Gangg Fungsi Tiroid Pato

8/21/2019 Gangg Fungsi Tiroid Pato

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Gangguan Fungsi Gangguan Fungsi

Tiroid Tiroid

Oleh :Oleh :

Eli Halimah Eli Halimah


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FUNGSIFungsi Kelenjar Tiroid :

Pengikat Iodida

Sintesis hormon tiroidPenyimpanan hormon tiroid

Fungsi Hormon Tiroid :Mengatur kecepatan metabolisme

tubuh

Mengatur produksi panas

Mengatur pelepasan energi dalamotot

Mengatur pertumbuhan dandiferensiasi


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Structure of the thyroid follicle


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The Thyroid Produces and

Secretes 2 MetabolicHormones

Two principal hormonesThyroxine (T4 ) and

triiodothyronine (T3)

Required for homeostasis of allcells

Influence cell differentiation,

growth, and metabolism

onsidered the ma!or metabolic

hormones because they target

"irtually e"ery tissue


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Thyroid-StimulatingHormoneTSH!

Regulates thyroid hormone production, secretion, and

growth

Is regulated by the negati"e

feedbac# action of T4 and T3


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"iosynthesis of T#

and T$

The %rocess includes

$ietary iodine (I) ingestion%cti"e transport and upta#e of

iodide (I) by thyroid gland

&xidation of I' and iodination of

thyroglobulin (Tg) tyrosine residues

oupling of iodotyrosine residues

(IT and $IT) to form T4 and T3

roteolysis of Tg with release of T4and T3 into the circulation


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Iodine Sources

%"ailable through certain foods

(eg, seafood, bread, dairy

products), iodi*ed salt, or dietary

supplements, as a trace mineral

The recommended minimum

inta#e is +- µg.day


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Sintesis Hormon

Tiroid


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& &/

I

I

II

&/

&

0/1

Thyro&ine T#!

& &/

I

I

I

&/

&

0/1

$'('$)-Triiodothyronine T$

TH*+,I H,+M,N.S


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F.."/01 +.GU/TI,N

TH. H*P,TH//MI0-PITUIT/+*-

TH*+,I /3IS

/ormones deri"ed from the

pituitary that regulate thesynthesis and.or secretion of

other hormones are #nown as

tro%hic hormones2

1ey %layers for the thyroid include

T+H ' Thyrophin Releasing /ormoneTSH ' Thyroid timulating /ormone

T#4T$ ' Thyroid hormones


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PITUIT/+*-TH*+,I /3IS

/ 5oodman, 6%I 7$I%8 70$&RI0&8&59 3rd 7d2

: :

;


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Mekanisme PengaturanTiroid


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Hy%othalamic-Pituitary-Thyroid /&is

Negati5e Feedbac6 Mechanism


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T/ binds to specific cell surface

receptors that stimulate adenylatecyclase to produce c%2

T/ increases metabolic acti"ity

that is required to synthesi*eThyroglobulin (Tg) and generate

peroxide2

T/ stimulates both I' upta#e andiodination of tyrosine resides onTg2

TSH +.GU/TI,N ,F

TH*+,I FUN0TI,N


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I,N T+/NSP,+T "* TH.

TH*+,I F,I0U/+ 0.

I' I'organification

ropylthiouracil

(T


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T/

T/ receptor

Iodination of

Tyr residues of Tg

&88&I$

T&

TH*+,G,"UIN S*NTH.SIS IN TH.

TH*+,I F,I0U/+ 0.


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TH*+,I H,+M,N. S.0+.TI,N "*

TH. TH*+,I F,I0U/+ 0.

&88&I$

T/

T/ receptor

$IT

IT I'

T4T3


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TH*+,I H,+M,N.S

IN TH. ",,

%pproximately ==2=>? of T4 is

bound to 3 serum proteinsThyroid binding globulin (T"G)

@A?B

Thyroid binding %realbumin (T"P/

or transthyretin) +'1-?B

albumin @'+-?

&nly @-2-1? of the total T# in blood is

unbound or free7

&nly @-24? of total T$ in blood is free2


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"/SI0S ,F TH*+,I H,+M,N.

/0TI,N IN TH. 0.


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SP.0IFI0 /0TI,NS ,F

TH*+,I H,+M,N.8

M.T/",I0

Regulates of "asal Metabolic

+ ate ("M+ )2Increases oxygen consumption in

most target tissues2

Permissive actions: T/ increasessensiti"ity of target tissues to

catecholamines, thereby ele"ating

lipolysis, glycogenolysis, and

gluconeogenesis2


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T/ is critical for normal de"elopment

of the s#eletal system and musculature2

T/ is also essential for normal brain

de"elopment and regulates

synaptogenesis, neuronal integration,myelination and cell migration2

0retinism is the term for theconstellation of defects resulting from

untreated neonatal hypothyroidism2

SP.0IFI0 /0TI,NS ,F

TH*+,I H,+M,N.8

.9.,PM.NT


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+is6 factors for thyroid disease

personal history of thyroid disease

strong family history of thyroid

disease

diagnosis of autoimmune disease

past history of nec# irradiation

drug therapies such as lithium and

amiodarone

women o"er age -

elderly patients

women C wee#s to C months post'

partum


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Signs4Sym%toms

Hy%othyroidism •Hy%erthyroidism

Deight gain/air loss8ethargy

enstrual irregularitiesmenorrhagia)ogniti"e impairment$epressiononstipation

5oitre$ry s#inold intolerance

•Deight loss•/air loss•alpitations .Tachycardia . %trial

fibrillation•enstrual irregularities(amenorrhea.oligomenorrhea)•Didened pulse pressure• 0er"ousness and tremor •uscular wea#ness•5oitre•/eat intolerance,diaphoresis, clammy hands•/ypertension


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0auses of high thyroid-stimulating hormone TSH!

/ypothyroidismReco"ery from se"ere illness

ituitary excess due to

pituitary tumours causingsecondary hyperthyroidism

("ery rare)


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0auses of lo:

thyroid-stimulating hormone TSH!

2 Hy%erthyroid Statea2 6oth T3 and T4 ele"ated

5ra"esE disease

Toxic multinodular goiter

b2 &nly T3 ele"ated with normal T4T3 toxicosis (e2g2 %utonomous nodule)

7xogenous T3 ingestions (liothyronine)

c2 &nly T4 ele"ated with normal T3

/yperthyroidism patient with nausea,"omiting and star"ation causing decreased

con"ersion of T4 to T3

2 Hy%othyroid State

ituitary or hypothalamic disease (both T4 andT3 low)

2 .uthyroid State

ic# euthyroid (both T3, T4 low, rT3F ele"ated)

$rugs such as glucocorticoids, octreotide, anddopamine


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T/

8ow/igh

GT4 GT4 H GT3

8ow

+ /ypothyroid

8ow

entral/ypothyr

oid

TR/ tim2

If

equi"ocal

RI, etc2

/igh

+ Thyrotox

/igh

thyrotoxicosis

J7ndo consultJGT3, rT3JRI, K'<

R%I


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%) + /ypothyroidism

6) entral /ypothyroidism

) 7uthyroid

$) + Thyrotoxicosis


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Thyroid Function Tests

T/ -24 :2- m p

Gree T3 (triiodothyronine) 1213'23 p


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Hy%othyroidism Hypothyroidism is a disorder

with multiple

causes in which the thyroid failstosecrete an adequate amount ofthyroid hormone

The most common thyroid disorder


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Hy%erthyroidism

/yperthyroidism refers toexcess synthesis and secretion

of thyroid hormones by the

thyroid gland, which results inaccelerated metabolism in

peripheral tissues


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Ty%ical Thyroid Hormonee5els in Thyroid isease

TSH T4 T3

ypothyroidism High owow

yperthyroidism ow HighHigh


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www2hsc2missouri2edu.@da"eg.thyroid.thyLdis2htm

.3/MP.S ,F TH*+,I IS./S.S

+ /ypothyroidism /yperthyroidism


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.3/MP.S ,F TH*+,I IS./S.S

0ongenital Hy%othyroidism;u5enile Hy%othyroidism


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Gangg Fungsi Tiroid Pato