thyroid

Thyroid,PTH,
Calcitonin
Lasiah Susanti,dr,MPH
Sintesis hormon tiroid
Efek hormon tiroid
1. ↑ BMR
2. Intermedianing metabolism
• Glikogenesis, glikolisis
• Sintesis protein, degradasi protein
3. Sympathomimetic
• Proliferasi sel target katekolamin
4. Pertumbuhan
• Stimulasi sekresi Growth Hormone dan produksi Insulin Like
Growth Factor 1
• ↑ efek GH dan IGF 1 pada sintesis protein dan pertumbuhan
tulang
Regulasi hormon tiroid
Patologi tiroid
Kegagalan kelenjar
tiroid (autoimun,
neoplasma, infeksi,
radiasi)
Defisiensi TSH, TRH
(kel. Kongenital,
neoplasma,
radiasi)
primer
Defisiensi diet
Iodine
sekunder
sekunder
Hypo
thyroidism
Etiology hypothyroidism
1. Defisiensi iodium
5. Neoplasm
2. Congenital
maternal
• Pituitary adenoma
3. Autoimun
• Hypophisitis
lymphocytic
•
Thyroiditis Hashimoto
• Radiation
•
Thyroiditis pospartum
•
Thyroiditis
subacute/de
Quervain
• Drugs: dopamine,
opioid
4. Goitrogens
• Congenital
• TRH resistance
• TRH deficiency
Manifestasi klinis hypothyroid
↓ Metabolic:
↓ sympatomimetic:
• Fatigue, lethargy,sleepiness
• ↓ nafsu makan, ↑ BB
• Decreased systolic blood
pressure and increased
diastolic blood pressure
• ↓ perspiration, cold intolerance
• Bradycardia
• Dry skin, Hair loss
Others:
• Muscle pain, joint pain,
weakness in the extremities,
hyporeflexia
• Oligomenorrhea
• Depression, Emotional lability,
mental impairment
• ↓ fungsi kognitif
• Myxedema : periorbital
puffiness
• Goiter
• Dysphagia, odinophagia,
hoarseness
Myxedema
Pitting vs non pitting edema
Patologi tiroid
↑ TSH, TRH (kel.
Kongenital,
neoplasma,
radiasi)
Kegagalan kelenjar
tiroid (autoimun,
neoplasma, infeksi,
radiasi)
sekunder
primer
Hyper
thyroidism
Etiology hyperthyroidism
1.
autoimun
4. Idiopathic
•
Grave diseases
• Multinodular toxic goiter
•
Thyroiditis Hashimoto
5. Iatrogenic
•
Thyroiditis
Subacute/deQuervain
• Surgery
•
postpartum thyroiditis
2. Infection
•
Bacterial and viral
3. goitrogens/drug induced
6 . Neoplasm
• Adenoma toxic
• Thyrotropin producing
pituitary tumor
• Teratoma ovarii
Manifestasi klinis hyperthyroidism
Metabolic:
Others:
• ↓ BB ↑ Nafsu makan
• Oligomenorrhea
• Increased perspiration
• Myxedema : periorbital
puffiness
• Heat intolerance
• Hyperactivity , etc
Symphatomimetic:
• Nervousness
• Anxiety
• Palpitations/tachycardia
• Systolic hypertension, etc
• Goiter
>> agonis reseptor TSH
↑ TSH
(neoplasma thyroid,
hypothalamus,
hypophysis, HCG
producing tumor)
( def iod,
goitrogens*)
Goiter
- Toxic
- non toxic
- hypothyroid
*drugs: amiodaron, litium, fenitoin, rifampicin
Food: ubi, kol, kacang2an, dll
thyroid storm
• Thyroid storm : ↑ ↑ excessive circulating thyroid hormone
on thyrotoxicosis
• Etiology:
1. Infection
2. Surgery
3. Physiologic stress: Cardiovascular , hipoglicemia,
ketoacidosis diabetic, pregnancy
4. Medication discontinuation
5. Radioactive iodine
6. Palpasi berlebihan pada penderita hyperthyroidism
endocrine control and calcium
Fungsi kalsium:
1. Eksitabilitas neuromuskular
2. Eksitasi-kontraksi otot polos dan jantung
3. Stimulus-kontraksi  eksositosis produk sekretorik
4. Eksitasi-sekresi  sekresi insulin
5. Sel Tight junction
6. Blood clotting
Regulasi kalsium
PTH
Vit D
Calcitonin
1. Immediate
•
Constant plasma concentration
•
Tulang – ECF – urine
2. Slow
•
Total amount
•
Intestinal absorption – urine excretion
Tulang
Ginjal
Saluran cerna
Parathyroid hormone
↑ plasma calcium
•
Bone remodelling : osteoblast and osteoclast
•
PTH ↑ transfer Ca dari bone fluid ke plasma
 aktivasi cAMP  pompa Ca  Ca masuk
plasma
•
PTH promoting dissolution tulang  osteoblast
•
PTH ↑ reabsorpsi Ca ↑ ekskresi fosfat
•
PTH mengaktivasi vit D
•
PTH ↑ absorpsi Ca dan fosfat di saluran cerna
Osteoblast and osteoclast
Transpor Ca Tulang-Plasma
PTH dan regulasi kalsium
Calcitonin
• Produk C cell thyroid gland
• Calcitonin ↓ transfer Ca tulang ke plasma
• Calcitonin ↓ dissolution dengan inhibisi
osteoclast
• Calcitonin ↓ reabsorpsi kalsium dan fosfat di
ginjal
PTH dan calcitonin
hyperparathyroidism
• Parathyroid secreting tumor
• Hypercalcemia
1. ↓ eksitabilitas neuromuskular
2. Nephrolithiasis
3. Peptic ulcer, nausea
4. Penipisan tulang
hypoparathyroidism
• Autoimmune, surgery
• Hypocalcemia, hyperphosphatemia
 ↑ eksitabilitas neuromuskular
Thank you for your attention