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XC NH TH TCH TUYN GIPCA NGI TRNG THNH BNG SIU M

Nguyn Hi Thu, Trn B ThoiTrng i Hc Y Khoa Hu

Determination of mature thyroid volume ofadult by ultrasonography

Objective : to determined the mature thyroid gland sizeof adult by 2D echography

Subjects & Methods : a total of 677 pupils and studentsaged 15-23 years with normal urinary iodine level in

Hue city, were examined thyroid gland size byultrasound with 7,5 MhZ sector. We evaluated thecorrelation between the thyroid volume with age,height, weight, BMI and BSA

Results : The total thyroid gland size of male and

female in groups with aged 15 - 23 years were :+ 10.44 2.79 cm3 and 10.53 2.88 cm3 in aged of15+ 10.53 2.35 cm3 and 10.12 2.76 cm3 in aged of16+ 12.82 2.58 cm3 and 12.82 2.58 cm3 in aged of17+ 11.52 2.77 cm3 and 11.15 2.45 cm3 in aged of18+ 12.08 2.89 cm3 and 11.59 2.37 cm3 in aged of19+ 10.59 3.08 cm3 and 12.23 2.80 cm3 in aged of20+ 11.83 2.94 cm3 and 11.24 2.94 cm3 in aged of21+ 10.50 2.63 cm3 and 10.95 2.63 cm3 in aged of22and 11.84 2.80 cm3 and 11.74 2.78 cm3 in aged of23Volume of thyroid right lobe is larger than left lobe inthe age of 15 23 ( p : 0,05 0,001 ). The largestvolume of thyroid is 12,82 2,58 cm3 in 17 years oldmales and 12,23 2,8 cm3 in 20 years old females.The maximum thyroid volume in mature is 17,98 cm3( 17 years old of male ) and 17,83 cm3 (20 years old of

female )Correlation Thyroid volume increased graduallyaccording to age and there were the positivecorrelation between thyroid volume in age of 15-23 ( r=0,06144 in male ) and ( r=0,14422 in female ). Themost restrictively positive correlation was at the age of15-17 in male ( r=0,882224 ) and at the age of 15-20 in

female ( r=0,929651).There was positive correlation between height andvolume ( r = 0,26457 in male , r=0,16278 in female ).There was positive correlation between weight andthyroid volume ( r = 0,24839 in male and r = 0,23065in female ). There were positive correlation between

BMI and thyroid volume in male ( r = 0.24839 ) andfemale ( r = 0.23065 ) . There were positive correlation

between thyroid volume and BSA ( r =0,31937 inmale and r = 0,29664 in female )Conclusions : The thyroid volume increases

gradually and correlates toage,height,weight,BMI and body skin surface. Themaximum thyroid volume of adult in male and

female were 12,82 + 2x2,58 cm3 and 12,23 +2x2,8cm3 respectively. The maximum thyroidvolume in mature adult could be 17,98cm3 inmale (17 years old ) and 17,83 cm3 in female ( 20

years oldTm tt

Mc tiu ti :Xc nh kch thc bnh thngca tuyn gip ngi trng hnhi tng v phng php : 677 hc sinh v sinhvin c tui t 15 - 23 ti Thnh Ph Hu , cnng iode niu bnh thng, c kim tra sium tuyn gip vi u d 7,5 MHz theo phng

php ca R.Guterkunst .Kt qu : Th tch thu phi ln hn thu trituyn gip trong tui 15 - 23 c nam ln n.( p: 0.05 - 0.001 ).

Kch thc tuyn gip : Th tch ton phn tuyngip ca nam v n theo tng tui ln lt nh

sau tui 15 l 10.44 2.79 cm3 v 10.53 2.88cm3, tui 16 l 10.53 2.35 cm3 v 10.12 2.76cm3, tui 17 l 12.82 2.58 cm3 v 12.82 2.58cm3, tui 18 l 11.52 2.77 cm3 v 11.15 2.45cm3,tui 19 l 12.08 2.89 cm3 v 11.59 2.37cm3,tui 20 l 10.59 3.08 cm3 v 12.23 2.80cm3,tui 21 l 11.83 2.94 cm3 v 11.24 2.94cm3,tui 22 l 10.50 2.63 cm3 v 10.95 2.63cm3 v tui 23 l 11.84 2.80 cm3 v 11.74 2.78 cm3. Th tch tuyn gip ln nht nam 17tui l 12,82 2,58 cm3 v n l 20 tui vi so l 12,23 2,8 cm3. Th tch tuyn gip ti a

( X + 2SD) ca ngi trng thnh l 17.98 cm 3( nam ) v 17.83 cm 3 ( n gii ) .Tng quan Th tch tuyn gip tng dn theotui v tng quan thun trong tui t 15 - 23vi r = 0.06144 i vi nam v r = 0.14422 ivi n. C s tng quan thun cht ch nht t15 - 17 tui nam ( r = 0.882224 ) v t 15 - 20tui n ( r = 0.929615).. Th tch gip tngquan thun vi chiu cao i vi nam ( r =0.26457) ln n ( r = 0.16278 ). Th tch tuyn

gip tng quan thun vi trng lng c thi vi nam ( r = 0.34684 ) cng nh n ( r =0.31640 ). .C s tng quan thun gia BMI v

th tch tuyn gip i vi nam ( r = 0.24839 ) lnn ( r = 0.23065 ) .c bit th tch tuyn gip s

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tng quan thun cht ch vi din tch da i vi nam( r = 0.31937 ) cng nh n ( r = 0.29664 ).

Kt lun : Th tch tuyn gip tng dn v tng quanvi tui, chiu cao, cn nng, BMI v din tch da. Thtch tuyn gip ln nht ca ngi trng thnh nam

gii l 12,82 + 2x 2,58 cm3 v ca n l 12,23 +2x 2,8 cm3. Trong V gip pht trin ti a cangi trng thnh nam gii c th l 17.98 cm 3( 17 tui ) v ca n gii l 17.83 cm 3 ( 20tui ).

I. T VN Tuyn gip l mt trong nhng tuyn ni tit quan trng bc nht ca c th v bnh

tuyn gip cng l mt th bnh thng gp trn lm sng, trong bu gip cng l mttrong nhng triu chng rt quan trng hng n chn on bnh tuyn gip.

Theo ti liu ca T chc y t th gii ( TCYTTG ) mt ngi c xc nh l c bu gip khi thu bn ca tuyn gip ln hn t tn cng ca ngn tay ci ca ngi .Nhng s kt lun ny thng mang tnh ch quan v ch yu da vo kinh nghim cangi khm.

Tuy nhin chng ta cng bit nh gi tuyn gip qua khm lm sng cn phthuc mt s yu t ti ch nh c vng c thay i do mp hay gy, yu t ton thn nhgii tnh, tui, chiu cao, cn nng, ch s dng mui iode d phng v cc dn cht tngt v.v.. V th vic xc nh bnh nhn c bu gip hay khng l mt vn ht sc nghimtc, cn c cn nhc v ht sc t nh trc khi i n kt lun.

Tht vy kch thc tuyn gip l mt thng s quan trng trong chn on bnhtuyn gip trn lm sng, trong sng lc bnh l ca tuyn gip khi iu tra dch t thiu htiode. Mt s cng trnh ghi nhn c mt sai s kh cao khi so snh vi tuyn gip ln quakhm lm sng v siu m tuyn gip khi nh gi v t l bu gip qua cc iu tra v dcht hc.

Ngy nay kch thc tuyn gip c xc nh chnh xc hn nh vo mt s k thutchn on hnh nh nh siu m gip, CT Scan, Cng hng t ht nhn, trong siu mtuyn gip l mt k thut an ton, khng xm nhp, t hoc hu nh v hi, kinh t, c ng,

d thc hin c bit cho kt qu nhanh vi chnh xc cao, sai s khng ng k.V phng din sinh l v gii phu, qua y vn ghi nhn kch thc v trng lngtuyn gip ca ngi bnh thng pht trin ngay t khi cn phi thai v tng dn theo latui t s sinh cho n lc trng thnh sau gim dn th tch v khi lng khi v gi.

Tuy nhin cc nc i sng kinh t thp, do tng trng c th thng chm, vicnh gi th tch tuyn gip lin quan theo tui v th c th khng cn thch hp, trongtrng hp ny th tch tuyn gip l hm s ca ch s nhn trc.

Trc y nh gi th tch tuyn gip chng ta phi vay mn s liu nc ngoi so snh. V th vic tm kim mt hng s v kch thc tuyn gip bnh thng cho ngiVit Nam tui trng thnh t trc ti nay y vn cha cp nhiu.

Mt s y vn nc ngoi ghi nhn tuyn gip ca ngi bnh thng pht trin ti

a t tui 14- 18 nhng khng xc nh r v tui. V vy kho st th tch tuyn gipca tui t 15 tui ca ngi Vit Nam tr ln l vic lm cn thit, v t xc nh tui no tuyn gip c th tch ti a v hon chnh, c s sau ny khng nh c bu gipcho ngi Vit Nam mt cch khoa hc v khch quan.

Mc tiu1.Kho st siu m tuyn gip ca hc sinh trung hc v sinh vin i hc ( t 15 tui n 23tui ) xc nh kch thc tng thu gip, th tch ton phn ca tng i tng qua xcnh th tch tuyn gip ti a ca ngi trng thnh.2. Xc nh s tng quan gia th tch tuyn gip vi tui, chiu cao, cn nng, ch s khc th v din tch da theo gii tnh trong tui ni trn.

III.I TNG V PHNG PHP NGHIN CU1. i tng c chn:

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i tng nghin cu 677 ngi gm 250 hc sinh ( tui t 15-17) hc sinh trng Quc HcHu v 427 sinh vin ( tui t 18-23 ) i hc Hu.Tt c i tng trn khng c bu gip ( TCYTTG )Trong c 569 hc sinh v sinh vin c kim tra minh chng c xut nhp Iode bnh thngvi nng iode niu: 150 -450 g. iode/ g creatinin niu.

2. i tng khng nghin cu:i tng c bu gip ( theo TCYTTG ) bt c giai on no, hoc siu m c hnh nh

bt thng3. a im nghin cu.Trng Quc Hc, Bnh vin Trng i hc Y Khoa Hu, Phng khm bu c Thnh phHu, Phng khm Clinic4. Thi gian nghin cu: trong 2 nm t thng 12/2000 n thng 12/2002.2. Phng php nghin cu .2. 1. C mu chn:Mi tui chn ngu nhin t 60 - 100 em chia lm 2 gii nam v n2.2. Cc bc tin hnh

Bc 1: Chun b i tng nghin cu:Bc 2: Khm lm sng: cc thng s lm sng trong nghin cu ny bao gm:Cn nng ( kg ), o chiu cao ( cm ), nh gi ch s khi c th (BMI ), o din tch da:

S=W 0,425 x H0,725 x 71,84x10-4

Bc 3: Khm tuyn gip: Phn bu gip ( TCYTTG -1994 )Bc 4. Siu m tuyn gip:My siu m TOSHIBA (Nht) v MEDISON ( Nam Triu Tin ).Phng php siu m: 2 bnh din (2D.) v s dng u d Linear ( 7.5 MHzCc thng s v kch thc ca tuyn gip: Eo tuyn gip, Tnh th tch tng thu gip theo

phng php ca R.Guterkunst : V = a x b x c x /6 tnh bng cm3

- Th tch tuyn gip ton phn: Thu phi (cm3) + Thu Tri ( cm 3 )Bc 5. So snh v nghin cu tng quan:1. So snh th tch trung bnh cu thy pha v thy tri gip theo tu theo gii2. So snh th tch tuyn gip ton phn theo tng tui theo gii.3. ng gi cc tng quan gia th tch tuyn gip ln lt vi:- Th tch ton phn tuyn gip v Tui theo gii- Th tch ton phn tuyn gip v Cn nng theo gii: theo tng nhm nh vi hng cn 45,45-50, 51-55. 56-60, 61-65, 66-70, 71-75kg.- Th tch ton phn tuyn gip v Chiu cao theo gii: tng nhm c chiu cao ln lt l: (145, 145-150, 151-155, 156-160, 161-165, 166-170, 171-175, 176-180, >180 cm.- Th tch ton phn tuyn gip v BMI theo gii theo nhm c BMI t 15,

16,17,18,19,20,21,22,23,24,25- Th tch ton phn tuyn gip v Din tch da theo gii theo nhm c din tch da cch nhau0.1 m 2 v c 8 nhm t 1,1. 1,2. 1,3. 1,4. 1,5. 1,6. 1,7. 1,8 m2.Bc 7. Xc nh th tch trung bnh tuyn gip ngi trng thnhX l cc s liu bng phng php thng k Y hc

III. KT QU & BN LUN3.1. C IM LM SNG CA NHM NGHIN CU3.1.1. Phn b v nhm tu theo gii:

Bng 3.1: Phn b tui v gii cc i tng nghin cuTu Nam N Tng cng (T l )

1516

5134

3937

9081

13.29%11.96%

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1718192021

2223

3033344737

3130

4836453937

3039

7869798674

6169

11.52%10.19%11.67%12.70%10.93%

09.01%10.19%Tng cng 327( 48.30%) 350( 41.70%) 677T l cc nhm tui khng khc bit , t nht l 9,01% v cao nht l 13,29%.

3.2. IODE NC TIU:Bng 3.4. Kt qu kho st v iode niu

T Iode/creatinin( (g/ g) S lng (n) T l (%)< 100 66 11,60

100 - 450 498 87,52> 450 5 0,88

Tng cng 569 100%87,5% c nng iode niu bnh thng ( 100 -450 g /gcreatinine )3.3. KT QU V SIU M TUYN GIP3.3.1. Th tch tng thu gip ( siu m ) theo tui v gii tnh:

Bng 3.5: Th tch tng thy gip theo tui ca nam v nTui Th tch gip nam (cm3) Th tch gip n (cm3)

Thy phi Thy tri p Thy phi Thy tri p15 5.69 1.69 4.75 1.31 < 0.001 5.59 1.42 4.95 1.54 < 0.00116 5.81 1.49 4.73 1.21 < 0.001 5.52 1.71 4.61 1.36 < 0.03717 6.71 1.40 6.11 1.56 < 0.05 6.17 1.60 4.85 1.32 < 0.001

18 5.98 1.73 5.54 1.31 < 0.05 5.94 1.36 5.21 1.31 < 0.00919 6.50 1.54 5.58 1.63 < 0.003 6.14 1.61 5.44 1.18 < 0.00620 5.82 1.50 4.77 1.70 < 0.001 6.53 1.45 5.71 1.58 < 0.00421 6.51 1.83 5.32 1.45 < 0.001 5.98 1.69 5.26 1.46 < 0.0122 5.44 1.42 5.06 1.43 < 0.05 5.83 1.52 5.12 1.29 < 0.0223 6.32 1.62 5.52 1.38 < 0.01 6.35 1.84 5.39 1.14 < 0.001

V thu phi ln hn tri tuyn gip ( p : 0.05 - 0.001 ) nam ln n gii.+ Thu phi ln hn thu tri tuyn giap:Muller-Leisse C v cng s (1988), Takalo RM v cng s ti Phn Lan ( 1991 ),Klingmuller V v cng s (1991) i hc Justus Liebig, Geressen CHLB c, Nygaard B

v cng s (1993) ti an Mch, Schonrman L v cng s (1995) u xc nhn nh trn.+ Th tch hai thu gip khng khc bit:Phm Vn Choang, Hong Kim c, Nguyn B S (1996), Nguyn c Thun, V Phng,

Nguyn Hi Thy (1998) .Kt qu chng ti : Thu phi tuyn gip ln hn tri ph hp vi y vn khi nghin cu trnqun th ln ca cc tc gi nc ngoi.Tnh th tch gip cn phi o th tch tng thu mt ri cng li l ph hp nht.3.3.2.Th tch ton phn tuyn gip

Bng 3. 6. So snh th tch tuyn gip ton phn gia nam v n gii

TuV gip ( cm3 )

Nam giiV gip ( cm3 )

N giiChnh p

15 10.44 2.79 10.53 2.88 0.09 > 0.0516 10.53 2.35 10.12 2.76 0.41 > 0.05

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10.4410.53

10.5310.12

12,82

11.0211.52

11.15

12.0811.59

10.59

12,2311.83

11.2410.5

10.95

11.8411.74

0

2

4

6

8

10

12

14

15 16 17 18 19 20 21 22 23

Nam

N

Tui

V

(cm 3)

17 12.82 2.58 11.02 2.55 1.80 < 0.00118 11.52 2.77 11.15 2.45 0.37 > 0.0519 12.08 2.89 11.59 2.37 0.49 > 0.0520 10.59 3.08 12.23 2.80 1.64 < 0.00121 11.83 2.94 11.24 2.94 0.59 > 0.0522 10.50 2.63 10.95 2.63 0.45 > 0.0523 11.84 2.80 11.74 2.78 0.10 > 0.05

Th tch tuyn gip ln nht nam 17 tui l 12,82 ( 2,58 cm3 v n l 20 tui vi12,23 ( 2,8 cm3.

Biu 3.1. Biu din th tch tuyn gip ton phn gia nam v n gii

Bng 3.7. Tng quan gia th tch tuyn gip v tui theo gii

HSTQ r1 r2 r3 r4 r5 r6 r7tui 15-17 15-18 15-19 15-20 15-21 15-22 15-23

Nam 0,8822 0,6438 0,6635 0,2237 0,2996 0,2547 0,2547N 0,5437 0,7539 0,8747 0,9296 0,7779 0,5759 0,6373

t 15 - 23 tui vi r = 0.061441 ( nam ) v r = 0.14422 ( n ).

nam t 15-17 tui vi r = 0.8822 v n t 15-20 tui vi r = 0.9296

3.4. TNG QUAN :1. Th tch tuyn gip ton phn v tui ( theo gii ) .Berghout A, Wiersinga WM, Smits NJ, Touber JL (1987) i hc Amsterdam, H Lan,Muller-Leisse C, Troger J, Khalipour F, Pokher C (1988) Klingmuller V, Otten A, BodekerRH (1991), Takalo RM, Makarainen HP, Kaarina Jaakkola (1991), Delange F gim c iuhnh ICCIDD, trng nhm nghin cu Thyromobil (1997), Phm vn Choang, Hong Knh,

Nguyn B S (1996), Nguyn c Thun, V Phng, Nguyn Hi Thy (1998)Chng ti ch ghi nhn c s tng quan thun ny cht ch nht t 15 - 17 tui ( r =0.882224 ) i vi nam v i vi n s tng quan ny cht ch vi r = 0.543729 ( 15-17

tui ), r = 0.753918 ( 15 -18 tui ), r = 0.874771 ( 15 - 19 tui ), r = 0.929615 ( 15 - 20 tui ),r = 0.777907 ( 15 - 21 tui ), r = 0.575964 ( 15 - 22 tui ) v r = 0.637398 ( 15 - 23 tui ).

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Vi s tng quan ny i vi n gii th tch tuyn gip tng i giao ng v pht trinti a nht vo tui 20 v nam tui 17. s pht trin tuyn gip cn lin quan n giitnh vi th tch tuyn gip ti a i vi nam gii tui 17 v i vi n gii l 20 tui.2. Th tch gip v cn nng

Th tch tuyn gip c khuynh hng tng theo trng lng trong tui 15 -23 tui c

nam ln n. C s tng quan thun cht ch gia th tch tuyn gip vi trng lng c th vi r= 0.34684 i vi nam v r = 0.31640 i vi n.Berghout A, Wiersinga WM, Smits NJ, Touber JL (1987) i hc Amsterdam, H Lan,Golkowski (1993), Hsiao YL v cs (1994) Muller Leisse C, Troger J, Khabipour F, PocklerC (1988), Ho SS, Metreweli C (1995) bnh vin Prince, Wale, Hng Kng, Phm VnChoang, Hong Kim, Nguyn B S, Nguyn c Thun, V Phng, Nguyn Hi Thy (1998) :Th tch tuyn gip tng dn vi trng lng

Chng ti ghi nhn c s tng quan thun gia th tch tuyn gip vi trng lngc th vi r = 0.34684 i vi nam v r = 0.31640 i vi n.

Biu 3.4: Tng quan gia th tch tuyn gip v trng lng nam gii Vi r =0.34684, n = 327 v p < 0.01

3. Th tch tuyn gip v chi cao.C s tng quan thun gia th tch tuyn gip vi chiu cao vi r = 0.26457 i vi nam vr = 0.16278 i vi n. Muller Leisse C, Troger J, Khabipour F, Pockler C (1988),Gomez JM,Marvall FJ, Gomez N, Guma A, Soler J Barcelona, Ty Ban Nha (2000) ].Phm VnChoang, Hong Kim c, Nguyn B S (1996) Nguyn c Thun, V Phng, Nguyn

Hi Thy (1998) Th tch tuyn gip lin quan n chiu cao. Chng ti : c s tng quanthun gia th tch tuyn gip vi chiu cao vi r = 0.26457 i vi nam v r = 0.16278 ivi n.

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Tng quan gia trong lng (P) vathtch tuyn giap na

y =0.1541x +3.372

R2=0.1203-

5.00

10.00

15.00

20.00

30 40 50 60 70 80

T ng quan gia T htch giap v

y = 0 .1 1 8 7 x - 8 .

R2

= 0 .0 7 0 1

-

5 . 0 0

1 0 . 0 0

1 5 . 0 0

2 0 . 0 0

1 2 0 1 3 0 1 4 0 1 5 0 1 6 0 1 7 0 1 8 0 1 9 0

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Biu 3.6: Tng quan gia V tuyn gip v chiu cao nam gii vi r =0.26457, n = 327 v p < 0.01

4. Th tch tuyn gip v BMI.Th tch tuyn gip c khuynh hng tng theo BMI nam ln n gii trong tui15-23 tui. Tng quan thun cht ch gia th tch tuyn gip vi BMI vi r = 0.24839 ivi nam v r = 0.23065 i vi n.Gomez JM v cng s ( 2000 ) v chng ti : V gip c lin quan n BMI. vi r = 0.24839i vi nam v r = 0.23065 i vi n .

Biu 3.8: Tng quan gia th tch tuyn gip v BMI nam gii vi r = 0.24839, n =327 v p < 0.01

5. Th tch gip v din tch daMuller-Leisser C, Troger Klabirpour F, Pockler C (1988) Klingmuller V, Fiedler C, Otten A,Egidi R, Koch C (1989) i hc Justus, Liebig, Giessen c Takalo RM v cng s ( 1991)Xu F, Sullivan K, Houston R, Zhao J, May W, Maberty G (1995) Atlanta, Gergia M,Delange F (1997) gim c ICCIDD trng nhm Thyromobil ,Gomez JM, Maravali FS,Gomez N, Guma A, Soler J (2000), Trn B Thoi v Nguyn Hi Thu ( 2001 ) ; gip tngquan vi S da.V gip tng theo S da tui 15 -23 tui c nam ln n.S da vi r = 0.31937 i vi nam v r = 0.29664 i vi n.

Biu 3.10. Tng quan gia V gip v S da n ( r = 0.29664, n = 350 v p < 0.01 )6..Th tch tuyn gip ti a ca tng tui

7

Tngquan gia BMI namvathtch giap

y =0.3899x +3.8594

R2=0.0617

-

5.00

10.0015.00

20.00

10 15 20 25 30

BMI

Tng quan din tch da vathtch giap n

y =8.7843x - 0.9207

R2=0.088

-

5.00

10.00

15.00

20.00

1.00 1.20 1.40 1.60 1.80S(da)

V

tuy

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1/ Phm Vn Choang. ( 2000 ) Kt qu siu m tuyn gip trong 3 nm 1993-1995 ti VinNi tit. K yu ton vn Cng trnh Nghin cu Khoa hc Ni tit v Chuyn ha. Nh Xutbn Y hc 5.2000. Trang 23-26.2/ Nguyn Hi Thy.( 2000 ) Siu m tuyn gip . Chn on v iu tr bnh tuyn gip Nhxut bn Y hc H Ni.Tr. 79-99

3/ Fobble. F (1995), Thyroid gland - Color Duplex sonography - Principles and clinicalapplications - Thieme.4/ Gomez J.M, Maravall F.J, Gomez N, Guma, Soler J (2000), Determinants of thyroidvolume as measured by ultrasonography in healthy adults randomly selected, ClinEndocrinol (Oxf), 53(5), pp 629-34.5/ Muller L. C, Troger J, Khabirpour F, Pockler C (1998), Normal values of thyroidgland volume: Ultrasound measurements in schoolchildren 7 to 20 years of age , DeutschMed Wocheschr 2; 113(48), p 1872-5.6/ Berlin X. , J Tramalloni, C. Swagier.( 1999 ) Rgion cervicale. cho Doppler vasculaire etviscrale. Masson (1999).

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