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

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

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

Myxedema

Pitting vs non pitting edema

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

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

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

>> 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

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

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

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

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 ↓ eksitabilitas neuromuskular Nephrolithiasis Peptic ulcer, nausea Penipisan tulang

hypoparathyroidism Autoimmune, surgery Hypocalcemia, hyperphosphatemia  ↑ eksitabilitas neuromuskular

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