Thyroid,PTH, Calcitonin

Presentasi berjudul: "Thyroid,PTH, Calcitonin"— Transcript presentasi:

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

2 Sintesis hormon tiroid

3 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

4 Regulasi hormon tiroid

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

6 Etiology hypothyroidism
Defisiensi iodium Congenital maternal 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 ↑ TSH, TRH (kel. Kongenital, neoplasma, radiasi)
Hyper thyroidism ↑ TSH, TRH (kel. Kongenital, neoplasma, radiasi) sekunder Kegagalan kelenjar tiroid (autoimun, neoplasma, infeksi, radiasi) primer

11 Etiology hyperthyroidism
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 >> agonis reseptor TSH
Goiter - 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 Thyroid storm : ↑ ↑ excessive circulating thyroid hormone on thyrotoxicosis Etiology: Infection Surgery Physiologic stress: Cardiovascular , hipoglicemia, ketoacidosis diabetic, pregnancy Medication discontinuation Radioactive iodine Palpasi berlebihan pada penderita hyperthyroidism

15 endocrine control and calcium
Fungsi kalsium: Eksitabilitas neuromuskular Eksitasi-kontraksi otot polos dan jantung Stimulus-kontraksi  eksositosis produk sekretorik Eksitasi-sekresi  sekresi insulin Sel Tight junction Blood clotting

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

17 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

18 Osteoblast and osteoclast

19 Transpor Ca Tulang-Plasma

20 PTH dan regulasi kalsium

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

22 PTH dan calcitonin

23 hyperparathyroidism Parathyroid secreting tumor Hypercalcemia
↓ eksitabilitas neuromuskular Nephrolithiasis Peptic ulcer, nausea Penipisan tulang

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

25 Thank you for your attention