HIPERTIROIDISME

Ifiq Budiyan Nazar, dr.HIPERTIROIDISMEPatologi Manusia DasarDwi LestariDefinisi Hipertiroidisme : keadaan (tanda dan gejala) akibat produksi hormon tiroid yang berlebihanTirotoksikosis : suatu keadaan toksis pada jaringan akibat peningkatan hormon tiroid yang berlebihan. Dwi LestariEtiologiPenyakit Graves (Toxic difus goiter)Nodul tiroid toksik (multinodular dan mono nodular)TiroiditisHipertiroidisme neonatalHipertiroidisme faktisiusSekresi TSH yg tdk tepat oleh pituitari (tumor)Yodium eksogenMetastasis kanker tiroid Koriokarsinoma dan mola hidatidosaDwi LestariPatofisiologi-Patogenesis

Dwi LestariGambaran Klinis HipertiroidismeUmum :berat badan turun, keletihan, apatis.berkeringat, tidak tahan panas.CV : palpitasi, sesak nafas, angina, gagal jantung.sinus takikardi, fibrilasi atrium, nadi kolaps.Neuromuskuler : gugup, agitasi, tremor, psikosis, paralisis periodikmiopati proksimal, miastenia gravisGI :BB meskipun nafsu makan diare, steatore, muntah.Reproduksi :oligomenore, infertilitas.Kulit :pruritus, rambut tipis, kering, edema pretibialStruma :difusa dg/ tanpa bising, nodosa.Mata : lid retraction, lid lag, optalmoplegi, diplopia, proptosis, penglihatan kabur.Dwi Lestari

Dwi Lestari6Consequences

Dwi Lestari7These are the well recognized symptoms and signs of hyperthyroidism.Diagnosis HipertiroidismePada umumnya gambaran klinis pasien jelas tak ada kesulitan dlm menegakkan diagnosis.Diperiksa TSHs & FT4 (jika perlu ditambahkan T3).Dwi Lestari

Dwi Lestari9This flow chart helps outline steps in the diagnosis of subclinical hyperthyroidism.. Best diagnostic test : serum TSH, except in recently treated hyperthyroid patients, , those with excess thyroid hormone supplements, or anyone who has been labile. In those cases it is best to monitor a Free T4 as well as a TSH for up to one year. For the most part, subclinical hyperthyroidism is associated with a low or suppressed TSH, except for rare cases of TSH producing tumors. A low TSH can also be due to central hypothyroidism, but then the Free T4 will be low. Step 1- check Free T4, , Free T3. Isolated Free T3 thyrotoxicosis can occur in ~ 5% of hyperthyroidism. If both FT3 and FT4 are normal, we are in this group. Rule out non thyroid causes. Next step : Thyroid scan and uptake, just like with overt hyperthyoidism. This distinguishes between endogenous causes with normal/ high uptake due to overproduction, and low or absent production due to inflammation or thyroiditis.Low TSHMeasure Free T4 LevelNormalHighMeasure Free T3 LevelNormalHigh-Subclinical hyperthyroidism-Resolving Hyperthyroidism -Medication-Pregnancy -New thyroid illnessT3 ToxicosisPrimary hyperthyroidismThyroid uptakeLowHighMeasure thyroglobulindecreasedIncreased Exogenous ThyroiditisIodide exposureExrtraglandular productionDIffuseNodularhormoneGraves diseaseMultiple areasOne hot areaToxic multinodular goiterToxic adenomaDwi Lestari10No.Gejala Yang Baru Timbul Dan Atau Bertambah BeratNilaiSesak saat kerja+1Berdebar+2Kelelahan+3Suka udara panas-5Suka udara dingin+5Keringat berlebihan+3Gugup+2Nafsu makan naik+3Nafsu makan turun-3Berat badan naik-3Berat badan turun+3NoTandaAdaTidak1.Tyroid Teraba+3-32.Bising Tyroid+2-23.Exoptalmus+2-4.Kelopak Mata Tertinggal Gerak Bola Mata+1-5.Hiperkinetik+4-26.Tremor Jari+1-7.Tangan Panas+2-28.Tangan Basah+1-19Fibrilasi Atrial+4-10.Nadi Teratur90 x/menit

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Skor:Hipertiroid : 20Eutiroid:11 - 18Hipotiroid: