DEFINISI
(Sudoyo,W Aru,dkk.2006)
Tirotoksikosis
vs
hipertiroidisme
Apapun sebabnya, manifestasi
klinisnya sama
Efek ini disebabkan ikatan T3 dengan
T3-inti makin penuh
(Sudoyo,W Aru,dkk.2006)
www.univ-st-etienne.fr/lbti/Mednucl/AtlasEnd/thyro
THYROID HORMONES
OH
OH
O
NH2
I
O
Thyroxine (T4)
OH
NH2
I
O
OH
3,5,3-Triiodothyronine (T3)
FEEDBACK REGULATION
THE HYPOTHALAMIC-PITUITARY-THYROID AXIS
Hormones derived from the pituitary that regulate
the synthesis and/or secretion of other hormones are
known as trophic hormones.
PITUITARY-THYROID AXIS
Liver
Increased LDL
Cholesterol
Elevated
Triglycerides
Intestines
Constipation
Decreased GI
Activity
Reproductive
System
Decreased Fertility
Menstrual Abnormalities
May Harm Development of Infant
Brain
Depression
Decreased Concentration
General Lack of Interest
Heart
Decreased Heart Rate
Increased/Decreased
Blood Pressure
Decreased Cardiac
Output
Kidneys
Decreased Function
Fluid Retention and
Edema
etiologi
Etiologi
Hipertiroidisme primer : penyakit Graves, struma
Difficulty Sleeping
Hoarseness or
Deepening of Voice
Persistent
Sore or Dry Throat
Difficulty Swallowing
Rapid or Irregular Heartbeat
Infertility
Menstrual Irregularities or
Weight Loss
Light Period
Heat Intolerance
Increased Sweating
First-Trimester Miscarriage
Family History of
Thyroid Disease
or Diabetes
Nervousness
Increased Sweating
Irritability
Heat Intolerance
Difficulty Sleeping
Bulging Eyes
Unblinking Stare
Goiter
Frequent Bowel
Movements
Rapid Heartbeat
Manifestations of hyperthyroidism
Symptoms
Hyperactivity, irritability, altered mood, insomnia
Heat intolerance, increased sweating
Palpitations
Diagnosis
Diawali oleh kecurigaan klinis.
Berdasarkan indeks klinis Wayne and
Newcastle yang didasarkan anamnesis
dan pemeriksaan klinis yang teliti.
Dilanjutkan dengan pemeriksaan
penunjang untuk konfirmasi diagnosis
anatomis, status tiroid dan etiologi
diagnosis
Untuk fungsi tiroid
diperiksa kadar
hormon beredar
TT4, TT3, dalam
keadaan tertentu
sebaiknya fT4 dan
fT3, dan TSH
Investigations
Evaluation Thyrotoxicosis
Treatment of
Hyperthyroidism
H Y P E R T H Y R O ID IS M
T y p e t i t le h e r e
M E D IC A L
S U R G IC A L
IO D IN E
A n ti t h y r o id d r u g s
B e ta b lo c k e r s
S u b to ta l th y r o id e c to m y
R a d io a c tiv e io d in e
L u g o l's s o lu tio n
Duration of treatment
18-24 months
Side effects- Rash
Leukopenia
Agranulocytosis
Control of adrenergic
symptoms
Adrenergic antagonists:
Propranolol-40-120mg/day
Complications of ablative
therapy
Immediate complications of surgery:
Bleeding,injury to recurrant laryngeal
nerve and thyroid crises.
Other complications
Hypothyroidism
Radiation thyroiditis
Complications of
thyrotoxicosis
1)Cardiac- Heart failure
Atrial fibrillation
Treatment of ophthalmopathy
and Dermopathy