THYROID& ANTITHYROID

Thyroid Gland
 One of the largest endocrine glands
 Secretes three hormones essential for proper
regulation of metabolism
– Thyroxine (T4)
– Triiodothyronine (T3)
– Calcitonin
 Located near the parathyroid gland
 Involved in many bodily processes, growth, body
temperature regulation, cardiovascular, endocrine
& neuromuscular functions.
 Iode from diet is responsible for the
synthesis thyroglobuline

 Hypothalamus secretes TSH that stimulates

the thyroid to break down thyroglobulin into
T3(iodine 59%) & T4(iodine 65%) and is
released into the circulation
Tahapan sintesa & sekresi :
1. uptake yodida
2. oksidasi & yodinasi
3. pembentukan T4 & T3 dari yodotirosin
4. sekresi hormon tiroid
5. konversi T4 T3 di jar. perifer

enz.5-deyodinase

dihambat oleh : malnutrisi, hipoglikemi,
kortikosteroid,  bloker,
PTU, defisiensi Se dll.
 Kel.tiroid
tyroglobulin
I-  I- peroxidase I* MIT, DIT, T3, T4

transport proteolisis
I- tyr MIT, DIT exocytosis

T4, T3 (ikt.protein)
darah
Jar. perifer : T4, T3

T3
 Mekanisme Kerja :
Melalui reseptor tiroid di dlm sel  regulasi gen
spesifik

pertumbuhan & metabolisme

1. Tiroid diperlukan unt.tumbuh kembang

termsk CNS  hipotiroid (hamil)kretinisme
2. Efek kalorigenik : T4 meningkatkan
metabolisme, katabolisme, pembentukan
kalori , termogenesis, vasodilatasi perifer,
curah jantug .
3. CVS
takhikardia, CO , SV , hipertropi
 Hypothyroidism:
Deficiency in Thyroid Hormones
 Primary: abnormality in the thyroid gland
itself. Most common cause is hashimoto’s
thyroiditis.

 Secondary: results when the pituitary gland

is dysfunctional and does not secrete TSH
 Thyroid abnormalities
Cretinism: Hyposecretion of thyroid hormone during
youth. Low metabolic rate, retarded growth and sexual
development, possibly mental retardation

Myxedema: Hyposecretion of thyroid hormone as an adult.

Decreased metabolic rate, loss of mental and physical
stamina, weight gain, loss of hair, firm edema, yellow
dullness of the skin

 Goiter: Enlargement of the thyroid gland. Results from

overstimulation by elevated levels of TSH. TSH is elevated
because there is little or no thyroid hormone in circulation
 Hypothyroidism
 Common symptoms
– Thickened skin
– Hair loss
– Constipation
– Lethargy
– Anorexia
 Thyroid Preparations
 levothyroxine * most common
– Synthetic thyroid hormone T4
 liothyronine
– Synthetic thyroid hormone T3
 Mechanism of Action
 Thyroid preparations are given to replace
what the thyroid gland cannot produce to
achieve normal thyroid levels.
 Thyroid drugs work the same way as
thyroid hormones
 Indications
 To treat all three forms of hypothyroidism
 levothyroxine is the preferred agent because its
hormonal content is standardized; therefore, its
effect is predictable
Also used for thyroid replacement in clients whose
thyroid glands have been surgically removed or
destroyed by radioactive iodine in the treatment of
thyroid cancer or hyperthyroidism
 Side Effects
 Cardiac dysrhythmia is the most significant
adverse effect
 May also cause:
– Tachycardia, palpitations, angina, hypertension,
insomnia, tremors, headache, anxiety, nausea,
diarrhea, menstrual irregularities, weight loss,
sweating, heat intolerance, others
 Hyperthyroidism
Excessive Thyroid Hormones:
free T3 & T4
 Caused by several diseases
– Graves’ disease
– Toxic nodular disease
– Multinodular disease
– Thyroid storm
– Thyroid cancer
– Pituitary hormones
 Hyperthyroidism
 Affects multiple body systems, resulting in an
overall increase in metabolism
– Wt loss
– Diarrhea – Fatigue
– Flushing – Palpitations
– Increased appetite – Nervousness
– Muscle weakness – Heat intolerance
– Sleep disorders – Irritability
– Altered menstrual flow
Treatment of Hyperthyroidism
Surgery to remove all or part of the thyroid gland
Antithyroid drugs

1. Prevent hormone thyroid synthesis

2. Prevent yodide ion transport/anion inhibitors
3. Yodides  prevent synthesis & release thyroid
hormone
4. Radioactive iodine
5.  bloker
 Kel.tiroid
tyroglobulin
I-  I- peroxidase I* MIT, DIT, T3, T4

transport PTU proteolisis Yod

I- tyr MIT, DIT exocytosis
SCN
ClO4
T4, T3 (ikt.protein)
darah
Jar. perifer : T4, T3
bloker
T3
1. Prevent hormone thyroid synthesis

contoh obat : PTU (propilthiourasil), Metimazol,

Karbimazol, Metiltiourasil
Farmakokinetik :
per oral, distribusi slrh tubuh,
ekskresi mel. urin & ASI
masa kerja pendek  8 jam (PTU)
Efek samping :
demam, purpura, agranulositosis, ikterus,
goiter pada fetus (dose dependent)

Sering digunakan bersama yodium untuk mengurangi

vaskularisasi pra operasi
2. Prevent iodide ion transport
Drug exp : thiocyanate (SCN-), perchlorate(ClO4-).
Effect : block uptake iodideprevent thyroid functions

3. Yodide
Drug exp : natrium yodida, kalium yodida
(lugol solution)
Effect : inhibit release & organification thyroid horm
decrease the size and vascularity of gland
4. Radioactive iodine
Drug exp. : I131
Effect : I131 works by destroying the thyroid gland
5.  BLOKER
Prevent yodisation T4, clinical improvement
Tugas :

Buat ringkasan tentang hormon

Paratiroid dan regulasi calcium

Sifat kimia
Sintesa dan sekresi
Fungsi fisiologis
Regulasi sekresi
Efek pada organ : tulang dan ginjal