Tuyn gip

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- Tuyn gip nm hai bn v pha trc kh qun, ngay di thanh qun

- Tuyn gip hot ng nh 2 hormon TSH (thyroid stimulating (kch thch)

hormon) v TRH (thyroid releasing hormon)
RH: releasing hormone
IRH inhibiting releasing hormone

- TSH c tc dng kch thch tuyn gip gii phng hormon gip vo mu, s bi
tit ca TSH c iu ha bi hormon hng tuyn gip TRH ca vng di i.
TRH tc dng trc tip ln tuyn yn lm tng gii phng TSH.
I. S tng hp v bi tit hormon tuyn gip:

Tuyn gip tng hp cc hormon gip trng T3 (Triiodothyronine) T4

(Tetraiodothyronine) thyroxine t iod v tyroxine.
1. Qu trnh tng hp:

- Iod trong thc n phi c bin i thnh Iodur mi hp thu vo rut sau
c vn chuyn vo cht keo ca tuyn gip di dng vn chuyn ch ng bi
bm Iod, bm Iod hot ng ph thuc vo Na+, K+ ATPase v b kch thch bi
TSH.
- Khi Iodur vo trong cht keo ca tuyn gip th s c Oxy ha tr li thnh Iod.

- Iod gn vo v tr th 3 ca phn t tyroxine => Monoiodo tyroxine (MIT).

- Iod gn vo v tr th 3 v 5 ca phn t tyroxine =>Diiodo tyroxine (DIT).

- 2 phn t DIT kt hp vi nhau =>T4

- 1 phn t MIT kt hp vi 1 phn t DIT =>T3

- T4 c sn xut bi tuyn gip khi tuyn yn gii phng hormon kch thch tuyn
gip. Ch c 1 phn nh T3 c sn xut trc tip t tuyn gip phn ln T3 c
sn xut bi cc m bin i T4 thnh T3.

2. Qu trnh bi tit v chuyn ch hormon tuyn gip:

- Sau khi c tng hp bi tuyn gip T3 T4 c phng thch vo mu, trong

mu cc hormon tuyn gip tn ti di 2 dng:
+ Dng gn vi protein huyt tng ch yu vi TBG (thyroxine binding
globuline), 1 phn gn vi TBPA (thyroxine binding prealbumine) v TBA
(thyroxine binding albumine).
+ Dng t do FT3 (Free Triiodothyroxine) FT4 (Free Thyroxine), ch chim 1
phn nh ca T3 v T4 nhng th hin chc nng sinh l r rng.
- T3 T4 lu thng trong mu ph thuc vo cc protein vn chuyn m cc protein
ny thay i ty vo iu kin lm sng ca bnh nhn nh mang thai, dng thuc
trnh thai, iu tr bng estrogenkhi lng protein vn chuyn thay i th nng
 ca T3T4 s thay i theo trong khi dng T3T4 t do khng ph thuc vo
protein vn chuyn v ch c Free T3, Free T4 l phn chu trch nhim v hot
ng sinh hc ca tuyn gip, nh vy o nng Free T3, Free T4 trong chn
on bnh tuyn gip s c tin cy v chnh xc hn.

II. iu ha bi tit hormon tuyn gip:

1. Tc dng xui:

Vng di i tit ra yu t gii phng l TRF,TRH tc dng ln tuyn yn, tuyn

yn tit ra TSH, TSH tc dng ln tuyn gip lm cho tuyn gip tit ra T3 T4.
2. Tc dng ngc m tnh:
Nu T3 T4 tng n 1 mc no th c tc dng c ch li tuyn yn hay vng
di i khng tit ra TRH hay TSH na, nh th th tuyn gip khng b kch
thch tit ra T3 T4 na.
3. Tc dng ngc dng tnh:

- Nu T3 T4 gim s kch thch ln tuyn yn hay vng di i tng tit TRH hay
TSH dn n kch thch tuyn gip tng tit T3 T4.

- Vic tuyn yn sn xut TSH hay khng l 1 vn quan trng trong iu ha

kch thch tuyn gip sn xut ra T3 v T4 (iu ha xui), cn nh hng ca
nng T3 T4 tng hay gim (iu ha ngc) thng t xy ra hn.

III. Trc nghim thm d chc nng tuyn gip:

Da vo trc iu ha ta thy lun lun c s ngc chiu gia TSH v T3 T4 trn

kt qu xt nghim. Khi TSH tng th T3 T4 gim v ngc li.

1. Nhc gip T3 T4 gim trong mu:

Tuyn yn tit ra nhiu TSH, TSH kch thch tuyn gip sn xut ra T3 T4, khi T3
T4 gim c 2 nguyn nhn:

+ Tuyn yn vn tit ra y TSH kch thch tuyn gip nhng tuyn gip yu
(bnh) khng tit ra c T3 T4 nh vy l suy gip tin pht (suy gip ti tuyn
gip)

+ Tuyn gip vn bnh thng khe mnh nhng tuyn yn khng tit ra c
TSH nn khng kch thch tuyn gip tit ra T3 T4 c nh vy l suy gip th
pht (suy gip do tuyn yn) => phn bit nhc gip do tin pht hay th pht
ta dng trc nghim TRF chch
Phn bit suy gip tin pht v suy gip th pht?
 Suy gip tin pht( ti Suy gip th pht( ti
tuyn gip) tuyn yn)

Tuyn yn Bnh thng Bnh

Tuyn gip Bnh Bnh thng
TSH Tng Gim
T3T4 Gim Gim
V d Vim tuyn gip Suy tuyn yn do u
Hashimoto tuyn yn

- Nguyn tc: tim tnh mch 200 ->250g TRHsau nh lng TSH trong mu
sau tim 30, 60, 90, 120 pht.
*Kt qu:

+ Bnh thng th sau khi tim TRH 30pht th nng TSH trong mu t cao
nht l 16U/ml v tr v bnh thng sau 120pht.
+ Trng hp nhc gip do tuyn gip (nhc gip tin pht) sau khi tim TRH
30 pht, nh lng TSH tng iu ny chng t tuyn yn vn khe mnh, vn tit
ra c TSH nhng T3 T4 vn gim nh vy l do tuyn gip b suy yu
+ Trng hp nhc gip do tuyn yn (nhc gip th pht) sau 30pht tim
TRH, nh lng TSH gim iu ny chng t tuyn yn bnh (yu) khng tit ra
c TSH, TSH khng kch thch tuyn gip sn xut T3 T4 -> T3 T4 trong
mu gim
Ti sao khng o nng TSH ngay t u nu nh :
-TSH bnh thng,T3T4 gim: suy gip ti gip
-TSH gim,T3T4 gim: suy gip do tuyn yn

2. Cng gip T3T4 tng:

Khi T3T4 tng s c ch vng di i cng nh tuyn yn khng tit ra

TRF,TSH, khng sn xut T3T4
c ch vng di i: T3T4 tng dn n c ch vng di i khng tit ra c
TRF.

- Dng trc nghim chch TRF vo tnh mch nh gi tc dng ca lc c ch

v lc kch thch

- Sau khi chch nh lng li TSH nu lng TSH khng tng ln c tc l lc

c ch mnh hn lc kch thch ngha l bnh nhn b cng gip.
- Nu sau khi chch m lng TSH tng ln vy lng c ch khng thng ni
lc kch thch ngha l cha chc bnh nhn b cng gip, c th tng T3T4 do
nguyn nhn khc.(u tuyn yn tit TSH, khng tuyn yn vi hormon gip)

IV. Triu chng lm sng cc bnh l v tuyn gip:

1. Cng gip:
a. Nguyn nhn:

- Do ni tit: bnh Basedow y l bnh cng gip t min hormon tuyn gip
khng chu s iu ha ca s hng nh ni m, thng gp ph n t 30 ->50
tui ( 80% )
Trnh by c ch ca bnh t min Basedow?
- Do Iode: Nguyn nhn l do thuc hoc do iu tr bng Iode qu liu, bnh ny
s khi nu ngng dng Iode.

b. Triu chng:

- Th trng gy, gim cn d n nhiu.

- Khng chu c thi tit nng.

- Huyt p tng, tay run, da m v m, m hi nhiu.

- Mch nhanh v tng lu lng tim, tng tc tun han mu.

- c bit cng gip do ni tit (Basedow), tuyn gip ph i, mt li.

2. Nhc gip:
a. Nhc gip nguyn pht:

- Do t min: gp ph n sau thi mn kinh, ngi tr b bnh ny dn n

vim tuyn gip t min .

- Do sau phu thut: gp nhng ngi sau khi ct b hon ton tuyn gip (k
tuyn gip), ct b gn hon ton (Basedow ), hoc ct 1 phn ( bu gip).

- Do dng thuc: gp nhng ngi dng thuc khng gip tng hp, bnh s gim
nu ngng thuc hoc gim liu.

- Do thiu Iode: th hin hi chng n n tr em v hi chng thn h

ngi ln.
H/c n n tr em l do thiu iode gy gim tit T3T4.
Thiu iode ngi ln : hi chng thn h.V sao?=> vai tr ca iode i
vi thn?

b. Nhc gip th pht:

Nhc gip th pht gn lin vi s thiu ht iu ha ca vng di i hoc

tuyn yn cng vi s thiu ht kch thch t TSH cn thit cho vic kch thch s
pht trin ca t bo tuyn gip.
* Triu chng:
- Gim nhu ng rut.

- Gim nhp tim, gim cung lng tim.

- Huyt p c th tng hoc gim.

- Gim chc nng thn.

- Trm cm.

- Anh hng xu n thai nhi

V. Xt nghim bnh l tuyn gip:

nh gi bnh l tuyn gip ta cn nhiu thng s cn lm sng nhng v mt

sinh ha ch yu gm: TSH, T3, T4, FT3, FT4
1.nh lng TSH
+ Mc ch:
- Chn an v theo di iu tr nhc gip.

- Phn bit nhc gip nguyn pht v nhc gip do ri lon tuyn yn

- Phn bit bnh tng T3T4 do cng gip hay do nguyn nhn khc.
Gii thch v sao bnh nhn cng gip tng T3T4 li tng sinh t bo nang tuyn?
N c tng sinh t bo cn gip khng?=> nh hng n Calcitonin? Trong bnh
nhn cng gip?
Nu nh xt nghim TSH tng=> c 2 kh nng:
-Kh nng 1: bnh nhn b suy gip ,ti gip
-Kh nng 2: bnh nhn c th b u tuyn yn tit TSH, khng tuyn yn vi
hormon gip
Nh vy chn xem kh nng no xy ra th ngi ta s lm xt nghim:T3T4

+ Tr s bnh thng: 0.3 -> 4g/ml

- Tng trong bnh nhc gip nguyn pht.
- Gim trong bnh cng gip, nhc gip th pht do ri lon tuyn yn.

2. nh lng T4 trong mu

Tr s bnh thng: 4 ->12g/100ml

Tng trong bnh cng gip nhim c tuyn gip do bnh Graves
V sao trong bnh Graves T4 li tng?

Gim trong nhc gip

3. nh lng FT4 trong mu:

Tr s bnh thng: 8 ->12ng/100ml

Tng trong cng gip

Gim trong bnh nhc gip

4. nh lng T3 trong mu:

Tr s bnh thng 80 ->200g/100ml

Tr s tng gim tng ng vi T4 tuy nhin c 1 s trng hp T3 tng nhng T4

bnh thng (trong bnh nhim c tuyn gip do T3)
Phn bit nhim c tuyn gip do T3 v T4, ngha lm sng?

5. nh lng FT3 trong mu: c ch nh khi TSH gim nhng FT4 bnh thng,
theo di bnh nhn ang iu tr khng gip.
Tr s bnh thng: 0.45->3.48pg/ml
VI. Bnh tuyn gip v thai k:

1.Cng gip:

Ngi m mang thai nu b cng gip s nh hng n c m v thai nhi, c th

khin thai cht lu, sy thai, thai chm pht trin, sanh non hoc d tt bm sinh v
m c nguy c b tin sn git. Nhng nguy c k trn s c gim thiu nu sn
ph c pht hin bnh sm v iu tr thch hp. Bin chng thng gp nhng
ph n mang thai b cng gip l bnh l tim do nhp tim qu nhanh d gy suy tim.
Ngoi ra, mt s phng php iu tr c hiu bnh cng trn ph n mang thai
c th gy nguy him cho thai nhi do thuc c th truyn qua nhau thai v sa m.
Phu thut c th an tan vo ba thng gia ca thai k nhng ch iu tr trc
phu thut trnh cn bo gip trng. Ngay c khi iu tr thnh cng cng
gip cho m lc mang thai th tr sinh ra vn co nguy c pht trin cng gip bi
khng th cng gip truyn t m sang con. Ngoi ra dng thuc khng gip liu
cao c th gy nhc gip.
2. Suy gip:

Suy gip ph n mang thai thng a n hu qu xu cho thai nhi, nguy him
nht l tr sinh ra s b n n, km pht trin v th cht, nh cn, thai ph c th
b tin sn git, bt thng bnh nhau, chy mu nhiu sau sanh. Tuyn gip ca
thai nhi c hnh thnh v hot ng t tun th 10->12 ca thai k do trong 3
thng u thai nhi ph thuc hon ton vo ngun hormone tuyn gip ca m, nu
m b suy gip th con cng s b suy gip. Tr b suy gip c th c nhng bt
thng trm trng v s pht trin tr tu v th cht nu khng c pht hin v
iu tr kp thi.

Ti liu tham kho:

1. Bnh ni tit - Nh xut bn: Trng HYD Tp.HCM

2. Sinh l hc y khoa - Nh xut bn: Trng HYD Tp.HCM