CA LM SNG

Bnh nhn n 20 tui.Gn y bnh nhn c biu hin mt mi, hay kht, ung nhiu nc v i tiu nhiu hn,i ngoi c phn lng, km theo gy st nhanh ( 3kg/1 thng)
Cch y 1 thng bnh nhn vo vin trong tnh trng: -Ngt khng r nguyn nhn -Chiu cao: 1m50 Cn nng: 38 kg -Nhit : 36,9o C -HA:110/80 mmHg Mch: 110 ln/ pht -C du hiu co c mi -Run tay(+) -Bu c to 2,mm,khng nhn,khng c ting thi

I. T cc triu chng trn anh(ch) ngh bnh nhn c th mc cc bnh no sau y:

a. b. c. d.

Basedow i tho ng typ 1 i tho ng typ 2 a hoc b

II. gip cho chn on chnh xc anh(ch) chn lm xt nghim no sau y:

a. b. c. d.

TSH, FT3, FT4, T4 Glucose mu, insulin mu o t trng nc tiu a v c

Khi xt nghim thu c cc kq sau:

TSH: 0,007 uU/ml FT3: 30,24 pmol/l T4: 200,2 nmol/l FT4: 79,51 pmol/l

Anh ch hy a ra pp iu tr?
1.iu tr ni khoa: a. Chng li s tng hp hormon gip: Thuc khng gip trng tng hp
Dn xut Thiouracil: MTU,PTU,BTU. Dn xut imidazol: methimazol,carbimazol,thiamazol.

Iod v c b. Thuc chn beta giao cm: propranolol

2.iu tr ngoi khoa: Ct tuyn gip bn phn (bnh nhn tr,iu tr ni khoa tht bi hoc c bin chng)

3. iu tr bng ng v phng x Iod: Bnh nhn ln tui,khng cn ch nh phu thut. 4.iu tr bin chng: Cn cng gip cp: thuc khng gip trng tng hp,thuc chn beta,corticoid,b nc. Bin chng tim: thuc chng lon nhp tim,iu tr suy tim km theo khng gip trng tng hp Khng th iu tr trit li mt.