word tiroid
DESCRIPTION
Periodik ParalisisTRANSCRIPT
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THYROID
Dokter Pembimbing : dr. Camelia Khairun Nissa, Sp.PD
Richky Nurhakim 2010730091
KEPANITERAAN KLINIK ILMU PENYAKIT DALAMFAKULTAS KEDOKTERAN UNIVERSITAS
MUHAMMADIYAH JAKARTABLUD RS SEKARWANGI - CIBADAK
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Anatomi
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Vaskularisasi
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Persarafan Persarafan simpatis dari kelenjar tiroid adalah serabut saraf dari ganglia simpatis superior dan medial serviks.
Serabut saraf parasimpatis berasal dari saraf vagus dan mencapai kelenjar melalui cabang-cabang saraf laring (N. Laryngeal recurrent)
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Fisiologi,,
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Fungsi dari hormon tiroid,,
•Growth and development•Energy metabolism•Protein and carbohydrate metabolism
•Fat metabolism•Bone metabolism
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Pemeriksaan untuk Diagnosis tiroid,,
1. Serum TSH
2.Total T4 dan T3
3. Free T4 dan T3
4. Thyrotropin-Releasing Hormone
5. Thyroid Antibodies
6. Serum Thyroglobulin
7. Radionuclide Imaging
8. Ultrasound
9. CT/MRI Scan
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Hypertiroidism (Grave’s disease)
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Epidemiologi • Graves disease merupakan penyakit autoimun yang penyebabnya
tidak diketahui.• Riwayat keluarga • Penyakit ini dapat terjadi pada segala umur, dengan insiden puncak
pada kelompok umur 20-40 tahun dominan perempuan (5:1).
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Clinical Features
• Pembesaran kelenjar tiroid• Berat badan menurun• Kemerahan pada wajah (vasodilatasi kulit)• Kulit hangat dan lembab• Takikardi, tremor• Refleks tendon hiperaktif• Periorbital edema• pembengkakan konjungtiva, • Chemosis• Proptosis
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Diagnosa • Anamnesis • Pemeriksaan Fisik
1. Tanda Generalisasi 2. Status Lokalis
• Pemeriksaan Penunjang 1. Kadar T4 dan T3 2. Kadar TSH
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Penatalaksanaan
Pada hipertiroid dapat diterapi secara aktif dengan :1. Obat anti tiroid
1. propylthiouracil (PTU) 100-300 mg 2. Methimazole 10-30 mg
2. Radioaktif Iodine Therapy3. Pembedahan
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HYPOTIROIDISM
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Hypothyroidism
• Hypothyroidism adalah suatu penyakit akibat kekurangan hormon tiroid .
• Insidens berbagai penyebab hipotiroidisme akan berbeda-beda tergantung faktor-faktor geografis dan lingkungan seperti diet iodida dan asupan bahan-bahan goitrogenik
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Etiologi • Hashimoto's thyroiditis • Penyakit pituitari atau hipothalamus • Obat-obatan : methimazole (Tapazole) dan propylthiouracil (PTU),
lithium (Eskalith, Lithobid), amiodarone (Cordarone), potassium iodide (SSKI, Pima), dan Lugol's solution
• Kekurangan yodium yang berat
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Patogenesis,,• Hipotiroidisme kongenital (aplasia, dysplasia,
gangguan selama kehamilan)• Primer thyroiditis. hipotiroidisme diperoleh setelah
operasi, defisiensi yodium ekstrim• Sekunder hipotiroidisme (TSH defisiensi, kekurangan
TRH)• Peripheral hipotiroidisme (resistensi hormon tiroid)
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Manifestasi Klinis
Gejala • Kelelahan • Intoleransi dingin• Pembengkakan wajah • Kulit kasar dan kering • Rambut kering, rapuh,
rambut rontok• Konstipasi • Kreatinisme • Defisit neurologis dan
intelektual
Tanda
• Bradikardi • Pembesaran kelenjar getah
bening• Berat badan meningkat • Pucat • Kulit dingin• Kehilangan rambut tubuh
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Diagnosa
• Anamnesis • Pemeriksaan Fisik
1. Status Generalisasi 2. Status Lokalis
• Pemeriksaan Penunjang 1. Kadar T4 dan T3 2. Kadar TSH
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Penatalaksanaan • Oral Thyroid hormone replacement
1. Tiroksin (50-200 gram)
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STRUMA/GOITERS
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Struma yang biasa disebut Goiter mempunyai definisi yaitu pembesaran ukuran yang abnormal dari kelenjar tiroid yang dapat disebabkan dari kelainan atau gangguan pada glandula tiroid
Etiologi :• Endemic : defisiensi iodine• Medication : iodide, amiodarone, lithium• Thyroiditis : subacute, kronik• Familial : hormonal dysgenesis• Neoplasm
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Clinnical Features• Dyspnea dan disfagia• Disfonia• Pembesaran kelenjar tiroid
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Diagnosa
• Anamnesis • Pemeriksaan Fisik
1. Tanda Generalisasi 2. Tanda Lokal
• Pemeriksaan Penunjang 1. T42. Tyroid Scan3. TSH4. USG Thyroid5. Biopsi
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Penatalaksanaan • Biopsi insisi• Biopsi eksisi• Lobektomi • Istmolobektomi• Tiroidektomi subtotal atau total
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Karsinoma Tiroid
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Karsinoma tiroid adalah suatu keganasan yang terjadi pada kelenjar tyroid.
Etiologi :1. Penyakit ini belom pasti penyebabnya2. Genetik 3. Riwayat penyakit keluarga
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Epidemiologi • Insidensnya meningkat seiring dengan meningkatnya usia,
pada usia antara 21-40 tahun. • Wanita 2-4 kali lebih sering mengalami nodul daripada laki-
laki.
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Klasifikasi
•Papillary adenokarsinoma •Follicular adenokarsinoma•Medullary karsinoma•Anaplastik karsinoma
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Manifestasi klinis • Benjolan pada leher• Sakit di tenggorokan • Serak / kesulitan bersuara• Pembesaran KGB• Kesulitan Menelan dan bernapas • Batuk
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Pemeriksaan Penunjang
Pemeriksaan lab :• Pemeriksaan kalsitonin • Kadar T3 dan T4• Human TiroglobulinPemeriksaan radiologis :• Foto X-Ray• CT-Scan Pemeriksaan Biopsi Aspirasi
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Prognosis
Prognosis pada karsinoma papiler baik, tapi prognosis bergantung pada invasi jauh dan staging. Secara langsung berhubungan dengan tumor (<1,0 cm mempunyai prognosis baik) , hal ini bervariasi tergantung dari derajat invasi tumor dalam pembuluh darah, atau jaringan sekitarnya.
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Referensi• Way W. Lawrence : Current Surgical Diagnosis & Treatment,
Edisi 9, 267-272• Guyton & Hall. Textbook of Medical Physiology. Eleventh
edition. Elseviers Saunders. Pennsylvania.• Brunicardi, F. Charles. Schwartz’s Principles of Surgery, ninth
edition. The McGraw-Hill Companies, Inc. United States of America. 2010
• Falk A. Steven. Thyiroid Diesease : Endocrinology, Surgery, Neclear Medinice< and Radiotherapy., second edition. Lippincot-Raven. New York.
• Sabiston. Textbook of Surgery, nineteenth edition. Elseviers Saunders. Pennsylvania.
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Terima kasih