HIPERTIROIDISME

 Seorang wanita, 32 th datang dengan

keluhan sering berdebar-debar.
Beberapa hari ini sulit tidur dan sering
gelisah.
 Didapatkan riwayat berat badan

cenderung turun meskipun makan

seperti biasa
 Teman sekerjanya akhir-akhir ini sering

mengatakan “kok didaerah leher agak

beda ya, sepertinya membesar”
Apa Pengertian dari
Hipertiroidisme
 Keadaandimana kadar hormon tiroid
meningkat yang disebabkan oleh
overproduksi kelenjar tiroid
Bagaimana Seseorang bisa
menjadi
Hipertiroidisme
TSH ↓, FT4 ↑ → tirotoksikosis

TSH ↓, FT4 normal :

 T3 tirotoksikosis (FT3 ↑)
 Tirotoksikosis Subklin

TSH normal, FT4 ↑:

 TSH-secreting adenoma
 Pituitary resistance to thyroid hormon
 Generalized resistance to thyroid hormon
Apa saja Gejala-gejala
Hipertiroidisme
 Symptoms
- Nervousness
- Fatigue
- Weakness
- Increased perspiration
-
-
Heat intolerance
Hyperactivity
Signs
- Hyperactivity
- Tremor
- Increase apetite - Tachycardia/arrythmia
- Palpitation - Systolic hypertension
- Weight loss - Warm, moist, smooth skin
- Menstrual disturbance - Stare and eyelid retraction
- Tremor
- Hyperreflexia
- Muscle weakness
11
Bagaimana melakukan
Diagnosis
Hipertiroidisme
 Tersangka HIPERTIROIDISME

Ukur Kadar TSH dan FT44

TSH : n TSH :  TSH :  TSH : n / 

FT44 :n FT44 : n FT44 : 
 FT44 : 

Bukan Ukur FT33 Hipertiroidisme Pituitary Adenoma

Hipertiroidisme Thyroid Hormone
TSH  FT44 
resistance Syndrome
 Hipertiroidisme
TSH  FT4 

TSH , FT4 N, FT3 : N TSH , FT4 N, FT3 

T3 Toksikosis

Hipertiroidisme Subklinik
Evolving Graves’ disease
Penyakit Graves
Struma Nodosa Toksik Struma Nodosa Toksik (Multi/adenoma)
Terapi Tiroksin Berlebihan Tiroiditis
Nonthyroidal illness Hipertiroidisme Iatrogenik/Faktisius
Hipertiroidisme Gestasional
Karsinoma Tiroid
Struma Ovarii
Chorionic gonadotropin
 
 STRUKTUR TIROID
• Sintigrafi tiroid  radioaktif
• USG  bentuk kistik atau solid
• Biopsi jarum halus malignancy?
Bagaimana Pilar/Alur
Pengelolaan
Hipertiroidisme
 Anti Thyroid Drug
 Radioactive Iodine
 Surgical Therapy
 Thionamides :
• Propylthiouracil (PTU)
• Methimazole (MMI) &Carbimazole
 Inorganic Iodide
 Potassium Perchlorate
 Lithium Carbonate
-adrenergic Antagonist Drugs
 Long-term treatment of Graves' disease (preferred 1st-line
treatment in Europe, Japan, & Australia)

 PTU is treatment of choice in patients who are pregnant and

those with severe Graves' disease;

 Preferred treatment by many endocrinologists for children and

for adults who refuse radioactive iodine

 Pretreatment of older and cardiac patients before radioactive

iodine or surgery

 Both medications considered safe for use while breastfeeding

P T U & M M I…
Side effects

- High relapse rate; relapse more likely in smokers,

patients with large goiters, and patients with positive
thyroid-stimulating antibody levels at end of therapy
- Rash, urticaria
- Transient granulocytopenia
- Agranulocytosis (0,2 – 0,5%)
- Very rare : hepatitis/cholestatic
aplastic anemia
Inorganic Iodide
• To decrease T3 & T4 synthesis

Inhibiting iodide transport, oxidation and

organification (Wolff-Chaikoff effect)
• To block the release of T3 & T4 from thyroid
• Rapid decrease in thyroid hormone levels
• Preoperatively when other medications are

ineffective or contraindicated
• During pregnancy when antithyroid drugs are

not tolerated
• With antithyroid drugs to treat amiodarone-

(Cordarone-) induced hyperthyroidism

 Many of the manifestation of thyrotoxicosis mimic a
hyper adrenergic state
 Blockade of adrenergic receptor relief from some
symptoms of thyrotoxicosis
 Possible: inhibit conversion of T4 to T3
 Treatment of choice for thyroiditis
 First-line therapy before surgery, radioactive iodine, and
antithyroid drugs
 Short-term therapy in pregnancy
 High cure rates with single-dose treatment (80
percent)
 Treatment of choice for Graves' disease in the United

States, multinodular goiter, toxic nodules in patients

older than 40 years, and relapses from antithyroid
drugs
 Contraindicated in patients who are pregnant or

breastfeeding
 Delayed control of symptoms
 Posttreatment hypothyroidism in majority of patients

with Graves' disease regardless of dosage

 Treatment of choice for patients who are pregnant
and children who have had major adverse reactions
to antithyroid drugs, toxic nodules in patients
younger than 40 years, and large goiters with
compressive symptoms
 Can be used for patients who are noncompliant,

refuse radioactive iodine, or fail antithyroid drugs,

and in patients with severe disease who could not
tolerate recurrence; may be done for cosmetic
reasons
 Risk of hypothyroidism (25 percent) or hyperthyroid
relapse (8 percent)
 Temporary or permanent hypoparathyroidism or

laryngeal paralysis (less than 1 percent)

 Higher morbidity and cost than radioactive iodine
 Requires patient to be euthyroid preoperatively with

antithyroid drugs or iodides to avoid thyrotoxic crisis

Faktor risiko :
1. Hipertiroidisme yang tidak diobati
2. Pengobatan kurang memadai : tindakan bedah,
infeksi, tiroidektomi, serangan kardiovaskuler,
toksemia hamil, KAD, HHS, hipoglikemia induksi
insulin, penghentian terapi anti tiroid,
pemberian terapi yodium radioaktif.
 Penatalaksanaan Krisis tiroid

1. Umum : cairan untuk rehidrasi, elektrolit & glukosa

2. Koreksi hipertiroid cepat :
1. Blok sintesis : PTU 600-1000mg diikuti
200mg/4jam (100-1500mg)
2. Blok sekresi : solusio lugol 10 tts/6-8
jam/larutan Kalium yodida 5tts/6jam
3. Hambat konversi T4-T3 : propanolol
3. Hidrokortison dosis stres 100mg/8 jam
Deksametason 2mg/ 6 jam – defisiensi steroid relatif
akibat hipermetabolisme
4. Atasi demam dan faktor pencetus