Disorder of Thyroid Functions
-
Upload
govamaniacs-insave-iv -
Category
Documents
-
view
221 -
download
0
Transcript of Disorder of Thyroid Functions
-
7/25/2019 Disorder of Thyroid Functions
1/56
DISORDERS OF
THYROID
FUNCTIONSYUNIADI SUTOWO
-
7/25/2019 Disorder of Thyroid Functions
2/56
THE THYROIDGLANDCongenital diseasesInfammationFuntional a!no"malit#
Di$use and %ultinodula"goite"s
NEO&LASIA
-
7/25/2019 Disorder of Thyroid Functions
3/56
THYROID DISORDERS
H#'ot(#"oidism Unde"ati)e t(#"oid
H#'e"t(#"oidism O)e"ati)e t(#"oid
Goite" T(#"oid enla"gement
-
7/25/2019 Disorder of Thyroid Functions
4/56
CAUSES OFHY&ERTHYROIDIS%
*+ G"a)es Disease , Di$use To-i Goite"
.+ &lumme"/s Disease , To-i %ulti NodulesGoite"
0+ To-i '(ase o1 Su! Aute T(#"oiditis 2 SAT3+ To-i Single Adenoma , STA
4+ &ituita"# Tumou"s , e-ess TSH
5+ %ola" '"egnan# 6 C(o"ioa"inoma 7889 HCG:
;+ %etastati t(#"oid ane"s 71untioning:
-
7/25/2019 Disorder of Thyroid Functions
5/56
1.
LH, HCg, TSH DAN FSHSTRUCTURE
2. The sub unit of hCG is identical with
the sub unit of LH, TSH and FSH
The sub unit of hCG is identical with the
-
7/25/2019 Disorder of Thyroid Functions
6/56
E'idemiolog# o1G"a)es/ Disease
- Cause of 50 !0" of cases of h#$e%th#%oidis&
- '%e(alence) 0.*" of $o$ulation
- +ncidence) 0.5000#ea%
- Fe&ale&ale %atio) 5 0
- +ncidence) 20 0 #ea%s of a/e- Conco%dance %ate) &ono#/otic twins 15"
di#/otic twins 1"
- '%edis$osition) 34" /enetic 2" non/enetic
- Fe&ale siblin/sand fe&ale child%enha(e 5 !"
-
7/25/2019 Disorder of Thyroid Functions
7/56
DISEASE Assoiations>
=i"al?!ate"ialin1etions
Stress E-'osu"e to iodide
-
7/25/2019 Disorder of Thyroid Functions
8/56
Ne")ousness?T"emo"
%ental Distu"!anes?
I""ita!ilit#
Di@ult# Slee'ing
ulging E#es?Un!linBing
Sta"e? =ision C(angesEnla"ged T(#"oid 7Goite":
%enst"ualI""egula"ities
F"euentoel
%o)ementsWa"m %oist &alms
Fi"st2T"imeste" %isa""iage?
E-essi)e =omiting in &"egnan#
Hoa"seness?
Dee'ening o1 =oie&e"sistent D"# o" So"e
T("oatDi@ult# Salloing
&al'itations?
Ta(#a"dia
Im'ai"ed Fe"tilit#
Weig(t Loss o" Gain
Heat Intole"aneIn"easedSeating
Famil# Histo"# o1
T(#"oid Disease
or Diabetes
SIGNS AND SY%&TO%S OFHY&ERTHYROIDIS%
Sudden &a"al#sis
-
7/25/2019 Disorder of Thyroid Functions
9/56
SIGNS AND SY%&TO%S T"emulousness o" itte"iness E-o'(t(almos Weig(t loss des'ite e-ellent a''etite ,
(#'e"meta!oli state Insomnia Fatigue
&al'itations Heat intole"ane Seating Dia""(ea Dete"io"ation in (and"iting %enst"ual i""egula"ities
%usle eaBness E#e s#m'toms (i( ma# inlude 'ain o" di'lo'ia Ne")ousness Ta(#a"dia Goite" Ele)ated 'lasma le)els o1 t(#"o-in and?o"
t"iiodot(#"onine
-
7/25/2019 Disorder of Thyroid Functions
10/56
thyrotoxicosis (Grave's
disease) It is (#'e"1untion o1 t(#"oidgland due to autoimmune
disease in (i(autoanti!odies called t(#"oidstimulating immunoglo!ulins,
actiateTSH receptors !rod"ci#ge$cessie se"etion o1 thyroidhormones alt(oug(TSH
hormone itself is low.
-
7/25/2019 Disorder of Thyroid Functions
11/56
MAN!"STAT#NS
E-o'(t(almos di'lo'ia In"eased %R and (eat intole"ane+ Ca"dio)asula" s#m'toms ta(#a"dia
a""(#t(mias
liBe +At"ial !"illation a"dia is(emia and (ig(
a"dia out'ut 1ailu"e+ Insomnia i""ita!ilit# and (#'e""efe-ia
ne")ousness %entall# and '(#siall# (#'e"ati)e
Loss o1 eig(t and in"ease 1ood intaBe. %ala!so"!tion and dia""(ea De"mo'at(# 7 '"eti!ial m#-edema : in a mino"it#
o1
'atients
-
7/25/2019 Disorder of Thyroid Functions
12/56
GRA=E/S DISEASE($AS"%#&)
Hi'e"ti"oid > se"ing te"adi 'adaanita
Etiologi > otoimn Geala > erat adan intoleransi hawa panas
*si+,mental hipera+tif
(tremor,nervos) tachycardia- arhythmia
aal /antn
+erinat anya+
-
7/25/2019 Disorder of Thyroid Functions
13/56
%&'&1(Dr. )o*a+ed -ad
1
Lid %et%action and eo$hthal&os in
$atient with G%a(e6s disease
-
7/25/2019 Disorder of Thyroid Functions
14/56
at
accumulation
behind eyes
High TSH
Patient
previously had
a
Exothalamia
-
7/25/2019 Disorder of Thyroid Functions
15/56
/RETI0IAL )YEDE)A
-
7/25/2019 Disorder of Thyroid Functions
16/56
G"a)es/ disease 7anti2t(#"oidstimulating (o"mone "ee'to" anti2TSHR:
In G"a)es/disease t(eanti!odies do
not dest"o#t(e t(#"oid !utat as i1 t(e#a"e TSH 7i+e+
t(e# !ind and
No"mal
-
7/25/2019 Disorder of Thyroid Functions
17/56
-
7/25/2019 Disorder of Thyroid Functions
18/56
TSI -sec%eted b# l#&$hoc#tes in all$atients with G%a(e6s disease+
- +t has the sa&e action of TSH on
the th#%oid /land.
- Can c%oss the $lacenta and
sti&ulate the fetal th#%oid /land.
-
7/25/2019 Disorder of Thyroid Functions
19/56
Autoanti!odies 7IgG: an "oss t(e'laenta and a$et t(e 1etus
G"a)es/ disease is an autoimmune1o"m o1 (#'e"t(#"oidism
&lasma'(e"esisis 2 t(e "emo)al
t"eatment and "etu"n o1 7om'onents o1:!lood lasma3ro+ !lood i"ulation
*J *. HOURS
http://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Blood_plasma -
7/25/2019 Disorder of Thyroid Functions
20/56
*J2*. HOURS IN %OUSE ASSAY.+STRUCTURE AND GLYCO&ROTEIN+GG
%OLECULAR %ASS 0J+JJJ*4J+JJJ0+ INHIITION ACTI=ITY Y ANTI TSHY ANTI
SERU%IGG SERU%3+ SOURCE ANT+ &ITUITARYLY%&HOCYTE4+ ACTION STI%ULATED
STI%ULATEDTHYROID
THYROID5+ CIRCULATING LE=EL THYROID
HIGH DOSES
CO%&ARATION OF TSH ATSI
-
7/25/2019 Disorder of Thyroid Functions
21/56
Hyperthyroid
Diffuse
Graves disease
Nodular
Plummers disease
Age Young age Elderly
Onset abrupt Gradual
Course Remissions &ea!erbations
"teady !ourse
Nervoussymptoms
### #
$etaboli!
manifestations
### #
Eye signs ### # false
C% manifestations # ###
'yroid gland Diffuse Nodular
-
7/25/2019 Disorder of Thyroid Functions
22/56
In se)e"e ase
thyroid crisis
( fever -consciosness 0
arr thmia
-
7/25/2019 Disorder of Thyroid Functions
23/56
FINDING
Laboratory findings in Gravesdisease include Elevatedfree T4and
T3levels and depressedTSH
levelsThyroid-stimulatingimmunoglobulins
Radioactive iodine uptakeis
increased diffusely
In light hyperthyroid !T3
-
7/25/2019 Disorder of Thyroid Functions
24/56
1N%"2 S"32"T#N #! TH42#% H#2M#N"S (H45#TH42#%SM)
Dened as lo 1"ee T3 le)el it( a no"mal o" (ig( TSH+
Types of hypothyroidism
*25rimary 6 T(#"oid gland d#s1untion
%ost ommon >
*2 3onenital hypothyroidism (in neonates)
.2 3hronic lymphocytic thyroiditis (Hashimoto7s thyroiditis) Autoimmune disease o1 t(#"oid
T(#"oid gland is enla"ged
02 odine de*ciency
32 Thyroid srery
42 2adioactive iodine treatment
.2 Secondary 6&ituita"# d#s1untion 7hypopititarismdue to
"adiation t(e"a'# o" dest"ution o1 t(e
'ituita"#:
0+ Te"tia"# > H#'ot(alami d#s1untion
-
7/25/2019 Disorder of Thyroid Functions
25/56
ETIOLOGY
*+ CONGENITALH#'o'lasia
Familial enK#me de1etsIodine deien# 7endemi"etinism:
IntaBe o1 goit"ogens du"ing'"egnan#
&ituita"# de1etsIdio'at(i
-
7/25/2019 Disorder of Thyroid Functions
26/56
.+ ACUIREDIodine deien#Auto2immune t(#"oiditisT(#"oidetom# o" RAIt(e"a'#
TSH o" TRH deien#%ediations 7iodide 6Co!alt:
Idio'at(i
-
7/25/2019 Disorder of Thyroid Functions
27/56
Ti"edness
Fo"get1ulness?Sloe" T(inBing
%oodiness? I""ita!ilit#
De'"ession
Ina!ilit# to Conent"ate
T(inning Hai"?Hai" Loss
Loss o1 od# Hai"
Dr4, &at(# SBin
Weig(t Gain
Cold
Ele)ated C(oleste"ol
Famil# Histo"# o1 T(#"oid
Disease o" Dia!etes
%usle WeaBness?
C"am's
Consti'ation
In1e"tilit#
%enst"ual I""egula"ities
Sloe" Hea"t!eat
Di@ult# Salloing
&e"sistent D"# o" So"e T("oat
Hoa"seness?
Dee'ening o1 =oie
Enla"ged T(#"oid 7Goite":
&u$# E#es 'u$# 1ae
CLINICAL FEATURES OFHY&OTHYROIDIS%
-
7/25/2019 Disorder of Thyroid Functions
28/56
. H45#!1N3T#N #! TH" TH42#%G8AN%
A.Myxedema7M (#'ot(#"oidismin adults:> It is aused !#at"o'(# o1 t(e t(#"oid gland as a"esult o1 disease e+g+ ane" andt(is t#'e is alled'"ima"#(#'ot(#"oidism o" aused !# laBo1 TSH se"etion and t(is isalled seonda"# (#'ot(#"oidism.
MAN!"STAT#NS #!
-
7/25/2019 Disorder of Thyroid Functions
29/56
MAN!"STAT#NS #!M49"%"MA
D"# #ello sollen sBin+ De"eased %R+ De"eased a"dia '"o'e"ties liBe
de"ease HR and CO&+ De"eased mental 1untions it(
a'at(eti looB+
HusB# and slo )oie+ In"eased !lood (oleste"ol le)el+ De'"essed se-ual 1untions
-
7/25/2019 Disorder of Thyroid Functions
30/56
5AT"NT &TH M49"%"MA
-
7/25/2019 Disorder of Thyroid Functions
31/56
-
7/25/2019 Disorder of Thyroid Functions
32/56
$ 32"TNSM (H45#TH42#%SM N3H8%2"N)
It is ommonl# due to eit(e"mate"nal iodine deien# o"ongenital a!no"malit# in t(e
t(#"oid 1untions+ %ani1estations> Dela#ed '(#sial g"ot(>
%ental "eta"dation> om'leteidiot+ Se-ual "eta"dation
Gene"al 1eatu"es> Sollen e#e
-
7/25/2019 Disorder of Thyroid Functions
33/56
ongenital Hypothyroidism
retinism
Stunted gro!th
"eurological #
cognitivede$ects # mental
retardation
In$antileappearance%
pu$$y $ace &
protuberant
abdomen
5
-
7/25/2019 Disorder of Thyroid Functions
34/56
5 +THYROIDITIS 7HT: An autoimmune disease and assoiated
it( ot(e" autoimmune diso"de"s 7 lu'us"(eumatoid a"t("itis :
Di$use non2'ain1ul t(#"oid enla"gement
%ost '"e)alent !eteen 34 and 54 #ea"so1 age %o"e ommon in omen t(an in men
it( a 1emale '"edominane o1 *J>* 2
.J>*+ %a# ou" in (ild"en and is a mao" ause
o1 nonendemi goite" in (ild"en
Diagnosis is made !# deteting ele)atedle)els o1 anti2t(#"oid 'e"o-idaseanti!odiesin t(e se"um+
http://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodies -
7/25/2019 Disorder of Thyroid Functions
35/56
TIROIDITISHASHI%OTO 2
Hi$oti%oid 7a%ena $%oses imunologik
'%o/nosis 7u%an/ bai7 7%n $%oses
otoimun
Lab )T3 / T4
TSH
antibodi anti peroksidase tiroid
positif
-
7/25/2019 Disorder of Thyroid Functions
36/56
-
7/25/2019 Disorder of Thyroid Functions
37/56
CYTOTOIC T LY%&HOCYTE7 CTL :
CD M luste" o1
di$e"entiation
-
7/25/2019 Disorder of Thyroid Functions
38/56
Immune me(anisms ma#inludes>
. C8! 9 c#totoic T cell-&ediated
cell death
2. C#to7ine-&ediated cell death
1. :indin/ of antith#%oid antibodies
; antibod# de$endent cell-
D %ULTINODULAR GOITER
-
7/25/2019 Disorder of Thyroid Functions
39/56
D+%ULTINODULAR GOITER ENDE%IC OR S&ORADIC OR SI%&LE
It re6ects i+!aired s4#t*esis o3 t*4roid*or+o#s d"e to dietar4 iodi#e de7cie#c4TSH *4!ertro!*4 8 *4!er!lasia o3t*4roid 3ollic"lar cells t*4roid
e#large+e#t 7 di$use nonto-i goite":i3 I s"!!lied or t*e de+a#d decreased i#ol"tio# o3 3ollic"lar e!it*elial cells.
Rec"rra#t e!isodes o3 sti+"latio# 8i#ol"tio#multinodula" goite",as4++etricall4 e#larged gla#d, large si9e
:it* 3ocal c4stic c*a#ges 7brosis,
ENDE%IC GOITRE 7GAI GANGGUAN
-
7/25/2019 Disorder of Thyroid Functions
40/56
ENDE%IC GOITRE 7GAIMGANGGUANAIAT EURANGAN IODIU%:
Hi'oti"oidi )paling sering di Indonesia
Etiologi >tersering defisiensi yodium(penduduk pegunungan)
linis >mudah lelah irama antung
otot antung lemah anemia! rambut rontok berat badan
menorrhagia
impotensia
La!o"ato"# diagnosiS51
-
7/25/2019 Disorder of Thyroid Functions
41/56
La!o"ato"# diagnosiS
IN HY&OTHYROIDIS%
-
7/25/2019 Disorder of Thyroid Functions
42/56
La! > T: 0 - FT40 - T;
total
TSH
-
7/25/2019 Disorder of Thyroid Functions
43/56
Clinical 'ictu%e of Si&$le =odula% Goit%e
-
7/25/2019 Disorder of Thyroid Functions
44/56
Th%ee wo&en of the hi&ala#as with t#$ical ende&ic
-
7/25/2019 Disorder of Thyroid Functions
45/56
TH42#% !1N3T#N T"STS
- Tests to establish whethe% the%e isth#%oid d#sfunction
Th#%oid ho%&one > FT1 and FT ?
in the se%u& $las&a , TSH , T@H , :
-
7/25/2019 Disorder of Thyroid Functions
46/56
TH42#% !1N3T#N T"STS
1. Th#%oid en#&e acti(it#. :io$s# of the th#%oid
5. @A+B , Th#%oid scannin/ , 'e%chlo%ate test
*. CG, Se%u& choleste%ol, Tendon %eflees
3. Th#%oid > T1 ? su$$%ession test, T@HTSH
sti&ulation test
5. +&a/in/ ) BG, CT scan,
-
7/25/2019 Disorder of Thyroid Functions
47/56
E()L*)TIO" TEST O HYPOTH)L)+*S &
PIT*IT),Y )"- THY,OI- GL)"- '
.' T,H# TEST
.HD'@THD@E+8 ) @S'E=8 T@H TE TSH )
8C@AS E@ =GAT+
2.TE 8+FF@ SCE=8A@D HD'ETHD@E+8 A=8
T@T+A@D HD'ETHD@E+8 .1. '@+
-
7/25/2019 Disorder of Thyroid Functions
48/56
THERA&Y
-
7/25/2019 Disorder of Thyroid Functions
49/56
. SB@G@D
2. +SETE' AI
?
1. A=T+ THD@E+8 8@BGA. T+EB@AC+L >TB?, '@E'DLTH+EB@AC+L>'TB?,
A@:+
-
7/25/2019 Disorder of Thyroid Functions
50/56
RADIOACTI=EIODIDEThe beta %adiations of 1+ dest%o# th#%oid
$a%ench#&a, so dec%easin/ ho%&onal
%elease.
"d#antages$
as# ad&inist%ation >o%all#?.
ffecti(e.+t is not e$ensi(e.
Suitable fo% old a/es and ca%diac
$atients with &ode%ate to se(e%e
-
7/25/2019 Disorder of Thyroid Functions
51/56
"d#erse effe%tsAs with iodine the%a$#, o(e%doses &a# causeiodism 7metalli taste e-essi)e sali)ation
it( 'ain1ulsali)a"# gland dia""(ea '"oduti)e
oug( "unninge#es 6 nose so"e t("oat and "as(es
mimi (iBen2 'o-:+
E(e%dose is t%eated b# la%/e dose of sodiu& o%$otassiu& iodide to co&$ete with the %adioiodineu$ta7e b# the /land, and then hasten ec%etion b#fluids and diu%etics.Local $ain con/estion at the site of the /land
H#$oth#%oidis&
Indiations 1o" I*0*
-
7/25/2019 Disorder of Thyroid Functions
52/56
Indiations 1o" I*0*t"eatment
. Se(e%e th#%oca%diac disease
2. Toic nodula% /oite%
1. Ad(e%se %eaction to antith#%oid d%u/
. @ela$se afte% 2 to ! &onths of
antith#%oid d%u/ t%eat&ent
-
7/25/2019 Disorder of Thyroid Functions
53/56
&ontraindi%ations). '%e/nanc# >t%ou/h $lacenta?
2. Child%en
1. =u%sin/ &othe% >th%ou/h &il7?
-
7/25/2019 Disorder of Thyroid Functions
54/56
Indiations 1o"
T(#"oidetom# .La%/e /oite% with co&$%essi(e
&anifestations
2.'%e/nant $atient with ad(e%se
%eaction to antith#%oid d%u/
1.Se(e%e infilt%ati(e e#e disease. @ecu%%ence afte% adeMuate the%a$#
5. H#$e%th#%oidis& a%e difficult to cont%olwith anti th#%oid d%u/s
*. Khen T le(el N 30 $ &olL
-
7/25/2019 Disorder of Thyroid Functions
55/56
-
7/25/2019 Disorder of Thyroid Functions
56/56
THANK YOU