LBM 5

STEP 1 1.Palpitation : disruption of the heart rate that it is irreguler

2.Trembling hands : Tremor,uncontrol inmovement.Increase of sensitivity of nerve sinaps. STEP 2 1. Why the patient complain of palpitation,difficulty sleeping,can not stand the heat,a lot of sweat,itchy skin,tired,trembling hands,weight oss despite eating and appetite added, and more frequent bowel movement? 2. Why did her neck appear tumor like a lump? 3. Why after thumping great massage performed on the lump in the neck occur stool frequency? 4. What the causes of hipotension according from the scenario? 5. What are the differential diagnose from the scenario? 6. What are the etiologies of the true diagnose? 7. What are the patophysiologics from the diagnose? 8. What are the symptoms of the diagnose? 9. What kinds of physical and laboratory examination are to be used to support the diagnose of the disease?and interpretation? 10.Is there any relation between stool frequency with the decrease of blood pressure? 11.How to prevent the occurance of disease in the scenario? 12.What are the treatments of diagnose? 13.What are the prognosis of diagnose?

STEP 3

1. Why the patient complain of palpitation,difficulty sleeping,can not stand the heat,a lot of sweat,itchy skin,tired,trembling hands,weight oss despite eating and appetite added, and more frequent bowel movement? Palpitation : the increase of metabolism make the body need high oxygen so the heart rate increase to distribute oxygen in to all of the body. Lot of sweat : the increase of metabolism that give calories. Trembling hand : Increase of nerve sinaps sensitivity that include muscle tones Difficulty sleeping : Because of a lump in her neck,that disturb her when she was sleeping. Because of more frequent bowel movement. Frequent bowel : Because of increased of tyroid hormone caused the increased motility of the GIT thus increasing the speed of movement of the secretion digestivus juices and digestive tract. Weight loss : Caused by increase of thyroid hormone Increase the fat metabolism and increasing the free faty acid in the blood. Tired : More of thyroid secretion,can make the muscle is weak because of over of the protein catabolism. Cant stand the heat : Increasing in thyroid hormone the increase of tissue metabolism cause vasodilatation in most the bodies tissues and skin blood vesells increase the blood flow make a sympatatic center in the posterior hypotalamus barriers cause vasocontriction in nerves increasing the speed of heat transfer to the skin 8 times sweaty cant stand the heat. How tyroid hormone can do the sympatic and parasimpatic nerves? 2. Why did her neck appear tumor like a lump? Because the increase of secretion of tyroid hormone. 3. Why after thumping great massage performed on the lump in the neck occur stool frequency?

Frequent bowel : Because of increased of tyroid hormone caused the increased motility of the GIT thus increasing the speed of movement of the secretion digestivus juices and digestive tract. 4. What the causes of hipotension according from the scenario? 5. What are the differential diagnose from the scenario? - Tirotoksikosis : Occur enlarged of tyroid gland - Hypertiroidisme : that causes of tiroktoksikosis is hyperactive of tyroid gland 6. What are the etiologies of the true diagnose? - Primary : Graves disease,hiperfunctional adenoma,multinodular goiter,high consumption of yodium,karsinoma tiroid. - Secondary : Resistensi hormon tiroid,adenoma hipofisis penghasil hormon perangsang tiroid,tirotoksikosis gestasi. 7. What are the hormone that related with the disease and the function of each hormone? 8. What are the patophysiologics from the diagnose? TSH menurun karena ada sesuatu yang menyerupai TSH yaitu TSI atau tyroid stimuoatin immunoglobuoine TSI berikatan dengan reseptor pengikat TSH Merangsang pengaktifan cAMP peningkatan produksi T3 da T4 Peningkatan laju metabolisme tubuh,keja jantung,pertumbuhan,dll 9. What are the symptoms of the diagnose? - Hair loss - Menstruation become irreguler - Eksoftalmus with double vision - Pregnancy often end and miscarriage 10.What are the epidemiology of the disease? - Hypertiroid is the second killer disease after DM in Indonesia - Pasien usia muda gejala aktifitas simpatik,diare akibat stress. - Pasien usia tua gejala kardiovaskuler - Lebih sering diderita perempuan dibandingkan laki-laki (7:1)

- Usia 20-40 tahun :tyroid autoimune disease , usia >50 tahun : karena toksik multinodular. - Commonly occur with same frequency in kaukasian ,hispanic,and asian but lower frequency in africans and americans. 11.What kinds of physical and laboratory examination are to be used to support the diagnose of the disease?and interpretation? Pemeriksaan lab : - Pengukuran kadar hormone tiroid - Scan tiroid - Kadar lemak serum - Autoantobody tests - CT Scan - Pemeriksaan BMR Hiper : naik 30-60 Pemeriksaan fisik : Mengukur suhu tubuh Denyut nadi Laju pernafasan Tekanan darah

12.How to prevent the occurance of disease in the scenario? - Mengurangi konsumsi yodium berlebihan - Mengurangi konsumsi obat yang dapat meningkatkan hormon tiroid 13.What are the treatments of diagnose? - Long-term medication : Antityroid drugs Propylthiouracil and methimazole yang diberikan paling sedikit selama 1 tahun. 2 methods : 1.Titration ( memberi obat secara bertahap sesuai perkembangan penyakit) 2.Block Substitution : Memberi obat secara terus menerus hingga hipotiroid Diberi tiroksin Eutiroid - Beta-blocker Propanolol diberikan bersamaan dengan obat anti tiroid

- Tiroidektomi : Pembedahan tiroid - Pengobatan dengan yodium radioaktif : Memusnahkan kelenjar tiroid yang hiperaktif ( kontraindikasi dengan anak2 dan wanita hamil) 14.What are the prognosis of diagnose? - Bisa meningkatkan resiko gagal jantung - Jika tidak diobati bisa menyebabkan kepadatan mineral tulang dan meningkatkan resiko fraktur pinggul - Meningkatkan resiko hipertensi - Mortalitas : 10-15 % jika pengobatan adekuat. - Stroke iskemik meningkat pada usia 18-44 tahun - Hipertiroidism from toksik multinodular goiter and toksik adenoma is permanent ussualy occur in adult.

HAPPY BIRTHDAY
dr. PASID HERLISA, Sp.KK