ABSTRACT The Role of Levothyroxine on Goitrous Children in An Iodine Replete Area. SATRIONO.

Iodine deficiency produces a spectrum of disorders : endemic goiter, hypothyroidism, cretinism, and congenital anomalies that are termed the iodine deficiency disorders (IDDs). Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. There is persistence of goiter despite oral iodine supplementation in goitrous children in some endemic area in South Sulawesi and that area is categorized as iodine replete area . The study is aimed to investigate the effect of levothyroxine in the treatment of these goitrous children. A prospective, double-blinded, placebo-controlled randomized trial of 3 months duration with two parallel groups was conducted. The study procedures were approved by the ethics committee. The study occurred at Anggeraja and Baraka subdistricts, Enrekang regency, South Sulawesi. A total of 71 goitrous children were recruited . The children were then randomly assigned to levothyroxine treatment (n = 35) or placebo (n = 36). Capsul containing 100 ug levothyroxine or placebo capsul which was identical in appearance was given to each patient.. The subjects were examined at baseline and after 3-month treatment period. Goiter prevalence, thyroid hormones, thyroid volume, nutritional status, bone age, arterial blood pressure and pulse rate were determined. Following intervention, Total FT4 levels were not increased both in the treatment group and in the placebo group . TSHs levels decreased significantly in the treatment group following 3 month of intervention, while no significant changes were observed in the placebo group. Goiter prevalence was significantly reduced in the treatment group; however, no significant difference was noted in the placebo group. As for the thyroid volume, both groups showed no significant decrement following the intervention . Bone age was significantly increased in the treatment group and in the placebo group; however, no significant difference was noted in the difference between bone age at 3 month intervention and bone age at the commence of therapy in placebo group. With respect to the nutritional status, the treatment group showed a significant increase in body weight for age following the intervention. No significant increase in both systolic and diastolic blood pressures was observed in the ltreatment and placebo group following 3 month of intervention, but the placebo group showed a significant reduction in the pulse rate. The correction of iodine deficiency by levothyroxine therapy for 3 month intervention has a short-term beneficial effect in reducing the prevalence of goiter and improving the nutritional status and no cardiovascular side effects were noted among the goitrous children in endemic areas; however, proper monitoring and close supervision are needed to maintain compliance.

ABSTRAK Peranan Pemberian Levotiroksin Pada Anak Yang Menderita Struma Di Daerah Replete Iodium. SATRIONO. Defisiensi iodium dapat menyebabkan : struma endemik, hipotiroidisme, kretinisme, dan anomali bawaan yang diberi istilah sebagai gangguan akibat kekurangan iodium (GAKI) atau the iodine deficiency disorders (IDDs). Prevalensi struma pada anak sekolah dasar digunakan sebagai indikator hebatnya GAKI di masyarakat. Ternyata struma masih tetap ada meskipun telah diberikan suplementasi iodium pada beberapa daerah yang digolongkan sebagai daerah replete iodium di Sulawesi Selatan. Penelitian ini bertujuan untuk mengetahui pengaruh pengobatan levotiroksin pada anak yang menderita struma tsb. Suatu penelitian buta acak ganda memakai kontrol plasebo yang bersifat prospektif selama 3 bulan dengan 2 kelompok pararel telah dilaksanakan. Penelitian berlangsung di Kecamatan Anggeraja dan Baraka Kabupaten Enrekang Provinsi Selatan. Sejumlah 71 anak yang menderita struma direkrut. Anak-anak tadi dirandominasi menjadi kelompok terapi levotiroksin (n = 35) atau plasebo (n = 36). Kapsul yang mengandung 100 ug levotiroksin atau kapsul plasebo yang penampilannya mirip diberikan pada setiap subjek. Kode randomisasi akan dibuka bila semua data telah selasai terkumpul . Prevalensi struma, hormon tiroid, volume tiroid, status gizi, bone age, tekanan darah arteri dan frekuensi nadi diperiksa pada penelitian. Sesudah intervensi, kadar FT4 levels tak meningkat baik pada kelompok terapi maupun pada kelompok plasebo . Kadar TSHs menurun secara bermakna pada kelompok terapi sesudah intervensi 3 bulan, tak terdapat perubahan yang bermakna pada kelompok plasebo. Prevalensi struma menurun secarta bermakna pada kelompok terapi.; tetapi tak terdapat perbedaan yang bermakna pada kelompok plasebo. Mengenai volume tiroid pada kedua kelompok tersebut tak menunjukkan penurunan yang bermakna sesudah intervensi. Bone age meningkat secara bermakna pada kelompok terapi dan plasebo; tetapi tak ditemukan perbedaan yang bermakna selisih bone age pada 3 bulan terapi dan bone age pada permulaan terapi pada kelompok plasebo. Dalam hal status gizi menurut persentase berat badan untuk umur kelompok terapi memperlihatkan peningkatan yang bermakna seudah intervensi 3 bulan. Tak terdapat peningkatan yang bermakna baik tekanan sistolik maupun diastolik pada kelompok terapi dan plasebo., tetapi pada kelompok plasebo terdapat pengurangan denyut nadi. Pengobatan levotiroksin selama 3 bulan mempunyai pengaruh yang bermanfaat dalam hal menurunkan prevalensi struma dan memperbaiki status gizi dan tak didapatkan dampak samping kardiovaskuler, meskipun demikian perlu supervisi yang seksama dan ketat untuk mempertahankan kepatuhan minum obat.