Referat

Tiroiditis Hashimoto
Oleh:
Widianingsih
113170072

Pembimbing : dr.Nunik Royyani Sp.Rad

dipresentasikan pada :
Sabtu, Mei 2018

Kepaniteraan Klinik Ilmu Radiologi

Rumah Sakit Umum Daerah Waled
Fakultas Kedokteran
UNSWAGATI
 BAB I
PENDAHULUAN
 Latar Belakang
Tiroiditis → inflamasi tiroid.

Tiroiditis Hashimoto → penyakit tiroid autoimun.

Rasio kejadian 10-15 : 1

Umur rata-rata didiagnosis TH → 60 tahun

Hipotiroidisme subklinis 6-8 % wanita →10% usia > 60 tahun, 3% pada

laki-laki.

next
 Tujuan
Untuk memperdalam pengetahuan dokter muda mengenai
tiroiditis Hashimoto dan dapat mengetahui perbedaan tiroiditis
Hashimoto dan berbagai diagnosis bandingnya dalam
pemeriksaan penunjang radiologi khususnya dan dalam
pemeriksaan keseluruhan (anamnesis, pemeriksaan fisik dan
02 pemeriksaan penunjang) pada umumnya.

Untuk melatih dokter muda agar mampu berpikir kritis dan ilmiah
dalam menyusun karya tulis ilmiah

04

next
 BAB II
TINJAUAN PUSTAKA
 Anatomi
Your Picture Here

Anatomi Kelenjar
Tiroid Vaskularisasi
kelenjar tiroid
 Pada awalnya Hypothalamus
akan menghasilkan TRH
(Thyrotropine Releasing
Hormone) yang akan memacu
Kelenjar Pituitari (Hipofise)
untuk menghasilkan TSH
(Thyrotropine stimulating
hormone)
TRH (Thyrotropine releasing
Hormone) yang dihasilkan
Hypothalamus
TRH (Thyrotropine releasing
Hormone)akan memacu kelenjar
thyroid untuk menghasilkan T3
dan T4

Jika hormon thyroid diproduksi dalam TSH (Thyrotropine

jumlah sedikit maka TSH akan stimulating hormone)
meningkat nilainya untuk memacu agar
kelenjar thyroid dapat menghasilkan T3 TSH memacu kelenjar thyroid untuk
dan T4 dalam jumlah cukup. menghasilkan T3 dan T4
Sebaliknya jika terjadi peningkatan
produksi T3 dan T4 maka TSH akan
menurun jumlahnya agar tidak
terbentuk T3 dan T4 lagi.

Triiodotironin (T3) dan Tetraiodotironin/ Tiroksin

(T4) yang dihasilkan oleh kelenjar tiroid

Hypothalamus-----TRH-------->Pituitary -Gland-----TSH------>Kelenjar Thyroid------> T3 dan T4

 Fungsi Hormon Tiroid

Mengontrol seberapa cepat tubuh Mengontrol hormon

menggunakan energi

Membuat protein Memproduksi kalsitonin yang

berperan dalam homeostasis
kalsium

Mengontrol sensitifitas tubuh Memproduksi hormon tiroid→ T3

dan T4
 Definisi Tiroiditis Hashimoto
Tiroiditis Hashimoto → penyakit tiroid autoimun
Autoimun 01

Predisposisi genetik
02

Faktor lingkungan
03

Add Contents Title

Etiologi
 Patofisiologi Tiroiditis Hashimoto
Predisposisi genetik Kerusakan toleransi imunitas Pembangkitan sel-sel T helper
autoreaktif, limfosit T sitotoksik dan
sel-sel Bprodusen autoantibodi dalam
jumlah besar

Akumulasi sel-sel imun didalam

kelenjar tiroid

Meratanya respon autoimun yag

Hipotiroidisme dimediasi dan efek sitotoksik dari
(tiroiditis hashimoto) limfosit T sitotoksik di dalam kelenjar
tiroid
Apoptosis dari tirosit
 Gejala Klinis

Kelelahan
Peningkatan sensitivitas terhadap
dingin dan panas

Bengkak tidak nyeri pada Peningkatan sensitivitas

leher depan bagian bawah terhadap dingin dan panas

Kekakuan pada sendi Kulit kering

Nyeri otot Wajah membengkak

 Anamnesis

Anamnesis

Pemeriksaan Fisik

Pemeriksaan Penunjang
Diagnosis

Hashimoto
Penegakan Diagnosis Tiroiditis
 Pemeriksaan Penunjang
Gambaran USG Tiroiditis Hashimoto

Name Here Name Here

Programmer Programmer

Kelenjar tiroid yang terlihat sangat hipoekhoik disebabkan Kelenjar tiroid yang membesar merupakan gambaran khas
infiltrasi dari limfosit pada jaringan tiroid. Ekogenisitas tampak pada tiroiditis Hashimoto dengan pola hipoekoik tetapi
sama dengan otot sekitarnya heterogen
 Pemeriksaan Penunjang
Gambaran USG Tiroiditis Hashimoto

Name Here
Programmer

Gambaran USG parenkim tiroid ini menunjukkan beberapa

“Bag of marbles,” Daerah fibrosis tampak hiperekhoik
pseudonodul .Tetapi nodul-nodul ini tidak memiliki halo dan
dibandingkan dengan gambaran hipoekogenisitas dari
batas yang tegas, tidak teraba dan akan berubah sejalan
daerah kelenjar lainnya,
dengan waktu.
 Pemeriksaan Penunjang
Gambaran USG Tiroiditis Hashimoto

Tiroiditis Hashimoto menunjukkan nodul kecil multipel dan penurunan aliran pada skan Color Doppler. Aliran darah tampak normal
atau berkurang pada sebagian besar kasus TH.
 Penatalakasanaan

Terapi hormon pengganti hormon tiroid menghindari makanan kaya yodium

mengurangi asupan kafein, gula, dan berbagai

levothyroxine pengawet makanan.
 BAB III
PEMBAHASAN
 Tiroid tiroiditis Grave’s disease Diagnosis
Banding
Volume 6-15 cm me↓, normal, me↑ me↑ (goiter)

Ekogenitas >besar/sama dengan Isoechogenitas/hipoec hipoekoik

kelenjar submandibula hogenitas

Tekstur Homogen Heterogen difus, dapat Heterogen difus,

berupa area hipoekoik mungkin juga ada garis
tersebar (infiltrat hiperekogenitas
limfositik) garis
hiperekoik (gambaran
fibrotik)
Vaskularisasi parenkim Beberapa pembuluh me↓, normal, me↑ me↑
darah tersebar di 1/3 (intensitas >sedikit dari
tengah parenkim Grave’s), bisa
kelenjar dan pembuluh meningkat tapi tidak
darah di perifer seperti grave’s
kelenjar
Tiroiditis de
Your Picture Here Your Picture Here
Quervain

Your Picture Here Your Picture Here

Grave’s disease
 BAB IV
PENUTUP
 Simpulan
Tiroiditis Hashimoto → kelainan
autoimun pada kelenjar tiroid.
Etiologi → belum dapat ditentukan
secara pasti, faktor predisposisi
genetik, faktor lingkungan.
Diagnosa banding →Tiroiditis
granulomatosa subakut dan
penyakit Graves’.
Gambaran USG → pembesaran lobus
tiroid yang luas dengan ekhostruktur
yang inhomogen dan hipoekhoik,
mikronodul dan nodul soliter pada
parenkim tiroid
Gambaran → USG color Doppler
parenkim tiroid dapat bervariasi dari
sedikit hipovaskular sampai dengan
hipovaskularisasi yang cukup jelas.
Penatalaksanaan →terapi
pengganti hormon tiroid →
levotiroksin.
Thank you
 Simpulan
Tiroiditis Hashimoto → kelainan autoimun pada
kelenjar tiroid. Etiologi → belum dapat ditentukan
secara pasti, faktor predisposisi genetik, faktor
lingkungan.
Gambaran USG → pembesaran lobus tiroid yang
Your Picture Here
luas dengan ekhostruktur yang inhomogen dan
hipoekhoik, mikronodul dan nodul soliter pada
parenkim tiroid
Gambaran → USG color Doppler parenkim tiroid
dapat bervariasi dari sedikit hipervaskular sampai
dengan hipervaskularisasi yang cukup jelas.
Diagnosa banding →Tiroiditis granulomatosa
subakut dan penyakit Graves’.
Penatalaksanaan →terapi pengganti hormon Text Here
tiroid → levotiroksin.
 
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