dr yulfakhri tiroid
TRANSCRIPT
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PENYAKIT
TIROID
Buyung Palala
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TIROID
I. Klinik :Anamnesis, pemeriksaan Fisik
II. Laboratorik :
Test faal tiroid:- T3(FT3), T4 (FT4),TSHs
- Test Supresi Tiroid
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III. Penunjang
1. Rontgen ( X- Ray )2. CT Scan / MRI
3. Sidik ( Scan ) tiroid denganradionuklir
4. Ambilan ( uptake ) iodium
radioaktif5. Uji supresi tiroid
6. USG tiroid
7. Biopsi Tiroid.
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PEMERIKSAAN DIAGNOSTIKPEMERIKSAAN DIAGNOSTIK
PENUNJANGPENUNJANG
1. X1. X-- rayray-- Kalsifikasi kelenjar tiroidKalsifikasi kelenjar tiroid-- Pendorongan pada trakeaPendorongan pada trakea
-- Struma retrosternal / intratorakalStruma retrosternal / intratorakal
2. CT Scan / MRI2. CT Scan / MRI-- Struma IntratorakalStruma Intratorakal
-- EksoftalmusEksoftalmus
PEMERIKSAAN DIAGNOSTIKPEMERIKSAAN DIAGNOSTIK
PENUNJANGPENUNJANG
1. X1. X-- rayray-- Kalsifikasi kelenjar tiroidKalsifikasi kelenjar tiroid-- Pendorongan pada trakeaPendorongan pada trakea
-- Struma retrosternal / intratorakalStruma retrosternal / intratorakal
2. CT Scan / MRI2. CT Scan / MRI-- Struma IntratorakalStruma Intratorakal
-- EksoftalmusEksoftalmus
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3. Sidik ( Scan ) Tiroid denganradionuklid ( 99mTc, 123 I )
- Lokal- Seluruh tubuh
- Untuk : - Nodul : Soliter / multi,
panas, dingin, hangat- Intratorakal- Tiroid ektopik- Bentuk, ukuran
- Metastase
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.radioaktif
- Setelah 2,6, 8 ,24 jam I131
oral- o : Defisiensi Iodium,Hipertiroidism
- q : Hipotiroid
5. Uji SupresiNormal T4 Eksogen
TSH q Uptake q
Otonom ( hiper )
Uptake tidak q
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. ro g eso ut on- Bentuk , besar
- Nodul- Kista, solid
- Ganas
7. Biopsi- Core Biopsy
Jarum besar Histopatologi
- Biopsi Aspirasi Jarum Halus ( BAJH )
Sitologi
: Keganasan
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(Klinis)
1. Indeks Diagnosis Klinik (wayne) berdasarkanskor total symptoms (gejala dan sign (tanda)� Hipertiroid : skor total �+20
� Meragukan : skor total +10 sp +19
� Tidak hipertiroid : skor total � +92. Indeks Diagnosis New Castle (hanya untuk
wanita)� Toksik : skor total + 40 sp +80
� Meragukan : skor total + 24 sp +39
� Eutiroid : skor total -11 sp +23
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Diagnostik Pasti Hipertiroid- T3 ( FT3 ) o- T4 ( FT4 ) o
- TSHs q
Hipertiroid Subklinik :- T3 ( FT3 ) normal- T4 ( FT4 ) normal
- TSHs q
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Diagnosis Graves :
1. Indeks Diagnostik klinis2. FT4 o, TSHs q
3. TSH ² R Ab (s)
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Diagnosis Adenoma Toksika /
Struma NodosaToksika :
- Eksoftalmus ( - )- Dermopathi ( - )
- TSH-R Ab ( - )
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Diagnosis Tiroiditis ( Subakut,Hashimoto )
- Struma kenyal padat, nyeri + / -.- Hipertiroid transient, disusul
hipotiroid- RAI ² uptake o pada subakut- Anti TPO Ab ( + ), Anti TG Ab
(+) pada Hashimoto.
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Diagnosis Struma Nodosa Non
Toksika
- Palpasi / USG : Nodul +- Test Faal tiroid normal- BAJAH : Adenoma / Struma
Nodosa
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Diagnosis Ca Tiroid
- Pembesaran Noduler, keras,
lengket, tidak nyeri- Riwayat radiasi dileher / kepala- Test faal tiroid biasanya normal
- BAJAH : Sitologi
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Diagnosis Struma Endemik :
- Daerah defisiensi Iodium
( Ekskresi iodium urinq
)- Prevalensi > 10 %- Kretin ( + )
- Bisa hipotiroid
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Struma Simpleks
- Struma difus / nodular- Tidak hiper / hipotiroid- Tidak autoimun
- Tidak radang
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Diagnosis HipotiroidKlinik :
Kelelahan, intoleransi dingin,konstipasi, berat badan
meningkat, suara serak, kulitkering, bradikardi, reflek tendonmelambat, depresi.
Labor :T4 q, TSH o
RAI ² uptake q
Kolesterol o
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Gambar : Algoritma penegakan diagnosis penyakit-penyakit tiroid
TSH
T4
TSH:N
T4:
TSH :N
T4 : N
Tidak Ya
Struma
multinodosa
Adenoma toksika
Penyak it
Graves
Tidak Ya
Gejala
Graves
N
T3
Tirotoksikosis
Primer
TSH :
T4 : N
TSH :
T4 :
Hipertiroid
subklinik
Follow-up
4-6 bln
Tirotoksi-
kosis T3
NormalAdenoma
hipof isisTSH
Resist HT
Struma
nodosa
toksika
Tiroiditis (destr)
Kelebihan I
KelebihanHT
Lain : CGH
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