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HYPOTIROIDTISME

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  HYPOTIROIDTISMEHypothyroidism is a common endocrine disorder resulting from deciency of thyroid hormone It usually is a primary process in !hich the thyroid gland produces insu cient amounts of thyroid hormone It can also #e secondary$that is% lac& of thyroid hormone secretion due to inade'uate secretion of either thyrotropin (ie% thyroid)stimulating hormone *TSH+, from the pituitary gland or thyrotropin)releasing hormone (TRH, from the hypothalamus (secondary or tertiary hypothyroidism, The patient-s presentation may .ary from asymptomatic to% rarely% coma !ith multisystem organ failure (my/edema coma, The most common cause in the 0nites States is autoimmune thyroid disease (Hashimoto thyroiditis,1retinism refers to congenital hypothyroidism% !hich a2ects 3 per 4555 ne!#ornsSu#clinical hypothyroidism% also referred to as mild hypothyroidism% is dened as normal serum free T4 le.els !ith slightly high serum TSH concentration Recent studies In a 36)year longitudinal study% Stuc&ey et al in.estigated the long)term ris& of hypothyroidism in !omen !ho pre.iously had had postpartum thyroid dysfunction (PPTD, The study in.ol.ed 457 !omen% 83 of !hom had pre.iously #een diagnosed !ith PPTD 9t 36)year follo!)up% 68 !omen in the PPTD group and 34 !omen in the non)PPTD group (:;< and 4<% respecti.ely, !ere found to ha.e hypothyroidism =ased on an analysis of odds ratios (ORs,% the authors concluded that !ithin the PPTD group% !omen !ho had #een diagnosed !ith postpartum hypothyroidism !ere among thoseat particularly high long)term ris& for hypothyroidism (OR > 78,Hypothyroidism adalah gangguan endo&rin umum a&i#at &e&urangan hormontiroid Ini #iasanya adalah proses utama di mana &elen?ar tiroid menghasil&an ?umlah cu&up hormon tiroid Hal ini ?uga dapat se&under yaitu% &urangnya se&resi hormon tiroid tida& memadai &arena se&resi #ai& Thyrotropin (yaitu% thyroid)stimulating hormone *TSH+, dari &elen?ar pituitari atau Thyrotropin)releasing hormone (TRH, dari hipotalamus (se&under atau hipotiroidisme tersier, Presentasi pasien dapat #er.ariasi dari asimtomati& sampai% ?arang% &oma dengan &egagalan organ multisistem (my/edema &oma, Penye#a# paling umum di 9meri&a Seri&at adalah penya&it tiroid autoimun (Hashimoto tiroiditis, @retinisme mengacu pada hipotiroidisme &ongenital% yang mempengaruhi 3 per 4555 #ayi #aru lahir Hipotiroidisme su#&linis% ?uga dise#ut se#agai hipotiroidisme ringan% didenisi&an se#agai normal &adar serum T4 #e#as dengan &onsentrasi TSH  serum sedi&it tinggi Studi ter#aru Dalam se#uah studi 36 tahun mem#u?ur% Stuc&ey d&& menyelidi&i risi&o  ?ang&a pan?ang dari hipotiroidisme pada !anita yang se#elumnya telah memili&i disfungsi tiroid postpartum (PPTD, Penelitian ini meli#at&an 457 !anita% 83 di antaranya se#elumnya telah didiagnosis dengan PPTD Pada 36tahun follo! up% 68 !anita dalam &elompo& PPTD dan 34 !anita pada &elompo& non)PPTD (:;< dan 4<% masing)masing, ditemu&an memili&i hipotiroidisme =erdasar&an analisis rasio odds (OR,% penulis menyimpul&an #ah!a dalam &elompo& PPTD% !anita yang telah didiagnosa mengalami hypothyroidism postpartum di antara mere&a yang sangat tinggi risi&o  ?ang&a pan?ang untu& hipotiroidisme (OR > 7%8,AocaliBed disease of the thyroid gland that results in decreased thyroid hormone production is the most common cause of hypothyroidism 0nder normal circumstances% the thyroid releases 355)36C nmol of thyro/ine (T4, daily and only small amounts of triiodothyronine (T:, The half)life of T4 is appro/imately 8)35 days T4% a prohormone% is con.erted to T:% the acti.e form of thyroid hormone% in the peripheral tissues #y C)deiodination Early inthe disease process% compensatory mechanisms maintain T: le.els Decreased production of T4 causes an increase in the secretion of TSH #y thepituitary gland TSH stimulates hypertrophy and hyperplasia of the thyroid gland and thyroid T4)C-)deiodinase acti.ity This% in turn% causes the thyroid to release more T:=ecause all meta#olically acti.e cells re'uire thyroid hormone% deciency of the hormone has a !ide range of e2ects Systemic e2ects are due to either derangements in meta#olic processes or direct e2ects #y my/edematous inltration (ie% accumulation of glucosaminoglycans in the tissues, The my/edematous changes in the heart result in decreased contractility% cardiac enlargement% pericardial e2usion% decreased pulse% and decreased cardiac output In the I tract% achlorhydria and decreased intestinal transit !ith gastric stasis can occur Delayed pu#erty% ano.ulation% menstrual irregularities% and infertility are common Decreased thyroid hormone e2ect can cause increased le.els of total cholesterol and lo!)density lipoprotein (ADA, cholesterol and a possi#le change in high)density lipoprotein (HDA, cholesterol due to a change in meta#olic clearance In addition% hypothyroidism may result in an increase in insulin resistancePenya&it lo&al dari &elen?ar tiroid yang menghasil&an produ&si hormon tiroid menurunadalah penye#a# paling umum dari hipotiroidisme Dalam &eadaan normal% tiroid rilis355)36C nmol tiro&sin (T4, setiap hari dan hanya se?umlah &ecil triiodothyronine (T:,Setengah)hidup T4 adalah se&itar 8)35 hari T4% prohormon% diu#ah men?adi T:% #entu& a&tif dari hormon  tiroid% dalam ?aringan perifer oleh C-)deiodination 9!al dalam proses penya&it% me&anisme &ompensasi mempertahan&an ting&at T: Penurunan produ&simenye#a#&an T4 pening&atan se&resi TSH oleh &elen?ar hiposis TSH merangsanghipertro dan hiperplasia &elen?ar tiroid dan tiroid T4)C-)deiodinase a&ti.itas Hal ini% pada gilirannya% menye#a#&an tiroid untu& melepas&an le#ih T:@arena semua sel a&tif secara meta#oli& memerlu&an hormon tiroid% &e&uranganhormon memili&i #er#agai efe& Efe& sistemi& &arena #ai& derangements dalam proses meta#olisme atau efe& langsung oleh inltrasi my/edematous (yaitu% a&umulasiglucosaminoglycans dalam  ?aringan,My/edematous peru#ahan dalam hasil penurunan &ontra&tilitas ?antung% pem#esaran?antung% efusi peri&ardium% penurunan denyut nadi% dan penurunan cardiac outputDalam saluran pencernaan% achlorhydria dan penurunan transit di usus dengan lam#ungdapat ter?adi stasis Pu#ertas tertunda% ano.ulasi% &etida&teraturan menstruasi% daninfertilitas yang umum Penurunan efe& tiroid hormon dapat menye#a#&an pening&atan &adar &olesterol total dan lo!)density lipoprotein (ADA, &olesterol dan &emung&inan peru#ahan dalam high)density lipoprotein (HDA, &olesterol &arena peru#ahan iBinmeta#oli& Selain itu% hipotiroidisme dapat menye#a#&an pening&atan resistensi insuli Frequency United States  The Fational Health and Futrition E/amination Sur.ey (FH9FES 3777)6556, of 4%:76 indi.iduals reGecting the 0S population reported hypothyroidism (dened as TSH le.els 4C mI0A, in :8< of the population *6+ Hypothyroidism is more common in !omen !ith small #ody siBe at #irth and lo! #ody mass inde/ during childhood *:+ International  Iodine deciency as a cause of hypothyroidism is more common internationally The pre.alence is reported as 6)C< depending on the study% increasing to 3C< #y age 8C years Mortality/Morbidity In de.eloped countries% death caused #y hypothyroidism is uncommon Race FH9FES 3777)6556 reported that the pre.alence of hypothyroidism (including su#clinical, !as higher in !hites (C3<, and Me/ican 9mericans than in 9frican 9mericans (38<, 9frican 9mericans tend to ha.e lo!er TSH .alues *6+  Sex 1ommunity studies use slightly di2erent criteria for determining hypothyroidismJ therefore% female)to)male ratios .ary enerally% thyroid disease is much more common in females than in males% !ith reports of pre.alence 6); times higher in females Age  The fre'uency of hypothyroidism% goiters% and thyroid nodules increases !ithage Hypothyroidism is most pre.alent in elderly populations% !ith 6< to as much as 65< of older age groups ha.ing some form of hypothyroidism The Kramingham study found hypothyroidism (TSH 35 mI0A, in C7< of !omenand 64< of men older than L5 years *4+ In FH9FES 3777)6556% the odds of ha.ing hypothyroidism !ere C times greater in persons aged ;5 years and older than in indi.iduals aged 36)47 years *6+ fre&uensi9meri&a Seri&at@esehatan Fasional dan iBi Sur.ei (FH9FES 3777)6556, dari 4:76 indi.idumencermin&an pendudu& 9S melapor&an hipotiroidisme (didenisi&an se#agai ting&atTSH 4C mI0  A, dalam :%8< dari populasi *6+ Hypothyroidism adalah le#ih umumpada !anita dengan u&uran tu#uh &ecil saat lahir dan inde&s massa tu#uh rendah selama masa &ana&)&ana& *:+Internasional Yodium &e&urangan se#agai penye#a# hipotiroidisme le#ih umum internasionalPre.alensi dilapor&an se#agai 6)C< tergantung pada studi% mening&at men?adi 3C<pada usia 8C tahunMortalitas  Mor#iditasDi negara ma?u% &ematian yang dise#a#&an oleh hipotiroidisme ?arangrasFH9FES 3777)6556 melapor&an #ah!a pre.alensi hipotiroidisme (termasu& su#&linis,le#ih tinggi pada putih (C%3<, dan 9meri&a Me&si&o daripada di 9fri&a 9meri&a (3%8<,9fri&a 9meri&a cenderung memili&i nilai TSH yang le#ih rendah *6+se&sStudi masyara&at mengguna&an &riteria yang sedi&it #er#eda untu& menentu&anhipotiroidisme% sehingga perempuan)&e)la&i)la&i rasio #er.ariasi 0mumnya% penya&ittiroid adalah le#ih umum pada !anita di#anding pada la&i)la&i% dengan laporanpre.alensi 6); &ali le#ihtinggi pada !anita
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