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Lasiah Susanti,dr,MPH Thyroid,PTH, Calcitonin. Sintesis hormon tiroid.

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Presentasi berjudul: "Lasiah Susanti,dr,MPH Thyroid,PTH, Calcitonin. Sintesis hormon tiroid."— Transcript presentasi:

1 Lasiah Susanti,dr,MPH Thyroid,PTH, Calcitonin

2 Sintesis hormon tiroid

3 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 Efek hormon tiroid

4 Regulasi hormon tiroid

5 Hypo thyroidism Defisiensi TSH, TRH (kel. Kongenital, neoplasma, radiasi) sekunder Kegagalan kelenjar tiroid (autoimun, neoplasma, infeksi, radiasi) primer Defisiensi diet Iodine sekunder Patologi tiroid

6 Etiology hypothyroidism 1.Defisiensi iodium 2.Congenital  maternal 3.Autoimun Thyroiditis Hashimoto Thyroiditis pospartum Thyroiditis subacute/de Quervain 4. Goitrogens 5. Neoplasm Pituitary adenoma Hypophisitis lymphocytic Radiation Drugs: dopamine, opioid Congenital TRH resistance TRH deficiency

7 Manifestasi klinis hypothyroid ↓ Metabolic : Fatigue, lethargy,sleepiness ↓ nafsu makan, ↑ BB ↓ perspiration, cold intolerance Dry skin, Hair loss Muscle pain, joint pain, weakness in the extremities, hyporeflexia Depression, Emotional lability, mental impairment ↓ fungsi kognitif ↓ sympatomimetic: Decreased systolic blood pressure and increased diastolic blood pressure Bradycardia Others: Oligomenorrhea Myxedema : periorbital puffiness Goiter Dysphagia, odinophagia, hoarseness

8 Myxedema

9 Pitting vs non pitting edema

10 Patologi tiroid Hyper thyroidism ↑ TSH, TRH (kel. Kongenital, neoplasma, radiasi) sekunder Kegagalan kelenjar tiroid (autoimun, neoplasma, infeksi, radiasi) primer

11 Etiology hyperthyroidism 1.autoimun Grave diseases Thyroiditis Hashimoto Thyroiditis Subacute/deQuervain postpartum thyroiditis 2. Infection Bacterial and viral 3. goitrogens/drug induced 4. Idiopathic Multinodular toxic goiter 5. Iatrogenic Surgery 6. Neoplasm Adenoma toxic Thyrotropin producing pituitary tumor Teratoma ovarii

12 Manifestasi klinis hyperthyroidism Metabolic: ↓ BB ↑ Nafsu makan Increased perspiration Heat intolerance Hyperactivity, etc Symphatomimetic: Nervousness Anxiety Palpitations/tachycardia Systolic hypertension, etc Others: Oligomenorrhea Myxedema : periorbital puffiness Goiter

13 - Toxic - non toxic - hypothyroid ↑ TSH ( def iod, goitrogens*) >> agonis reseptor TSH (neoplasma thyroid, hypothalamus, hypophysis, HCG producing tumor) *drugs: amiodaron, litium, fenitoin, rifampicin Food: ubi, kol, kacang2an, dll

14 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 thyroid storm

15 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 endocrine control and calcium

16 1.Immediate Constant plasma concentration Tulang – ECF – urine 2. Slow Total amount Intestinal absorption – urine excretion Regulasi kalsium Tulang Ginjal Saluran cerna PTH Vit D Calcitonin

17 ↑ 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 Parathyroid hormone

18 Osteoblast and osteoclast

19 Transpor Ca Tulang-Plasma

20 PTH dan regulasi kalsium

21 Produk C cell thyroid gland Calcitonin ↓ transfer Ca tulang ke plasma Calcitonin ↓ dissolution dengan inhibisi osteoclast Calcitonin ↓ reabsorpsi kalsium dan fosfat di ginjal Calcitonin

22 PTH dan calcitonin

23 Parathyroid secreting tumor Hypercalcemia 1.↓ eksitabilitas neuromuskular 2.Nephrolithiasis 3.Peptic ulcer, nausea 4.Penipisan tulang hyperparathyroidism

24 Autoimmune, surgery Hypocalcemia, hyperphosphatemia  ↑ eksitabilitas neuromuskular hypoparathyroidism

25 Thank you for your attention


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