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TIROTOKSIKOSIS
HIPERTIROID
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/thyroide/
THYROID HORMONES
OH I I I O I O
OH I I O
NH2
OH
I O
NH2 OH
Thyroxine (T4)
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
Brain
Depression Decreased Concentration General Lack of Interest
Liver
Increased LDL Cholesterol Elevated Triglycerides
Heart
Decreased Heart Rate Increased/Decreased Blood Pressure Decreased Cardiac Output
Intestines
Constipation Decreased GI Activity
Reproductive System
Decreased Fertility Menstrual Abnormalities May Harm Development of Infant
Kidneys
Decreased Function Fluid Retention and Edema
Hormon tiroid berfungsi untuk mengendalikan kecepatan metabolisme tubuh. Hormon tiroid mempengaruhi kecepatan metabolisme tubuh melalui dua cara : 1. Merangsang hampir setiap jaringan tubuh untuk menghasilkan protein. 2. Meningkatkan jumlah oksigen yang digunakan oleh sel. (fitriani,2010)
http://yosefw.wordpress.com/2008/06/10/penggunaan-obat-antitiroid-pada-pasien-hipertiroidisme/
etiologi
Etiologi
Hipertiroidisme primer : penyakit Graves, struma multinodosa toksik, adenoma toksik, metastasis karsinoma tiroid fungsional, struma ovarii, mutasi reseptor TSH, obat kelebihan yodium (fenomena Jod Basedow).2 Tiroiditis silent, destruksi tiroid (tanpa amiodarone, radiasi, infark adenoma), asupan hormon tiroid yang berlebihan (tirotoksikosis factitia)2 Hipertiroidisme sekunder: adenoma hipofisis yang mensekresi TSH, sindrom resistensi hormon tiroid, tumor yang mensekresi HCG, tirotoksikosis gestasional2
Lebih dari 90 % hipertiroidisme adalah akibat penyakit graves dan nodul tiroid toksik.
Bulging Eyes/Unblinking Stare Swelling (Goiter) Menstrual Irregularities or Light Period Frequent Bowel Movements
Warm, Moist Palms Excessive Vomiting in Pregnancy Family History of Thyroid Disease or Diabetes
May Include:
Nervousness Irritability Difficulty Sleeping Bulging Eyes Unblinking Stare Goiter Rapid Heartbeat
Increased Sweating Heat Intolerance Unexplained Weight Loss Scant Menstrual Periods Frequent Bowel Movements Warm, Moist Palms Fine Tremor of Fingers
TABLE1.MAJOR SYMPTOMS AND SIGNS OF HYPERTHYROIDISM AND OF GRAVES DISEASE AND CONDITIONS ASSOCIATED WITH GRAVES DISEASE 5 Manifestations of hyperthyroidism Symptoms Hyperactivity, irritability, altered mood, insomnia Heat intolerance, increased sweating Palpitations Fatigue, weakness Dyspnea Weight loss with increased appetite (weight gain in 10 percent of patients) Pruritus Increased stool frequency Thirst and polyuria Oligomenorrhea or amenorrhea, loss of libido Signs Sinus tachycardia, atrial fibrillation Fine tremor, hyperkinesis, hyperreflexia Warm, moist skin Palmar erythema, onycholysis Hair loss Muscle weakness and wasting Congestive (high-output) heart failure, chorea, periodic Paralysis (primarily in Asian men), psychosis*
Manifestations of Graves disease Diffuse goiter Ophthalmopathy A feeling of grittiness and discomfort in the eye Retrobulbar pressure or pain Eyelid lag or retraction Periorbital edema, chemosis, scleral injection Exophthalmos (proptosis) Extraocular-muscle dysfunction Exposure keratitis Optic neuropathy Localized dermopathy Lymphoid hyperplasia Thyroid acropachy Conditions associated with Graves disease Type 1 diabetes mellitus Addisons disease Vitiligo Pernicious anemia Alopecia areata Myasthenia gravis Celiac disease Other autoimmune disorders associated with the HLA-DR3 Haplotype
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 Untuk fase awal penentuan diagnosis, perlu T4, T3, dan TSH Namun pada pemantauan hanya T4 saja.
Investigations
Thyroid function test: TSH- Undetectable T4 - Raised T3 - Raised RAIU- Raised TSH-receptor antibodies(TRAb)-elevated in Gravess disease Isotope scanning- Increased uptake
Treatment of Hyperthyroidism
HYPERTHYROIDISM Type title here
MEDICAL
SURGICAL
IODINE
Duration of treatment
18-24 months Side effects- Rash Leukopenia Agranulocytosis
Complications of thyrotoxicosis
1)Cardiac- Heart failure Atrial fibrillation 2)Thyrotoxic crises: or storm: Fulminating increase in signs and symptoms of thyrotoxicosis. Occurs in medically untreated or inadequately treated patients.May be precipitated by surgery or sepsis The syndrome is characterized by extreme irritability,delirium or coma,fever 41C or more,tachycardia,restlessness,hypotension,vomiti ng and diarrhea.