Hipertiroidisme

RS. Marinir Cilandak

2015

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)

THE THYROID GLAND

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.

Key players for the thyroid include:

TRH - Thyrophin Releasing Hormone
TSH - Thyroid Stimulating Hormone
T4/T3 - Thyroid hormones

PITUITARY-THYROID AXIS

HM Goodman, BASIC MEDICAL ENDOCRINOLOGY 3rd E

Negative Feedback Loop

Thyroid Disease Affects

Many Body Systems and Overall Health
Thyroid
Thyroid Disease Can
Have Widespread Effects

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

Hormon tiroid berfungsi untuk

mengendalikan kecepatan metabolisme
tubuh. Hormon tiroid mempengaruhi
kecepatan metabolisme tubuh melalui dua
cara :

etiologi

Etiologi
Hipertiroidisme primer : penyakit Graves, struma

Lebih dari 90 % hipertiroidisme

adalah akibat penyakit graves
dan nodul tiroid toksik.

Signs and Symptoms Of Hyperthyroidism

Nervousness
Irritability

Difficulty Sleeping

Hoarseness or
Deepening of Voice
Persistent
Sore or Dry Throat
Difficulty Swallowing
Rapid or Irregular Heartbeat

Bulging Eyes/Unblinking Stare

Swelling (Goiter)

Infertility

Menstrual Irregularities or

Weight Loss

Light Period

Heat Intolerance

Frequent Bowel Movements

Warm, Moist Palms

Increased Sweating
First-Trimester Miscarriage
Family History of

Excessive Vomiting in Pregnancy

Thyroid Disease
or Diabetes

Common Signs and Symptoms

of Hyperthyroidism
May Include:

Nervousness

Increased Sweating

Irritability

Heat Intolerance

Difficulty Sleeping

Unexplained Weight Loss

Bulging Eyes

Scant Menstrual Periods

Unblinking Stare

Goiter

Frequent Bowel
Movements

Rapid Heartbeat

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

Manifestations of Graves disease

Diffuse goiter
Ophthalmopathy
A feeling of grittiness and discomfort in the eye
Retrobulbar pressure or pain
Eyelid lag or retraction

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

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

Anti thyroid drugs

Chemically block hormone synthesis
Enhance evolution to remission
Best indicated for children,adolescents,young
adults and pregnant women.
Propylthiouracil-100-150mg every 6or 8 hrs
Carbimazole- 40-60mg daily initially for 3
weeks,then reduce to 20-40mg for another 8
weeks and maintain at 5-20mg daily for 18-24
months.
Methimazole-active metabolite of Carbimazole

Duration of treatment
18-24 months
Side effects- Rash
Leukopenia
Agranulocytosis

Control of adrenergic
symptoms
Adrenergic antagonists:
Propranolol-40-120mg/day

Ablative therapy(Surgery &

Iodine)
Indications:
Relapse or recurrance following drug
therapy
A large goiter
Failure to follow medical regimen.
Radioactive iodine is simple,effective
and economical

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

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,hypotensi
on,vomiting and diarrhea.

Treatment of thyroid crisis

Provide supportive care;

Treat dehydration
Administer glucose and saline
Vitamin B complex and glucocorticoids
Digitalization is required in those with
atrial fibrillation
Immediate and large doses of anti
thyroid agents(Eg-propylthiouracil
100mg every 2h)
Iodine intravenously or by mouth
Propranolol 40-80mg every 6h
Dexamethasone(2mg every 6h) and to
be tapered later.

Treatment of ophthalmopathy
and Dermopathy

Methylcellulose eye drops

Tinted glasses
Persistant diplopia can be corrected by surgery
Papilloedema,loss of visual field or acuity
requires urgent treatment with prednisolone
60 mg daily.
Majority of patients require no treatment other
than reassurance.
Dermopathy of Graves rarely requires
treatment