PENYAKIT KELENJER TIROID
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PENYAKIT KELENJER TIROID
dr. Fredia Heppy, Sp.PD
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Kelenjer tiroid
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Pengaturan hormon tiroid
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Sintesis hormon tiroid
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Peran hormon tiroid
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SKDI Penyakit Tiroid
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Definisi
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Etiologi
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ETIOLOGI TIROTOKSIKOSIS
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Aturan diagnosis penyakit tiroid
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Diagnosis tirotoksikosis
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Anamnesis gejala klinis Nervositas Kelelahan atau kelemahan otot-otot Penurunan berat badan sedang nafsu makan
baik Diare atau sering buang air besar Intoleransi terhadap udara panas Keringat berlebihan Perubahan pola menstruasi Tremor Berdebar-debar Penonjolan mata dan leher
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Gejala klinis pemeriksaan fisik
Sering penderita terlihat tegang Bicara dan tingkah laku yang cepat, tanda-tanda pada mata Kulit dan telapak tangan basah dan hangat Tremor, Onycholisis, vitiligo Pembesaran leher Nadi yang cepat Aritmia, tekanan nadi yang tinggi Pemendekan waktu refleks Achilles
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Indeks WayneNo
Gejala yang baru
ditemukan dan/tambah
berat
Nilai No
Tanda Ada Tidak ada
1. Sesak saat bekerja
+1 1. Tiroid terba +3 -3
2. berdebar +2 2. Bising tiroid +2 -2
3. kelelahan +2 3. Exoptalmus +2 -
4. Suka udara panas
-3 4. Kelopak mata tertinggal
+1 -
5. Suka udara dingin
+3 5. Hiperkinetik +4 -2
6. Keringat berlenbihan
+3 6. Tremor halus
+1 -
7. Gugup +2 7. Tangan panas
+2 -2
8. Nafsu makan naik
+3 8. Tangan basah
+1 -1
9. Nafsu makan turun
-3 9. Fibrilasi atrium
+4 -
10.
Berat badan naik -3 10.
Nadi teratur:
11.
Berat badan turun
+3 11.
<80x/menit80-90x/menit>90x/menit
--
+3
-3--
Hipertiroid jika indeks Wayne ≥ 20
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Indeks New CastleNo Tanda Ada Tida
k ada
No Tanda ada Tidak ada
1. Usia onset 15-2425-3435-4445-54>55
7. Bruit tiroid
AdaAberan
t
+180
2. Predisposisi psikologis
AdaAberan
t
-30
8. eksoptalmus
AdaAberan
t
+90
3. Sering memeriksa diri
Adaaberan
t
-30
9. Lid ratraksi
AdaAberan
t
+20
4. Ansiteas antisipasi berat
AdaAberan
t
-30
10. Tremor halus
AdaAberan
t
+70
5. Peningaktan nafsu makan
AdaAberan
t
+50
11. Nadi permenit
>908-90<80
+16+80
6. Goiter AdaAberan
t
+30
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Interpretasi indeks new castle
No. interpretasi Total skor
1.2.3.
EutiroidProbabilitas tiroidDefinint tiroid
(-11 ) – (+23)(+24) – (+39)(+40) – (+80)
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Pemeriksaan penunjang
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KADAR NORMAL
TSH : 0,3-3 u/dl fT4: 0,7-2 u/dl T3: 80-220 u/dl
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Alur pemeriksaan pasien gangguan tiroid
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Pemeriksaan penunjang umum
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Penatalaksanaan
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Terapi konservatif
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Operatif / pembedahan Indikasi: Kasus relaps Struma besar Gagal konservatif Sukar evaluasi pengobatan konservatif Kosmetik Penyulit pembedahan: Perdarahan Paralisisi N recurrent Krisis tiroid Hipotiroid dan hipoparatiroid
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Terapi radio aktif
Indikasi: Umur tua Menolak pembedahan Kondisi yang tak dapat di bedah
Obat yang dipakai adalah I131
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KRISIS TIROTOKSIKOSIS (THYROID STORM)
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Faktor pencetus krisis tirotoksikosis
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Gejala klinis krisis tirotoksikosis
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Penatalaksanaan
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Prognosis
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Goiter
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EPIDEMIOLOGI
Insiden didapatkan pada hampir semua negara sering daerah pegunungan
WHO: - > 200 juta penduduk dunia mengalami goiter
endemik - Indonesia ± 12 juta
Wanita > laki-laki Prevalensi tertinggi pada usia 9-18 tahun
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Klasifikasi klinis
Grade 0: tak teraba struma atau bila teraba ukuran
normal Grade 1A: teraba struma tapi tak terlihat Grade 1B: teraba struma tetapi baru dilihat saat
posisi kepala ekstensi Grade II: strum sudah terlihat dalam posisi biasa Grade III: struma mudah terlihat dalam posisi biasa Grade IV: struma terlihat amat besar
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Diagnosis
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Hasil pemeriksaan iodium urin
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Pengobatan
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Toksik goiter
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Graves disease
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ETIOPATOGENESIS GRAVES
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Gejala klinis penyakit Graves
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Oftalmopati Graves
Retraksi kelopak mata (Dalrymple)
overakitivitas simpatis otot mata dan palpebra
Infiltrasi sel inflamasi pada otot levator palpebra
hypotropia (bola mata kebawah/downgaze)
von Graefe (lid lag/menutup mata tertinggal)
Kocher´s (staring appearance)
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Dermatopati Graves
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Penatalaksanaan
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Hipotiroid
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Etiologi Tiroidal: Thyroprivic (kelenjer tiroid tidak ada) Kongenital Post ablasi Goitrous: Kekurangan iodium Obat-obatan Tiroiditis kronik Supra tiroid Gangguan hipofise Gangguan fungsi hipotalamus
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Gejala klinis Pada anak anak: Gangguan pertumbuhan fisik dan
perkembangan mental Dewasa: Gejala awal tidak khas: malaise, konstipasi Gejala lanjut Nafsu makan turun tapi BB naik Kulit kering dan kaku myxedema Kardiomegali dan efusi pleura Megakolon adinamik Bradikardi
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Pemeriksaan penunjang
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Penatalaksanaan
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