Slide Pleno Kel. 9

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


3/28

K&$# W!rd

A woman, 35 y.o

Weight loss more than 10 kg

since 6 last month

Palpitation

Aniety !he smarting eyes


4/28

"#$%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.


5/28

-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!')*


7/28

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


8/28

#'%!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"'


9/28

#'%!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


10/28

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&


11/28

HISTOLOGY


12/28

#'%!I%4$


13/28

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


14/28

A%XI$!*


15/28

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'%


16/28

!+$ ")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


17/28

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%


18/28

#'%!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


19/28

#'%!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&


20/28

"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&


21/28

&A>$"7I"$A"$

'I!$&%'74;A&

!'?"I?

AWoman,35y.o

>

Weight

;oss

> >

Aniety >

Palpitation > >

"marting > >

DIFFERENTIAL DIAGNOSE


22/28

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


23/28

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


24/28

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


25/28

#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(


26/28

!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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Slide Pleno Kel. 9