NH GA HIU QU CA IU TR IODE PHNG X BNH NHN BASEDOW

Hong c Dng , L Ch Thnh, Phm Nh Th H Ngc Hoa*, Nguyn Hi Thy** Bnh Vin TWHu. * CTy Thit b Y T Hoa Vit ** Trng i Hc Y Khoa Hu
EFFECTS OF RADIOIODINE I131 THERAPY ON GRAVES'HYPERTHYROIDISM Objective : evaluated the effects of radioiodine I131 therapy on Graves' hyperthyroidism and factors favourible to hypothyroid Patients & Methods : 112 patients with graves'disease divided into 3 groups ( 1 , 5 and 10 years after radioiodine I131 therapy). Patients were examined clinical features ( hyper, hypo and euthyroidism ) and thyroid function tests ( serum T3,T4 and TSH, radioactive iodine uptake ) and evaluated the weight of thyroid gland and choised the dose of radioiodine I131 Results : At the time of radioiodine I131 therapy : female patient was 84.8% ( p < 0.01) , mean aged was 40.1 9.05 years, in which aged of 30-55 was 84 .9% ( p < 0.01). Patients with previous antithyroid drugs was 76.9%. ( p < 0.01) and previous surgical thyroidectomy was 16,1%. . The thyroid weight from 30-50g was 69.6% ( p < 0.05) , mean doses of radioiodine I131 6.56 0.87 mCi with 110-140 Ci /g was 89.3% (p< 0.01). After radioiodine I131 therapy : The percentage of euthyoidism after 1 and 10 years of radioiodie therapy were 63.6% 46.7% respectively, hyperthyroidism was 6.25%.and hypothyroidism gradualy increase with time , in which 15.2% of 1 years and 40% of 10 years after treatment and the supraclinical hypothyroidism ( TSH : 5-10 U/ml ) was 14.3% Factors relative in patients with hypothyroidism composed : aged of time treament 40.2 - 45.7 years , 72.2% of patients with previous surgical thyroidectomy , 62.5% of patients no previous treatment and 31.4% of patients taking previous antithyroid drugs high prevalence of hypothyroidism occured in patients had dose of radioiodne from 125.3 - 136.9 Ci /gam, total dose 5.51 - 6.55 mCi, the thyroid weight 45.6 49.9 gam Duration after radioiodine treatment in 1, 5 and 10 years , prevalence of hypothyroidism were 30.4 % , 53.3% and 72.2% respectively Conclusions : The effects of radioiodine I131 therapy on Graves' disease is the better than the other treatment , It is necessary measurement of serum TSH level for detecting preclinical hypothyroidism

TM TT
Mc ch : nh gi hiu qu iu tr iode phng bnh nhn Basedow v mt s yu t lin quan i tng v phng php : 112 bnh nhn Basedow chia lm 3 nhm sau 01 nm, 05 nm v sau 10 nm c iu tr bng I 131 . Bnh nhn c kho st lm sng ( cng gip, bnh gip v suy gip ) v cn lm sng ( T3,T4,TSH, x hnh, trong lng tuyn ) v liu iode phng x iu tr ( sut liu, tng liu .. ) Kt qu : Thi im x tri : N bnh nhn chim t l 84.8% ( p < 0.01) , tui trung bnh vo thi im x tr l 40.1 9.05 nm , trong tui 30-55 t l 84 .9% ( p < 0.01). S bnh nhn iu tr KGTH trc chim t l 76.9%. ( p < 0.01). Trng lng tuyn gip t 30-50g chim t l 69.6% ( p < 0.05) Liu I 131 x dng trung bnh 6.56 0.87 mCi vi sut liu phng x 110-140 Ci /g chim t l 89.3% (p< 0.01). Kt qu sau x tr t l bnh gip nhm 1 ( sau 1 nm ) l 63.6% v nhm 3 ( sau 10 nm ) l 46.7% , T l cng gip l 6.25%. v t l suy gip tng dn theo thi gian trong nhm 1 l 15.2% v nhm 3: 40% , trong t l suy gip tin lm sng ( TSH : 510 U/ml ) l 14.3% Cc yu t lin quan n suy gip : T l cao suy gip gp tui vo thi im x tr l 40.2 - 45.7 tui , phu thut ct gim gip trc x tr 13/18 ( 72.2%), khng dng thuc : 5/8 ( 62.5%) v dng khng gip 27/86 (31.4% ), sut liu x t 125.3 136.9 Ci / gam, tng liu 5.51 - 6.55 mCi. Trng lng tuyn gip 45.6 - 49.9 gam. T l suy gip sau x tri 30.4 % sau 1 nm, 53.3% sau 5 nm v 72.2% sau 10 nm. Kt lun : Hiu qu ca iu tr phng x trn bnh nhn Basedow chim t l cao, cn theo di TSH nh k pht hin suy gip tin lm sng.

I.T VN Basedow l bnh l cng gip ph bin trn lm sng, chim t l rt cao trong cc bnh ni tit hp vin. Ti Vit Nam, qua thng k ghi nhn t l 45,8% cc bnh ni tit v 2,6% cc bnh ni khoa. La tui mc bnh thng gp nht l tui trung nin. tr em v ngi trn 50 tui t l ny thp hn nhiu.Bnh thng gp n nhiu hn nam vi t l n/ nam t 5/1 n 7/1. Trong bnh Basedow s gia tng sn xut hormone gip gy nhim c gip i vi cc c quan t chc, nh hng ln nhiu qu trnh khc nhau ca c th: S pht trin, chuyn ha nng lng, chuyn ha carbonhydrat, chuyn ha lipide, hot ng ca h tun hon, h thn kinh, hot ng sinh sn ca ph n .. . Hin ti c 3 phng php ch yu iu tr Basedow : Thuc khng gip tng hp ,iu tr Phu thut. v iu tr Phng x bng I131. nhiu nc pht trin hin nay, cng vi vic iu tr bng thuc khng gip tng hp v phu thut, Iode phng x l phng php c x dng nhiu nht v c ch nh mt cch tng i rng ri. nc ta, phng php iu tr Basedow bng phng x bt u t nhng nm 1980 - cho n nay c cc c s Y Hc Ht Nhn c iu kin trong nc s dng. Tuy nhin, ch nh x tr Basedow Vit Nam c phn t rng ri hn cng nh ch trng dng liu I131 thp hn ph hp vi sinh l ngi Vit Nam v gim thiu s bnh nhn suy gip sau iu tr. T l bnh nhn bnh gip, suy gip, cng gip ti pht sau iu tr Iode phng x lin quan trc tip n liu phng x iu tr v c phn nh mt cch trung thc qua nng hormon T3- T4 v TSH trong huyt thanh ca bnh nhn sau khi nhn liu iu tr. Sau 20 nm trin khai iu tr Basedow bng Iode phng x, Khoa Y Hc Ht Nhn - Bnh Vin TW Hu iu tr cho hn 500 lt bnh nhn vi kt qu trc mt rt tt, tuy nhin v lu di , cho n nay vn cha c mt nghin cu no y v vn ny. II Mc ch nghin cu : III 1. nh gi kt qu iu tr iode phng x bnh nhn Basedow 2. Tm hiu yu t thun li v bt li xy ra trc, trong v sau x tr II. I TNG V PHNG PHP NGHIN CU 1. i tng nghin cu . Gm 112 Bnh nhn Basedow .c iu tr bng iode phng x ti Khoa Y Hc ht Nhn Bnh vin TW Hu t 10 nm tr li y . Bnh nhn c chia lm 3 nhm Nhm1 : Sau x tr trn 01 nm, c 33 ngi,( 5 nam v 28 n ) Nhm 2 : Sau x tr trn 05 nm, c 49 ngi ( 7 nam v 42 n ) Nhm 3 : Sau x tr trn 10 nm, c 30 ngi (5 nam v 25 n ) 2. Phng php nghin cu . Chn phng php nghin cu ct ngang. vi bc tin hnh bao gm Trc iu tr : Tui, gii, trong lng tuyn gip, sut liu v tng liu iode phng xa v cc xt nghim lin quan n cng gip Sau iu tr : khm lm sng .nh lng T4 (Thyroxin), T3 (Triiodothyronin) v TSH . nh gi chc nng gip Theo s liu ca Hi Ho sinh Y dc hc Vit Nam - 1995 v CIS bio international - France nh sau : Nhm BN T3 ( ng/ml ) T4 (ng/ml ) TSH( UI/ml) Cng gip > 1,9 > 110 < 0,25 Bnh gip 0,6 - 1,9 45 - 110 0,25 - 4,9 Suy gip < 0,2 < 45 > 10 Suy gip tin LS 5 - 10

3. X l s liu :Phng php thng k y hc vi phn mm Excel 2000 v EPI-INFO 6.0 III. KT QU V BN LUN. T thng 7/2003 n thng 3/2004, chng ti tin hnh kho st 112 bnh nhn Basedow trc c iu tr iode phng x . bnh nhn c chia thnh 3 nhm theo thi gian iu tr nh sau : - Nhm 1 : Bnh nhn sau x tr trn 01 nm N = 33. - Nhm 2 : Bnh nhn sau x tr trn 05 nm N = 49. - Nhm 3 : Bnh nhn sau x tr trn 10 nm N = 30. 1. Kt qu ca x tr : + Cng gip lm sng : T l bnh nhn cn cng gip sau 1 nm l 6.1%, sau 5 nm 12%, sau 10 nm l 0%.Nhn chung t l trn khng cao.Tuy nhin, s khc bit t l gia cc nhm bnh nhn l khng r rng, c l do s lng bnh nhn cha nhiu. + Suy gip : Theo di bnh nhn sau x tr, vn suy gip lun c quan tm hng u. Cn phn bit suy gip tht s v suy gip tin lm sng Suy gip lm sng : Chn on thng mun do cc triu chng xut hin t t. Chn on xc nh khicc triu chng lm sng in hnh xut hin khng gp nhiu kh khn. Suy gip nu khng c iu tr th nguy c bin chng s rt cao, nhng nu c chn on sm v iu tr thch hp th tin lng s rt kh quan v rng liu php dng hormon thay th (T4) ng liu lng s cho kt qu gn nh tuyt i. Trong cc nhm nghin cu, s bnh nhn suy gip thc s chim t l 15.2% sau 1nm, 24.4% sau 5 nm v 40% sau 10 nm. Kt qu cao hn so vi nghin cu ca Phan Vn Duyt H ni ghi nhn 8.5% sau 1 nm, Trnh Minh Chu bo co 7% sau 1 nm. Nhng kt qu ca chng ti li thp hn nhiu so vi Belling v Einhorn cng b t l suy gip sau x tr 1 nm l 40.82 %, sau 10 nm l 69.5 %- T l suy gip sau phu thut 1 nm l 25.34 %, sau 10 nm l 42.5 %. Nhiu tc gi cho rng, d dng liu I 131 bao nhiu th cng gy t l suy gip cao. Hu qu ny khng ch c bnh nhn x tr m cn c nhng bnh nhn iu tr phu thut v dng thuc KGTH thm ch cha iu tr g cng c th b suy gip sau cng gip. Vi l do ny, c th tin tng hon ton rng suy gip l giai on cui cng v tt yu ca cng gip Graves, mc d ban u ca n l khc nhau v khng th d on trc c. Tuy nhin, mt iu hon ton chc chn l dng liu I 131 thp th s lm gim t l suy gip. V vy, tt c cc bnh nhn sau x tr u phi ti khm nh k v lm cc xt nghim kim tra. Suy gip tin lm sng : y l mt khi nim theo Hi gip trng M xut ch pht hin c khi nh lng nng TSH t 5 -10 UI/ml. Qua nghin cu ghi nhn nhm 1 chim 15.2 %, nhm 2 l 14.3%, nhm 3 l 14.3 %. y l s bnh nhn s gp phn tng t l suy gip thc s sau x tr nhng cha c cc biu hin suy gip trn lm sng. Vic pht hin c bin php iu tr sm. Nhm bnh nhn ny s gp phn quan trng trong vic hn ch t l suy gip sau iu tr. 2. Yu t lin quan n suy gip sau x tr 1. Tui vo thi im x tr : Trong nghin cu tui bnh nhn nam l 42.7 12.6 tui , ln nht 58, nh nht 30, n l 39.2 13.9, ln nht 55, nh nht l 17..Nhm tui 30-55 chim t l cao nht gm 95 ngi, chim t l 84.9 % so vi cc nhm tui < 30 v > 55 (15.1%). Quan im v chn tui khi iu tr phng x ( c bit n gii ) n nay c nhiu thay i cn bn. Trc y, do lo ngi v nhng bin chng nng nh ung th hoc cc t bin v di truyn do iu tr I 131 trn nhng c th cn tr, v vy ch nh iu tr tui > 50. Tuy nhin, theo kt qu nghin cu ca nhiu tc gi, t l bnh nhn ung th hoc c cc t bin di truyn sau x tr so vi nhm bnh thng khng x tr l xp x nh nhau.

Holm v cng s vin Karolinska Thy in 1991 cng b t l mc ung th sau iu tr cng gip bng I 131 trn 10552 bnh nhn c tui trung bnh l 57 , liu trung bnh 6.8 mCi. Sau 15 nm theo di kt hp vi Vin Ung th Thy in, cc tc gi tnh ra ch s mc bnh ung th chun SIR (Standardised Incedence Ratio ) l 1.06%. So vi ch s mc bnh chun SIR cng nhm tui khng iu tr phng x khng thy c s khc bit ng k. Theo cng b ca Ban An ton Bc x thuc U Ban Nng Lng Nguyn T Quc T (IAEA) cho thy : Liu chiu x bung trng ph n v chiu x mu l nh nhau. Cho1liu I 131 vo c th s thy nh cao nht ca PBI 131 l 1.0% liu ung/1lt mu, b phn sinh dc chu liu chiu khong 2 rad hoc 0.4 rad/mCi liu ung. Liu chiu ny t hn nhiu so vi liu chiu ca 1 ln chp khu vc sinh dc bng XQ. U ban Chm sc Sc khe Cng ng M (1968 ) ngh v iu tr bu c gip bng I 131 v ct b tuyn gip th t l mc ung th gip v bnh Leucemia ngi ln khng c g khc bit. Nhng bo co tip theo sau cng khng nh chng minh trn nhng khuyn co rng cn ch theo di thi gian di tr em v thanh nin sau iu tr phng x. V nhng l do trn, gii hn tui iu tr phng x c h thp dn. Theo khuyn co ca IAEA, tui x tr khng nn xung di 30 ( tr nhng trng hp c bit ). Tuy nhin qua nghin cu chng ti ghi nhn t l suy gip cao nhm c tui vo thi im x tr t 40.2 - 45.7 tui y cng l iu cn cn nhc v liu lng sau ny. 2. Cc phng php iu tr trc x tr .Dng khng gip tng hp : Vic iu tr thuc KGTH trc khi iu tr phng x l ht sc cn thit nhm ci thin hi chng nhim c gip, h nng hormon T3-T4 mu, bnh n th lc,s c tc dng rt ln n kt qu iu tr I 131, trnh c nguy c bo gip c th xy ra.vic iu tr bng thuc KGTH cng nh iu tr phng x s gp nhiu kh khn.Trong iu tr phng x, vic tnh liu iu tr qua Scintigrame s c chnh xc khng cao nh hng ln n tng liu iu tr. Trong nghin cu c 85 bnh nhn ( 75.9% ) c iu tr bng thuc KGTH vi thi gian trung bnh l 1.3 nm , trong ngi c thi gian iu tr ni khoa di nht l 3.5 nm, ngn nht l 02 thng. PhanVn Duyt v cng s nghin cu 76 bnh nhn trong c 66 B.n (84%) iu tr ni khoa bng thuc KGTH v mt s thuc khng gip khc, tng thi gian iu tr ni khoa ca 66 B.n ny l 365 nm, trung bnh 5.2 nm/1B.n. Nh vy, s nm iu tr ni khoa trung bnh ca nhm nghin cu l thp hn. Cha iu tr : Trong nghin cu c 9/112 bnh nhn ( 8% ).. y l iu khuyn co nu bnh nhn khng dng c thuc KGTH th phi dng cc thuc c tnh cht khng gip khc nh Iode, chn bta... hn ch cc triu chng cng gip trc khi iu tr I 131, ch tr nhng trng hp c bit. Phu thut ct gim gip trc x tr :Trong nhm nghin cu ca chng ti l 16.1% cao hn so vi nghin cu ca Phan Vn Duyt ( 3% ). Qua so snh cc phng php iu tr trc phu thut chng ti ghi nhn. T l suy gip xy ra trong nhm bnh nhn phu thut ct gim gip trc x tr l 13/18 ( 72.2%) cao hn so vi nhm khng dng thuc : 5/8 ( 62.5%) v dng khng gip 27/86 (31.4% ). y cng l khuyn co lm sng v phng din x tr bnh Basedow.. 3.Trng lng tuyn gip trc x tr. Trng lng tuyn gip c nh hng rt ln n tng liu iu tr theo phng php tnh liu ca Rubenfeld. c nhiu phng php tnh trng lng tuyn gip ( qua Scintigrame, qua siu m .v.v.), tuy nhin phng php no cng vp phi mt vi sai s rt kh khc phc.Bi vy, khi trng lng tuyn gip cng ln, sai s cng nhiu v tng liu iu tr cng thiu chnh xc,

nh hng ln n kt qu iu tr. .Trong nghin cu ca chng ti t l trng lng tuyn gip > 50g l 30.4%, tng ng vi nghin cu ca Phan Vn Duyt l 31.9 %. Trong nghin cu chng ti cn ghi nhn t l suy gip cao nhm c trong lng tuyn gip 45.6 - 49.9 gam. Theo khuyn co ca IAEA, vi nhng tuyn gip c trng lng > 50g nn u tin iu tr phu thut, nu iu tr phng x th nn dng sut liu iu tr thp, c th dng liu phng x b sung nu ti pht sau 6 thng 4. Liu phng x I 131 iu tr. Trong nghin cu chng ti s dng liu I 131 trung bnh l 6.45 0.69 mCi bng vi Phan S An v cng s nghin cu 98 B.n Basedow vi liu trung bnh l 6.3 1.8 mCi.nhng thp hn Trng Xun Quang v cng s nghin cu trn 226 bnh nhn Basedow vi trung bnh l 11.5 0.22 mCi. Rapoport v cng s dng liu thp I 131 ( 80 Ci/g ) th thy c 38% bnh nhn tr v bnh gip trong vng 1 nm. Barzelatter v cng s thy sut liu trung bnh l 160 Ci/g c th t 62% bnh nhn tr li bnh gip trong thi gian t 2 n 3 thng. Safa v Skiller dng liu I 131 cao t 160 n 240 Ci/g thy c 90% bnh nhn bnh gip sau thi gian 2-4 thng. Tuy nhin t l suy gip sau l rt cao Trong nghin cu chng ti ghi nhn t l cao suy gip i tng dng tng liu iode phng x 5.51 - 6.55 mCi 5. Sut liu iode phng x / gam tuyn Trn thc t, hin nay ang c 2 quan im khc nhau . Sut liu thp 80 - < 110 Ci/g hoc thp hn trnh bo gip trong iu tr v suy gip sau iu tr, chp nhn t l cng gip ti pht cao sau dng liu iu tr b sung. Sau nhng thng u iu tr, thuc KGTH phi tip tc ung gim triu chng ca bnh n khi c hiu qu iu tr ca I 131 . Nhn chung, bnh nhn tr v bnh gip sau 2 n 4 thng, nu khng khi, phi ch t nht 6 thng sau mi nn iu tr liu b sung. Tuy nhin, trong t iu tr b sung nu dng liu I 131 nh t u th hiu qu iu tr s khng cao v thi gian hiu ng ca I 131 b rt ngn li. Beierwanter khuyn co rng liu b sung I 131 s ch lng ng ti tuyn gip t 20 n 30 %. Sut liu cao ( 200 Ci/g gim nhanh tnh trng cng gip, tuy nhin cn phi chun b trnh bo gip v cc bin chng cp c th xy ra trong thi gian u iu tr v sn sng dng hormon thay th iu tr tnh trng nhc gip vi t l cao c d bo trc, v cho rng vn iu tr suy gip trong trng hp ny n gin, kinh t v kh chu hn nhiu cho bnh nhn so vi vic iu tr cng gip ko di. Trong nghin cu ca chng ti sut liu iu tr 80 - < 110 Ci/g x dng cho 9 bnh nhn (8.0 % ). v liu 110 - 140 Ci/g cho 103 bnh nhn (92.0 % ). Trong nghin cu chng ti ghi nhn t l cao suy gip nhm c sut liu x t 125.3 - 136.9 Ci/ gam tuyn ., 6. S ln x tr : S ln x tr trung bnh ca nhm nghin cu l 1.19 ln, t hn so vi nghin cu ca Phan Vn Duyt ti H Ni l 1.35 ln, Phan S An Mai Trng Khoa : 1.34 ln, Atkins : 1.8 ln v Holm : 1.7 ln. Nh vy, s bnh nhn ht cng gip sau 1 ln x tr l rt cao ( 91.1% ), t l bnh nhn phi dng n liu b sung l rt thp ( 8.9% ) ( p < 0.01 ) 7. nh gi nng hormone gip v TSH sau x tr Nng T3 v T4 mu c tng quan nghch vi nng TSH. Tuy nhin, s thay i nng TSH rt nhy cm vi s thay i nng hormone tuyn gip d tr. TSH c th tng thch

nghi vi tnh trng gim hormone gip d tr trong khi nng T3 v T4 mu ngoi vi c th vn ang trong gii hn bnh thng. Bnh nhn suy gip lun c hormon TSH cao v T3-T4 thp hn so vi nhm bnh gip. ( p < 0.05). S suy gip lm sng ( TSH > 10 UI/ml) c nng T3 v T4 khng khc bit hn so vi nhm suy gip tin lm sng ( TSH: 5-10 UI/ml) V vy, TSH l ch s nhy cm v trung thnh nht vi s thay i chc nng tuyn gip, c vai tr rt quan trng xc nh giai on suy gip. Nng T3 tng quan vi TSH trong nhm nghin cu theo phng trnh hi quy v hm s tng quan nh sau: Biu 3.9. Tng quan gia T3 v TSH ( n = 112 )
y = -1 5 .6 8x + 3 0 .84 1 2 R = 0 .0 94 3

2 00 .00 1 50 .00 1 00 .00 5 0 .0 0 0 .0 0 0 .0 0 -5 0 .0 0

TS H L ine a r (TS H)

2.0 0

4 .00

6 .0 0

Nng TSH tng quan nghch vi nng T3 theo hm s y = - 15.68x + 30.841 ; r = 0.30708 ; n = 112 ; p < 0.01 Biu 3.10. Tng quan gia T4 v TSH ( n = 112 )
200.00 150.00 100.00 50.00 0.00 -50.00 -100.00 0 100 200 300 TSH Linear (TSH) y = -0.4076x + 43.675 R = 0.2817
2

Nng TSH tng quan nghch vi nng T4 theo hm s y = - 0.4076x + 43.675 ; r = 0.530754 ; n = 112 ; p < 0.001 IV. KT LUN Qua kho st 112 bnh nhn Basedow gm 3 nhm sau 01 nm, 05 nm v sau 10 nm c iu tr bng I 131 .chng ti i n mt s kt lun sau :

N bnh nhn Basedow chim t l 84.8% ( p < 0.01) , Tui trung bnh ca bnh nhn thi im x tr 40.1 9.05 nm , trong tui 30-55 t l 84 .9% ( p < 0.01). S bnh nhn iu tr KGTH trc chim t l 76.9%. ( p < 0.01). Trng lng tuyn gip 30-50g chim t l 69.6%. ( p < 0.05) Liu I 131 x dng trung bnh 6.56 0.87 mCi . Sut liu phng x 110-140 Ci/g chim t l 89.3% (p< 0.01). Sau x tr t l bnh gip nhm 1 l 63.6% v nhm 3 l 46.7% , T l cng gip l 6.25%. v t l suy gip tng dn theo thi gian trong nhm 1 l 15.2% v nhm 3: 40% , trong t l suy gip tin lm sng ( TSH : 5-10 U/ml ) l 14.3% T l suy gip ( tin lm sng v lm sng ) sau x tr lin quan n mt s yu t bao gm tui bnh nhn vo thi im x tr t 40.2 - 45.7 nm, phng php iu tr trc x tr trong phu thut 13/18 ( 72.2%), khng dng thuc : 5/8 ( 62.5%) v dng khng gip 27/86 (31.4% ). T l cao cng gp trong nhm c sut liu x t 125.3 - 136.9 Ci/gam, tng liu 5.51 - 6.55 mCi, c bit trong lng tuyn gip 45.6 - 49.9 gam c nguy c suy gip cao. Thi gian suy gip sau x tri l 30.4 % sau 1 nm, 53.3% sau 5 nm v 72.2% sau 10 nm. c tng quan gia nng TSH vi T3 v T4. Phn bit suy gip lm sng v tin lm sng ch yu da vo TSH hn l nng T3 v T4. Kt lun : iu tr iode phng x bnh nhn Basedow t kt qa bnh gip chim t l u th . Tuy nhin cn theo di TSH nh k pht hin suy gip tin lm sng. TI LIU THAM KHO 1. Phan S An, Mai Trng Khoa, Phan Vn Duyt, Trn nh H, Hong Thu H (2000) ''nh gi tnh trng chc nng gip bnh nhn Basedow c iu tr 131-I bng mt s k thut y hc ht nhn'' K yu ton vn CT NCKH Ni tit v chuyn ho..NXBYH H Ni 1993. 2. Nguyn Hi Thu (2000) Chn on v iu tr bnh tuyn gip.NXBYH H Ni 2000. 3. Nguyn Xun Phch . S dng ng v phng x trong chn on lm sng v nghin cu y sinh hc .HVQY HNi 1987. 4. Nguyn Xun Phch iu tr bnh bng ng v phng x. HVQY H Ni 1998. 5.. Jacobson J,H and Piasena W.J (IAEA) Nuclear Medicine, Tex book. 6. Gayed I and col.(2001) -Timing for repeated treatment of hyperthyroid disease with radioactive iodine after inirial treament failure. Clin Nucl Med 2001 Jan; 26(1): 1-5 7.Gomi Y and col. (2000) - The outcome of treatment with adjusted dose of 1311 to thyroid weight for Graves' disease by estimation of effective half life using d single radioiodine uptake measurement. Kaku Igaku 2000 Mar; 37(2): 109-14. 8. IAEA Nuclear Medicine - Viena 1982 9. Piasenna J.P RIA Texbook 1996. 10. IAEA Graves disease and RIA. Viena 1989. 11. IAEA RIA and IRMA. Texbook ,Viena 1998.