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Suy tuyen can giap: Nguyen nhan gay ha calci mau

Suy tuyen can giap (goi tat la suy can giap) la tinh trang tuyen can giap tiet ra qua it hormon PTH dan den giam calci mau va tang phospho mau. Benh co the xuat hien o bat cu lua tuoi nao nhung pho bien la o tre duoi 16 tuoi va nguoi lon tren 40 tuoi.

Co rut co - bieu hien cua suy tuyen can giap. 
Nguyen nhan: Co rat nhieu nguyen nhan gay suy can giap, de de dang cho chan doan, nguoi ta chia ra 2 nhom chinh la:

Suy can giap di truyen: Trong the benh nay, dua tre sinh ra da khong co tuyen can giap hoac co nhung hoat dong kem. Day la benh di truyen theo gen lan va khi ca bo va me mang gen nay thi kha nang con cua ho bi benh la 25%. Cac trieu chung cua suy can giap xuat hien truoc nam 10 tuoi, thuong gap nhat la khi tre 2 tuoi.

Suy can giap mac phai: The benh nay thuong xuat hien sau khi tuyen can giap bi chan thuong hoac sau phau thuat (chu y de dieu tri u tuyen can giap hoac vo y nhu la tai bien cua phau thuat cat tuyen giap). Ngay nay do cac phau thuat vung co duoc thuc hien boi cac bac si co trinh do cao nen tai bien nay ngay cang it gap.

Trong mot so it truong hop, suy can giap la hau qua cua benh tu mien, trong do co the sinh ra cac khang the tan cong va loai bo tuyen can giap, dan dan suy can giap se xuat hien. Truong hop nay nguoi benh hay co mac them benh tu mien khac, vi du benh Addison.

Cac nguyen nhan khac: Dieu tri tia xa cac ung thu vung co pha huy tuyen can giap, nong do magne trong co the giam lam giam chuc nang tuyen can giap hoac khi benh nhan bi nhiem kiem.

Trieu chung: Cac trieu chung cua suy can giap kha da dang, gom:

- Cam giac te bi o cac dau ngon tay, moi va luoi.

- Dau cac co o chan, tay, bung va vung mat. Yeu co.

- Co rut cac co, nhat la co quanh mieng, canh tay va ban tay. Co that thanh quan co the gay kho tho nang doi hoi phai dieu tri cap cuu.

- Dau bung du doi moi khi co kinh nguyet.

- Rung toc tung mang va long may thua.

- Da kho, mong tay bi bien dang va de gay.

- Dau dau, met moi.

- Mot so benh nhan bi tram cam hoac co giat kieu nhu dong kinh.

Muc do va tan suat xuat hien cac trieu chung thuong phu thuoc vao muc do ha calci mau.

Chan doan benh suy can giap phai dua vao ca hoi tien su, benh su, kham lam sang va lam xet nghiem mau.

 Tien su phau thuat, tia xa vung co; tien su gia dinh co nguoi bi suy can giap.

 Cac trieu chung quan trong nhu te bi, co rut co.

 Cac benh nhan tre em co the bi sun rang, cham phat trien chieu cao...

 Lam cac xet nghiem mau, thuong trong suy can giap:

 Phau thuat cat bo tuyen can giap.

- Nong do calci mau thap.

- Nong do phospho mau cao.

- Nong do magne mau thap.

- Nong do hormon PTH thap.

- Lam dien tam do: Co the phat hien duoc loan nhip tim.

- Xet nghiem nuoc tieu: Co the thay calci nieu cao.

- Chup Xquang cac xuong xem calci mau thap co anh huong den cac xuong hay khong. Voi cac benh nhi co the thay dau hieu cot hoa cac xuong co ban tay bi cham.

Nhin chung, chan doan suy can giap tuong doi kho khan, phai do cac bac si chuyen khoa noi tiet dam nhiem.

Bien chung: Cac benh nhan suy can giap co the bi nhieu bien chung do calci mau thap, tuy nhien da so se duoc cai thien neu duoc dieu tri:

- Con tetani, nguoi benh co cam giac te bi moi, luoi, chan va tay. Sau do xuat hien co quap cac ngon tay thanh dau hieu dien hinh goi la “ban tay nguoi do de”, co the keo dai va rat dau. Thuong kem theo co giat cac co o vung mat va thanh quan, doi khi gay kho tho du doi, nghe co tieng rit thanh quan.

- Mat y thuc, co giat kieu dong kinh.

- Rang sun, loang xuong.

- Roi loan nhip tim va ngat.

- Ngoai ra con mot so bien chung khac, thuong la vinh vien va khong duoc cai thien voi dieu tri calci va vitamin D, do la lun, tri tue kem phat trien, duc thuy tinh the...

Dieu tri

Quyet dinh dieu tri dua vao cac yeu to nhu benh nhan co trieu chung hay khong, muc do nang hay nhe, tinh trang suc khoe chung... Muc tieu dieu tri la dua nong do calci va phospho trong mau ve muc binh thuong. Cu the, cac benh nhan suy can giap duoc dieu tri dong thoi bang: calcium carbonat dang vien uong. Luu y la calci lieu cao co the gay tac dung phu nhu tao bon hoac gay soi than; vitamin D lieu cao la chat can cho su hap thu calci; bo sung magie dang vien uong.

Che do an: Ben canh viec dung thuoc, cac benh nhan suy can giap nen ap dung che do an giau calci nhu bo sua, rau xanh, nuoc cam dam dac, ngu coc... va it phospho; tranh dung nuoc ngot co acid phosphoric.

Voi nhung benh nhan co calci mau rat thap, trieu chung nhieu va nang, hoac bi con tetani thi nen nhap vien de dieu tri bang tiem calci vao tinh mach. Sau khi xuat vien ho co the tiep tuc dung calci va vitamin D duong uong. Vi suy can giap la benh man tinh nen dieu tri se phai keo dai suot cuoc doi va thuong xuyen lam cac xet nghiem mau, nuoc tieu de dieu chinh lieu thich hop. Dieu tri dat ket qua tot neu benh nhan khong co trieu chung, calci mau binh thuong, calci nieu binh thuong.

ThS. Nguyen Quang Bay