Tiroid disease

dr. Pepi Nur Afifah

Sumber :
http://www.anatomy.yalemedicine.org/VisibleHumanLessonPlans.
Reference.medscape.com/thyroid Anatomy

Sumber : http://www.anatomydiagrams.net/muscle-anatomy-diagram/

Sumber : http://jama.jamanetwork.com/article.aspx?articleid=186627
www.youtube.com/thyroid hormone & thyroid function test
www.primaldocs.com

Fungsi hormon tiroid ???

Sumber : http://www.nature.com/nrendo/journal/v10/n10/full/nrendo.2014.143.html

Thyroid Disease ??

Struma

Perubahan ukuran
atau bentuk tiroid

Non
toxic
Nodul

Diffuse
Maligna

Nodular
Benigna

Toxic

Perubahan sekresi
hormon

Pembesaran
difus/struma/goiter

Diffuse
Toksik

Neoplastik
Hipertiroidisme

Nodular

Non toksik ; mis

karena kekurangan
yodium

KLASIFIKASI STRUMA American Society for Study of Goiter

Tiroiditis
Hipotiroidisme

 Hyperthyroidism is a clinical condition caused

by increased synthesis and secretion of
hormones by the thyroid gland which affects
the entire body.
Thyrotoxicosis (thyroid toxic) is defined as
clinical manifestations related to increased
thyroid hormone levels.

Sumber : Indonesian Clinical Practice Guidelines for Hyperthyroidism 2012

etiologi

Sumber : www.slideshare.net

 Young patients typically complain of excessive sympathetic nerve

symptoms, such as anxiety, hyperactivity and tremors, while the
elderly commonly complain of cardiovascular symptoms
(cardiomyopathy, arrhythmia) and unexplained weight loss.
The most commonly encountered symptoms in thyrotoxicosis are
the following: nervousness and anxiety; excessive sweating, warm
skin and heat intolerance; irritability; palpitations; hyperdefecation;
easy fatigability; weight loss with increased appetite (Von Mullers
paradox) and menstrual disorders.
While the most frequently observed clinical signs are as follows:
thyroid gland hypertrophy or struma; hyperactivity; tachycardia or
atrial fibrillation; systolic hypertension; warm and increased
perspiration of the skin; tremor; muscle fatigue; ocular disorders
such as Mobius sign (impaired ocular convergence), von Graefes
sign (the failure of the upper eyelid to follow promptly and
smoothly the downward movement of the eyeball), Joffroys sign
(the facial muscles remain immobile when the eyeballs are rolled
upward ), Stellwags sign (infrequent and incomplete blinking of the
eyes), lid lag ( the upper eyelid lags behind the upper edge of the
iris as the eye moves downward), exophthalmos and its following
consequences e.g., conjunctivitis, corneal ulcer, palpebral edema,
optic neuritis and optic atrophy.

Sumber : http://cureconnect.info/

Sumber : Hggstrm, Mikael. Medical gallery of Mikael Hggstrm 2014. Wikiversity

Journal of Medicine 1

Wayne index

Sumber : Indonesian Clinical Practice Guidelines for Hyperthyroidism 2012, The

Indonesian Society of Endocrinolog

Management hyperthyroid
The management of hyperthyroidism involves 3
inter-related aspects:
1. Inhibition of thyroid hormone synthesis and
secretion (ATDs)
2. Destruction or reduction of thyroid tissue
mass (radioactive iodine therapy or surgery)
3. Minimalization of thyroid hormone effects
on peripheral tissues (beta-blocker therapy)
Sumber : Indonesian Clinical Practice Guidelines for Hyperthyroidism 2012, The
Indonesian Society of Endocrinolog

Hamil

URACIL

ATD

IMIDAZOLE

PTU (dosis : 100200 mg 3x1

Krisis
tiroid/thyroid
storm

Methimazole
(dosis : 10-20
mg/hari)

Alergi obat

Carbimazole

thiamazole

Surgery :
total thyroidectomy, subtotal thyroidectomy, lobectomy,

Terapi hipotiroid

Efek samping

Durante
op
Krisis tiroid

tracheomalazia

Post operasi

Perdarahan

Parese n.
laringeal
recurrent

Hipokalsemi

Compartment
syndrome effect

Struma

Non toxic

Diffuse

Nodular

Toxic

Diffuse

Neoplastik
Neoplastik

Nodular

Tiroiditis

KARSINOMA TIROID
pertumbuhan tidak terkontrol dari sel yang
terjadi pada kelenjar tiroid
Insidensi meningkat seiring meningkat usia,
dgn puncak pada usia 21-40 tahun.
Wanita 2-4 kali lebih sering
Berasal dari sel folikular parafolikular
Faktor risiko :

Klasifikasi
Klasifikasi karsinoma tiroid berdasarkan
histopatologi mayor,
Karsinoma papiler (80%)
Karsinoma folikuler

Karsinoma anaplastik
Karsinoma meduler
Karsinoma epidermoid

Well
differentiated

Poor differentiated

DIAGNOSA
Curiga Keganasan Tiroid (Riccabona)

Umur < 20 tahun dan > 50 tahun

Riwayat terpapar radiasi leher pada masa kanak-kanak
Pembesaran kelenjar tiroid yang cepat
Struma dengan suara parau
Disfagia
Nyeri spontan
Riwayat keluarga menderita kanker
Struma hiperplasia yang tetap membesar setelah
diobati dengan tiroksin
Sesak napas

Diagnostic tools
Usg
TSH,
Anti-tiroid antibodi (DD : Hashimoto
thyroiditis)
Calcitonin serum (DD : ca medullary thyroid)
FNAB

STAGING

terapi

Tiroidektomi
Radioactive iodine ablation
TSH suppression therapy
Distant metastate/advanced cases :
radiotherapy-chemotherapy

Sumber : http://emedicine.medscape.com/thyroid cancer

Struma

Non toxic

Diffuse

Nodular

Toxic

Diffuse

Neoplastik

Nodular

TIROIDITIS
Tiroiditis

TIROIDITIS
Akut

Sub akut

Chronic

Akibat infeksi bakteri

Akibat infeksi virus

Autoimune disease (HLAAssociate)

Jarang terjadi

Bersamaan dengan penyakit

lain yang diakibatkan oleh virus

Tinggi pada anak

Gangguan piriform sinus

Self-limiting disease

Manifestasi klinis
Akut-sub akut : fever, chills, neck pain, sore
throat, hoarseness, and dysphagia, weakness,
fatigue, malaise.
Chronic autoimmune thyroiditis :
- Goiter that is usually diffuse and nontender
- Symptoms of hypothyroidism: In children, this
frequently includes poor growth or short stature.
Adolescent girls may have primary or secondary
amenorrhea. Boys may have delayed puberty.
- Symptoms of hyperthyroidism: These may include
poor attention span, hyperactivity, restlessness,
heat intolerance, or loose stools.

 Neck tenderness is present, and the swollen

thyroid gland is tender. The swelling and
tenderness may be unilateral. Erythemas
develop over the gland, and regional
lymphadenopathy may develop as the disease
progresses. Abscess formation may occur

DIAGNOSIS
diagnosis
Akut-sub akut tiroiditis :
hematologi
Kronik tiroiditis :

Terapi
Antibiotik parenteral, :
golongan cephalosporin
Simtomatik : aspirin,
propanolol, levothyroxin
(hypo)