem.

    TN THNG DNG NANG (Follicular lesions): kh th h bit

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    TN THNG DNG NANG (Follicular lesions):khng th phn bitc bng siu m v t bo hc

    - Phnh gip tuyn (adenomatous goiter).

    - Bu tuyn nang (Follicular adenoma )- Ung th tuyn gip dng nang (Follicular carcinoma)

    - Ung th tuyn gip dng nh bin th nang (Follicular-papilary carcinoma)

    Phnh gip tuyn

    Bu tuyn nang

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    K giap dang nang

    K GIAP DANGNANG

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    Nhn gii hn r

    Nhn c ch gii hn r

    Nhn gii hn khng r, c

    ch xm ln m chung quanh

    c/.Car. dang khong biet hoa:1%, ngoi ln tuoi, tien lng xau do dien tien

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    nhanh. Bou cng, ln nhanh va xam lan vao cac c quan lan canc, TQ, mach

    mau, hach, gay t vong do chen ep kh quan.SA: Nhan ac echo kem hay hon

    hp, khong halo, gii han khong ro

    d/. Car. dang tuy:

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    Carcinm TG dng tykhng vi ha

    CARCINM KHNGBiT HA

    Carcinm TG dng tyc vi ha

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    NANG

    GIAP

    KEO +++

    NANG

    DO K

    hiem)

    PGH

    +++)

    BU

    LANH

    ADENOMA)

    hiem

    K GIAP VIEM

    CNG GIAP

    BASEDOWHUOCSUY GIAP

    BNH GIAP

    SAU T LM GiM TH

    TCH TUYN GAP

    BNH L CHC NNG TUYN GIP

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    VIEM GIAP VA

    ROI LOAN CHC NANG TUYEN GIAP

    I. VIEM:

    hay gap tren lam sang,bieu hien rat a dang va de gay lam lan.

    1. Viem giap ban cap (De Quervain):

    Theo mua, sau nhiem sieu vi ng ho hap tren/ n 20-25t.Co the co giai oan

    nhiem giap oc to giai oan khi benh # 4-8w (do nang tuyen giap b pha huy) roi

    t het.

    S thay TG cng va au. Hach co thng co. Dien tien suy giap hiem (5-10%),

    tuy nhien co the e lai vai nhan lanh tren xa hnh giap. Benh co the tai phat.

    SA giai oan au TG to phu ne echo kem lan toa khong ro nhan, hach co dang

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    viem. oi khi ton thng viem ch khu tru tren mot thuy hay mot vung nho cua

    thuy giap (de lam vi k) . Hnh anh viem thng ton tai trong mot thi gian dai

    nen sau ieu tr the tch TG tr ve bnh thng nhngbat thng ve hnh thai van

    con.

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    2. Viem giap lympho bao man tnh (Hashimoto):

    Benh t mien, co khuynh hng di truyen, chan oan kho.

    Dang ien hnhla TG to b khong eu, phu niem t phat, khang the khang

    giap cao, xet nghiem chc nang co tnh trang nhc giap, bat chat phong xa yeu

    va khong eu. Dien tien suy giap la khong the tranh c vi tnh trang x hoa,

    teo TG.

    Dang khong ien hnhTG to ong nhat, b hi khong eu, hormone TG bnh

    thng, TG bat xa bnh thng hay khong ong nhat, ch co TSH luon luon cao.

    Nhiem oc giap thng thoang qua, nhng co khi ton tai lau (Hashitoxicose) =

    the benh chuyen tiep gia viem giap t mien va Basedow.

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    SA: TG cngkhong to hay to t, echo kem lan toa, co the co cachat echo day

    tren nen giap echo kemdung SA mau e phan biet vi. the tien trien,

    khong con thay c cau truc echo bnh thng cua TG, ma c thay the bang

    mo echo rat kem hay echo rat day va hap thu song am manh.

    Tang nguy c ung th giap dang nhu va lymphom/ Viem co suy giap: FNAC khi

    tang nhanh the tch TG.

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    57Hashimoto khng in hnh: to nt , dy x, tng sin mch mu v

    Hashimoto c

    to ht

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    Cng gip/vim gipkhng inhnh

    3. Viem giap tao x man tnh Riedel:

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    Hiem. Viem man co tnh trang hoa x lan toa, tan pha 1 phan hay toan bo TG

    & xam lan cau truc ke can. Dien tien suy giap trong 1/3 trng hp khi mo x thay

    the het mo tuyen giap. Co the ket hp vi x hoa ni khac: sau phuc mac, ng

    mat, trung that. Sieu am khong ac hieu, co the thay 1 hay nhieu ton thng dang bu echo

    kem 1 thuy xam nhiem vao c ke can, hiem vao mach mau, thong thong de

    lam vi K.

    X ha m mm chung quanh, kh qunX ha quanh M cnh

    C i kh

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    4. Cac viem khac:

    Viem cap tao mu.

    Sieu am :vung mo giap khong to chc hoa cha dch khong ong

    nhat echo kem hay hon hp tren nen TG to echo kem lan toa.

    Nguyen nhan: viem hau hong, nhiem trung vung au co, do dng

    tieu hoa, hay suy giam mien dch, ng mau . VN con do cat le.

    Viem giap hau san: benh t mien do co khang the chong TG (= viem

    giap limpho bao ban cap): co hoi chng cng giap thoang qua, 1/3 ca suy

    giap phai T.

    Viem giang mai, lao , nam, xa tr.

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    II. Benh ly chc nang:

    1. Cng giap:la hien tng tang san xuat hormone TG lam nong o

    hormone/mau tang cao va gay nhiem oc giap

    Cng giap do tang s kch thch(nam ben ngoai TG): benh Basedow, thai trng

    hay choriocarcinoma, ung th (TSH-like) gay tang lng hormone giap lu hanh trong mau

    va c che TSH noi sinh.

    Cng giap t chu:mot phan mo giap tang sinh va tr nen cng giap nen

    kiem soat t tuyen yen b c che va lam cho mo giap nam ngoai vung ton

    thng b c che theo: u oc giap (u Plummer= nhan cng nang t chu oc tuyen),

    viem giap:mo viem phong thch nhieu hormone TG.

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    1.1/. Basedow:

    SA co 2 kieu hnh anh:_ Tang san lan toa ong nhatvi vai vung mach mau dan .

    _ 86 % TG khong ong nhat khong to chc hoa,echo kem giong nh viem gap

    hay hnh anh nhan gia.

    o at the tch tuyen giap rat can thiet sau phau thuat cat giap(tai phat 20%),

    khi co ch nh T bang iot phong xa.

    Suy giap sau phau thuat 1%, sau T iot phong xa25%.

    Ket hp vi K chiem 0,3 16,6%, dang nhu >> dang nang.

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    Basedow cha ieu tr

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    Basedow cha

    ieu tr

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    SA dung anh gia s ap ng ieu tr va tien lng kha nang tai phat.

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    Basedow a ieu tr bang thuoc KGTHPhong xa

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    1.2/. Nhan gap oc:

    Nhan nong / xa hnh TG va tang sinh mach mau / SA mau.

    Tnh oc cua nhan khong phai luon ro rang ma no co the tiem an trong

    nhieu nam.Mot so trng hp mo TG con lai b teo nho.

    SA thay c cac vung xuat huyet trong nhan, la dau hieu chng to nhan angtien trien;ong thi cho biet o teo nho cua chu mo giap.

    ieu tr: chch alcool hay nhiet tr lieu.

    Bu tuyn nang c tnh: bu ln nhanh

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    Bu tuyn nang c tnh: bu ln nhanhnn to nhiu vng hoi t bn trong, tngsinh mch nhiu

    2. Suy giap:

    a so thng khong co bu giap

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    Suy giap tien phatviem giap Hashimoto, viem ban cap, tai bien do T iot

    phong xa T thuoc khang giap hay phau thuat cat giap, roi loan chuyen hoa,

    thieu men tong hp hormone giap, chat khang giap trong thc an, Lithium thuoc

    T tam than.

    Suy giap th phat suy tuyen yen do u, phau thuat, do tuyen yen b pha huy

    (h/c Sheehan)

    Suy giap e tam cap roi loan chc nang ha oi

    Suy giap nguyen nhan ac biete khang ngoai vi vi tac dung hormone TG,bat thng thu the v T4 te bao.

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    Sieu am:

    TG nho, echo kem, khong bat xa.

    FNAC neu nghi suy giap do viem De Quervain hay Hashimoto.

    NHN GIP(LS HAY DI LS)

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    NANG

    GIAP

    KEO +++

    NANG DO

    K hiem)

    PGH

    +++)

    BU LANH

    ADENOMA)

    hiem

    K GIAP VIEM

    CNG GIAP

    BASEDOW

    THUOC

    SUY GIAP

    BNH GIAP

    NHN GIP DNG NANG# NANG GIP

    NHN GIP DNG C

    SAU T LM GiM TH

    TCH TUYN GAP

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    KET LUAN

    Sieu am la phng tien n gian, nhanh, re, khong oc hai, hieuqua cao.

    Giup phan biet c cac loai benh ly TG: nhan, viem, RL chc

    nang.

    Ket hp viSA mau & choc hut te bao bang kim nho nang hieu

    qua chan oan.