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8/18/2019 Slide Pleno Kel. 9
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ENDOCRINE ANDMETABOLISM SYSTEM
MODUL I
DEGRADATION OF BODY
WEIGHT
group IX
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9 th GROUP
Ai Kardi
Ari Achmad Bch!ri
Bdi Pratama
Ri! I"#a" Riad$
Sa$ti
A%&"' W!r! Lara#ati
E'a Dia"i#$a
Er"a(ati
I"ta" O)i*ia
Ki+i Nr A,idah
M#ti+a R!hdi"i$a"ti
Nr) Ma)id$a
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K&$# W!rd
A woman, 35 y.o
Weight loss more than 10 kg
since 6 last month
Palpitation
Aniety !he smarting eyes
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"#$%A&I'
A Woman, 35 y.o comes tothe clinic with complain
weight loss more than 10kg since 6 last month. "he
complain too palpitation,aniety, an( the smartingeyes.
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-UESTIONS
./E01)ai" a2!t a"at!m$3 1h$#i!)!'$32i!ch&mi#tr$3 a"d hi#t!)!'$ thatr&)ati!" (ith th& #c&"ari! 4
5/E01)ai" th& ri#+ 6act!r a"d th&1ath!m&cha"i#m !6 (&i'ht )!## 4
7/E01)ai" th& 1ath!m&cha"i#m !6a"0i&t$3 1a)1itati!"3 a"d th& #marti"'
&$ 4
8/E01)ai" di&r&"tia) dia'"!#tic 6r!m th&#c&"ari! 4
:/E01)ai" a2!t dia'"!#tic m&th!d 6!rthi# #c&"ari! 4
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A%A!')*
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PHYSIOLOGY
!&+ rom+ipothalamus
!"+ rom +ipo-sis
"timulating lan(ula !hyroi(
"ecretion !hyroin/!
#on2ertion ! to !riio(othyronin /!3
!riio(othyronin acti2e
SECRE
T ION
OF
T HYROI
D
SYST E
M
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#'%!I%4$
!hyroi( +ormone unction
- Im1!rta"t 6!r 'r!(th< I"cr&a#& 2a#a) m&ta2!)i#m a"d h&at 1r!dc&< I6 th$r!id h!rm!"& i# i"cr&a#i"'
# d&cr&a#i"'
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#'%!I%4$
"timulating hipo-sis with !&+ rom hipothalamus
"ecretion !"+ rom hipo-sisan( stimulating the glan(ula
thyroi(
"ecretion ! an( con2ertingto !3 as a acti2e hormone
I 3 an( ! is enough,glan(ula thyroi( sen( a
mesaage to hipo-sis
7ecreasing !"+ rom+ipo-sis
7ecreasing !&+ romhipothalamus
FEED BACK MECHANISM
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8I'#+$)I"!&*
./ I!did& Tra11i"'5/ I!di"& c!m& i"t! th&c!))!id a"d &01&ri&"c& !6th& !0idati!"
@&"$m& 1&r!+#ida#&7/ I!di"a#i Tir!#i"38/ C!"cat&"ati!"I!d!tir!"i) @&"$m&tir!1&r!+#ida#&:/ Hidr!)i#i#
;/ Tir!+#i" A"dtrii!d!tir!#i" '! !t 6r!m6!))ic)& c&)) a"d c!m& i"t!th& 2)!!d/ MIT A"d DIT (hich )&6t2&hi"d 6!))ic)& c&)) (i))
&01&ri&"c& !6 th&i!di"a#i3 @&" m&
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HISTOLOGY
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#'%!I%4$
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a PATHOMECHANISM OF WEIGHT BODY
In eneral 9
In take an( up take actor
8)& /8asal )eta:olic&ate
+ormon actorF!r E0am1)& Gra* Di#&a#& ?
TSH TSI stimulate tiroid
hormone
hipertiroidism
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A%XI$!*
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Thyrotoxicosis
Thyroid hormone
metabolism of tisse
!ic"en #sa$e O2
%asodilatation of tisse
Mlti&ly release of amont ofmetabolic end &rodcts from Tisse
'lood stream
Cardiac ot&t
(al&itation
PA;PI!A!I'%
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!+$ ")A&!I% $*$"
Anti:o(y orme( to the eyesmuscle
!yroglo:ulin rom thyroi( is
transporting to the or:ital tissue an(happen immune response there.
/ en(ocrinology
!he eyes ha2e epitel cell thatnormally will :e ollowe( to closewhen we close our eyes, :ut therewas immunoglo:ulin that make an
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7IA%'"!I# )$!+'7"
Kelainan tiroid ??
TSH sensitif
NormalMeningkat Tak terukur
Hipotiroidisme Eutiroid Hipertiroidisme?
FT FT
Normal Menurun Meningkat Normal
Hipotiroidisme
Su!klinis
Hipotiroidisme
"n#ata$
FT%
Meningkat Normal
Hipotiroidisme
su!klinis
Hipertiroidisme
"#&$
$%I%
!$"
!
KET & Se!agai tes saring fungsi tiroidKET & Se!agai tes saring fungsi tiroid
urutann#a s!!&urutann#a s!!&
'( Tes TSHS 2( Tes FT %( FT%'( Tes TSHS 2( Tes FT %( FT%
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#'%!I%4$
A"am"i#Gra*&># Di#&a#& S$m1t!m#?= W&i'ht )!## a)th!'h ha*& "!rma) a11&tit&= W&a+3 )!## &"&r'$
= S(&at a"d (arm #+i"= H!t di#a2)&= Pa)1itati!"= Tr&m!r= S&"#iti*& @)a2i) &m!ti!"a)3 #1itr&3&/t/c
= E")ar'& !6 "&c+3 hard t! &at3 h!ar#&3&/t/c= F!r 3 #!m&thi"' ha*& !)i'!m&"!rh&a= !mit#= Diarh&a= E$& di#tr2a"c& @)a+rima#i3 &+#!6ta)m#3 &$&
#marti"'3 &/t/c= F!r !)d a'&3 #!m&thi"' ha*& cardi!*a#c)ar
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#'%!I%4$
Ph$#ic &0ami"ati!" '&"&ra) c!"diti!" ? 1ati&"t )!!+&d thi" #!6t #+i"3 (arm3 a"d m!i#t &0tr&mita# ?
< h$1&r+i"i#< tr&m!r d&)icat& !6 th& ha"d/
< i"cr&a#& !6 1at&))a r&&0 a"d t&"d!" achi)) r&&0< #!m&tim ? h$1!+a)&mi+ 1&ri!dic 1ara)$#i#
N&c+ ? Strma @S(&))i"' E$ ?
< E0!1tha)m#< St&))(a' Si'" ? rar& t! #ht a"d !1&" 2$ tr"#< !" Gra&6& Si'" ? #1&ri!r 1a)1&2ra "!t t! 6!))!(
!c)i (h&" )!!+&d t! "d&r3 )id)a'< M!r2# Si'" ? hard t! c!"*&r'&"c$< J!r!$ Si'" ? ca">t t! 6!r&h&ad (ri"+)&d< R#&"2ach Si'" ? Tr&m!r 1a)1&2ra i6 c)!#&d th&
&$& Cardi! ?
< hard #!"d !6 cardi!< hi'h 2)!!d 1r#r&
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"4PP'&! $XA)I%A!I'%
Th$r!id 6"cti!" tt ? i"cr&a#& !6 T8a"d T7 a"d d&cr&a#& !6 TSH
B)!!d tt ? At!a"ti2!d$ th$r!id1&r!+#ida#& tir!id a"d a"titir!')!2)i"i"dicat&d t! at!imm"& &ti!)!'$
CT #ca" ? T! di&r&"tia) 'ra*di#&a#& @#a))$ ? di# (ith #trmam)ti"!d)ar @h!t #1!t m)ti1)&/ F!r&+#!6ta)m#3 CT #ca" i" th& !r2ita #h!(h$1&rtr! !6 &$&># m#c)& !t#id&
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&A>$"7I"$A"$
'I!$&%'74;A&
!'?"I?
AWoman,35y.o
>
Weight
;oss
> >
Aniety >
Palpitation > >
"marting > >
DIFFERENTIAL DIAGNOSE
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7i@errential7iagnose
ra2es 7isease oiter %o(ular !oksik
7e-nition Autoimun
Anti:o(y like !"+
/thyroi(
$nlargement thyroi(glan(, its cause yo(ium
(e-ciencyPre2alention 30 0 years ole(
Women 9 )en 9 1
amilier Pre(isposition
)ore -n( at the ol(patient :y complicationgoiter no(ular chronic.
$tiology Autoimmune Io(ium (e-ciency
Autoimmune oitrogenes
-I(iopathic
"ign an( "ymptomps "igns 9
+yperunction rom !hyroi( lan(
In-ltrati2eopthalmopathy/$opthalmus
In-ltrati2e (ermopathy/mye(ema
"ymptomps 9
atigue, Increase oapetite, !remor, Worry
eneral "tatus
$yes 9 e.$ophthalmia, etc.
#ar(io 9 e. !achycar(ia, etc.
;ocals &egion #oli Ant."tatus
Inspection 9 swelling,colour, surace, :e
acti2e when swelling
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PATHOMECHANISM OF GRAES DISEASE
AntibodyReseptor of TSH
or membran of
plasma thyroid
stimulate the tiroid
fun)tion o*er and
o*er on cAMP
Hipertiroidism
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PATHOMECHANISM OF GOITERNODULAR TOIC
H#perth#roidism +utoimmune
, th#roid a)ti*it# and
er# a)ti*e
.odium /efi)ien)#
Nothing help
th#roid0s 1orkFatigue enlargement
th#roid gland
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#omplication Atrium i:rilation
Paralysis
+ypocalemia
+ypercalsemia Bnerocalsinosis
7eacrease o li:i(o
Impotensi
7ecrease o "perma
ynecomastia
a/ Sh!rt 1&ri!d
8lee(ing rom a.tiroi(ea superior
7ispneu #risis o thyroi(
2/ L!"' 1&ri!d
&ough 2oice :ecause(amage o n. reccurentlaryngeus
;ite( up o paratiroi(glan( that causehipocalsemia thanhappen a tetani/"in(rom carpope(al 9ocal sti@ at han( an(oot, that happen ater
D years
Prognosis Worst, i going tothyroi( crisis
#an :e releapse
!hs patient,hiperthyroi(ism happen2ery slow, an( a clinicmaniestation more .......
!han ra2es 7isease.
A Patient may :ecom lain aritmia an(
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!reatment 1. Antithyroi( (rug therapyPropylthiouracil/P!4,methimaEole, an(
car:imaEole
Inhi:it synthesis o thyroi(
hormone.P!4 mengham:at se:agian
(eio(inasi !men
Fa(i !3 (i perier se(angkan
methimaEole (an
#ar:imaEole ti(ak.
"i(e e@ect 9 rash,Agranulositosis
D. "urgical treatment
su:total thyroi(ectomy
#omplication 9 +ypothyroi(ism,
recurent
;aryngeal ner2e inFury
3. &a(ioacti2e io(ine therapy7osis 9 D10 mili#uri
#omplication 9 hypothyroi(ism
. 'ther
#orticosteroi( or ophtal
)opathy
8eta8locker or (istur:ance
o heart
./ C!"#&r*ati*&
In(ication 9 ol( age,resi(i2e stuma
"truma non toksik 9 Fo(ium, ekstrak tiroi( 30
D0 mgH(l "truma toksik 9
PTU @1r!1i)ti!ra#i).
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&$$&$%#$"
D!r)a"d3 W/A/ N&(ma"/55/ Kam#&d!+t&ra" D!r)a"d Edi#i 59/ Ja+arta? EGC/
Farma+!)!'i da" T&ra1i/ 5/D&1art&m&" 6arma+!)!'i da" t&ra1&ti+Fa+)ta# K&d!+t&ra" U"i*&r#ita# I"d!"ia/
G)&ad)& J!"atha"3 At a Glance ANAMNESIS DAN PEMERIKSAAN FISIK,Hipertiroidisme hlm.1!, %a+arta ? EMSHa"am3 M/W/ E"d!+ri"!)!'i/ Ba"d"'/
Ha"am MW3 Endo"rinolo#i, Pen$a"it
Gra%es 3 h)m/ .5;3 Ba"d"' ?A"'+a#a O6#&t/O)#!"3 Jam/ B&)a%ar MdahFarma+!)!'i/ 58/ Ja+arta ? EGC/
(((/c&rmi"d"ia+&d!+t&ra"/c!m(((/m&dica#t!r&/c!m(((/'!!')&/c!m
http://www.cerminduniakedokteran.com/http://www.medicastore.com/http://www.google.com/http://www.google.com/http://www.medicastore.com/http://www.cerminduniakedokteran.com/
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Thank you
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