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Nama : Lk/Pr MR :

Umur : Ruangan :

INDEX WAYNE
Tanggal INTERPRETASI
Simptoms Indeks Wayne:
Dyspneu deffort 1 Eutiroid
11
Palpitasi 2 Equivocal =
11 -18
Fatigue 2 Hipertiroid > 18
Suka udara -5
panas
Suka udara 5 Indeks New
dingin Castle :
Over sweating 3 Eutiroid : 11
-23
Gugup 2 Equivocal : 24
39
Appetite 3 Hipertiroid : 40
80
Appetite -3
BB -3 T3 :
nmol/L
BB -3 T4 :
ng/dl
Sign + - FT3 :
Palpable tiroid 3 -3 Ft4 :
Bruit 2 -2 TSH :
Exophthalmus 2 0
(Eye) lid lag 1 0 Up take :
Hiperkinetic 4 -2 - 2 jam :
(gelisah)
Fine finger 1 0 - 24 jam :
tremor
Tangan hangat 2 -2
Tangan basah 1 -1 USG Tiroid :
Atrium fibrilasi 4 0
Nadi < 80 0 3 Scanning
x/menit Tiroid :
Nadi 80-90 0 0
x/menit
Nadi > 90 3 0
x/menit
JUMLAH

INDEX NEW Usia mulai :


CASTLE
Usia saat mulai 15 20 : 0
Psycological -5 25 34 : 4
precipitate
Frequent -3 35 44 : 8
checking
Severe anticip. -5 45 54 : 12
Anxiety
Appetite 5 > 55 : 16
Palpable Tiroid 3
Bruit 18 Heart rate
Exophthalmus 19 < 90 :1
Lid retraction 9 80 90 : 8
Hiperkinetic 4 < 80 :0
Fine finger 4
tremor
Heart rate
JUMLAH

EKG

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