Graves Disease

ANANTO WINDHA PRATIWI, S.KED

K1A1 15 051

PEMBIMBING
dr. SARI YUNIAR, Sp.PD

KEPANITERAAN KLINIK
BAGIAN ILMU PENYAKIT DALAM
FAKULTAS KEDOKTERAN
UNIVERSITAS HALU OLEO
2019
PENDAHULUAN

Hipertiroid merupakan suatu kondisi dimana kelenjar tiroid terlalu

aktif dan memproduksi hormon tiroid berlebihan. Berbeda dengan
hipertiroidisme, tirotoksikosis adalah gejala klinis yang disebabkan
peningkatan kadar hormone tiroid di dalam darah.

Terdapat beberapa penyakit yang menyebabkan terjadinya hipertiroid sep

erti Graves’ Disease, Nodular Thyroid Disease, Subacute Thyroiditis, Post
partum Thyroiditis. Namun sebanyak 95% hipertiroid disebabkan oleh
Grave’s Disease yaitu suatu penyakit tiroid autoimun yang antibodinya
merangsang sel-sel untuk menghasilkan hormon yang berlebihan.
 DEFINISI

Penyakit Graves adalah penyakit autoimun yang menyebabkan aktivitas berlebihan secara
keseluruhan dari seluruh kelenjar tiroid (hipertiroidisme) disebabkan peristiwa imunologi
dimana terbentuknya IgG yang mengikat dan mengaktifkan reseptor tirotropin disebut
thyroid-stimulating antibody (TSAb) yang menyebabkan hipertrofi dan hyperplasia
folikuler yang berakibat membesarnya kelenjar dan meningkatnya produksi hormone tiroid
.
EPIDEMIOLOGI

Prevalensi GD relatif tinggi dibandingkan dengan

penyebab hipertiroidisme lainnya.

Menurut Weetman, dari semua kasus hipertiroidisme,

ada 60-80% kasus yang didiagnosis dengan penyakit
Graves

Pada kelompok umur dewasa (20-39 tahun), perempuan

jauh lebih banyak dibandingkan pasien laki-laki.

Insiden hipertiroid adalah 82,27 per 100.000 perempuan,

sedangkan pada laki-laki adalah 16,24 per 100.000
laki-laki
ETIOLOGI
Ada beberapa kelainan yang terkait dengan hipertiroid, beberapa
keadaan tersebut dapat menyebabkan manifestasi klinis yang
bermakna.

Kelainan Mekanisme patologis

Graves disease Auto antibody pada reseptor TSH

Toxic Moltinoduler goiter Multiple foci of functional autonomy

Toxic hot nodule Single focus of functional autonomy

Hipersekresi TSH Adenoma tiroid dan resistensi terhadap T4

Tumor throphoblastic Chorionic gonadotropin

Hiperemis gravidarum Chorionic gonadotropin

PATOMEKANISME
 MANIFESTASI KLINIK
TANDA GEJALA
• Takikardi • Hiperaktivitas
• Atrial Fibrilasi • Iritabilitas
• Tremor • Disforia
• Goiter •
04
Palpitasi
• Hipertensi sistolik • Agitasi
• Kulit yang hangat dan lembab • Lemah dan lesu
• Hiper reflex • Intoleransi panas
• Kelemahan Otot • 05
Mudah berkeringat
• Miopati proksimal • Peningkatan selera makan
• Lid lag retraction & lid retraction • Penurunan berat badan
• Ginekomastia • Gangguan menstruasi
06
Triad Merseburger : tirotoksikosis, gondok difus
, dan oftalmopati (orbitopati).
DIAGNOSIS
ANAMNESIS
& PEMERIKSAAN PENUNJANG
PEMERIKSAAN FISIK

Diagnosis penyakit Grave

• Serum TSH
(GD) dibuat berdasarkan
• Kadar hormone tiroid
tanda, gejala, dan hasil te
FT4 dan FT3
s laboratorium tambahan.
• TRAb (thyrothropin
Manifestasi penyakit ini
reseptor antibody)
adalah triad Merseburger
• Radioactive iodine
yang terdiri dari tirotoksiko
uptake (RAIU)
sis, gondok difus, dan
• Ultrasonography (USG)
oftalmopati (orbitopati).
DIAGNOSIS
Apabila terdapat ketidaksesuaian antara gambaran klinis atau bila gejala ringan atau
bila pemeriksaan lab tidak memungkinkan maka dapat digunakan indeks wayne
yang membantu penegakan diagnosis berdasar gambaran klinis.

Interpretasi:
>19 = toxic,
11-19 = meragukan,
<11 = eutiroid/ non toxic)
TATALAKSANA
1. FARMAKOLOGI
Obat Anti Tiroid
Propythiouracil
Dosis awal : 100-150 mg secara oral setiap 8 jam. Dosis awal akan dilanjutkan s
elama 2 bulan setelah semua gejala terkontrol.
Perawatan : 100-150 mg/hari dalam dosis yang dibagi rata setiap 8-12 jam. Pen
gobatan biasanya dilanjutkan hingga remisi spontan terjadi (hingga 1-2 tahun) at
au sampai terapi ablative dilakukan.

Methimazole
Dosis : untuk awal terapi dianjurkan dosis tinggi 10-20 mg perhari untuk menca
pai eutiroid lalu dititrasi ke dosis perawatan (5-10 mg perhari).
Thiamazole
Dosis : untuk kasus ringan 2x10 mgperhari, kasus berat 2x20 mg perhari (selama
3-8 minggu) lalu dititrasi ke dosis perawatan (5-20 mg perhari)
Carbimazole
Dosis : untuk dosis awal 15-40 mg perhari selama 4-8 minggu, lalau dititrasi ke
dosis perawatan 5-15 mg selama 12 bulan.
TATALAKSANA
Beta Bloker
Direkomendasikan untuk semua pasien tirotoksikosis dengan
manifestasi yang jelas, terutama pada lansia, mereka yang
berdenyut> 90x / menit, atau penyakit kardiovaskular lainnya.
Pada awal terapi diberikan, sementara menunggu pasien menjadi
eutiroid setelah 6-12 minggu pemberian anti tiroid.
Propanolol dosis 40-200 mg dalam 2-3 dosis

2. BEDAH
Tiroidektomi total.
3. Radioactive Iodine Therapy (RAI)
RAI dapat diterapkan pada pasien dengan risiko efek samping obat
anti-tiroid dan dengan komorbiditas.
 KOMPLIKASI PROGNOSIS

Prognosis GD tercermin dengan baik

• Krisis Tiroid
dengan tingkat remisi dan relaps.
• Graves Ophtalmopathy Tingkat remisi di antara orang dewasa
lebih tinggi daripada anak-anak.
TERIMA KASIH
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