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PENYAKIT 

TIROID

Buyung Palala

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 TIROID

I. Klinik :Anamnesis, pemeriksaan Fisik

II. Laboratorik :

Test faal tiroid:- T3(FT3), T4 (FT4),TSHs

- Test Supresi Tiroid

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III. Penunjang

1. Rontgen ( X- Ray )2. CT Scan / MRI

3. Sidik ( Scan ) tiroid denganradionuklir

4. Ambilan ( uptake ) iodium

radioaktif5. Uji supresi tiroid

6. USG tiroid

7. Biopsi Tiroid.

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PEMERIKSAAN DIAGNOSTIKPEMERIKSAAN DIAGNOSTIK

PENUNJANGPENUNJANG

1. X1. X-- rayray-- Kalsifikasi kelenjar tiroidKalsifikasi kelenjar tiroid-- Pendorongan pada trakeaPendorongan pada trakea

-- Struma retrosternal / intratorakalStruma retrosternal / intratorakal

2. CT Scan / MRI2. CT Scan / MRI-- Struma IntratorakalStruma Intratorakal

-- EksoftalmusEksoftalmus

PEMERIKSAAN DIAGNOSTIKPEMERIKSAAN DIAGNOSTIK

PENUNJANGPENUNJANG

1. X1. X-- rayray-- Kalsifikasi kelenjar tiroidKalsifikasi kelenjar tiroid-- Pendorongan pada trakeaPendorongan pada trakea

-- Struma retrosternal / intratorakalStruma retrosternal / intratorakal

2. CT Scan / MRI2. CT Scan / MRI-- Struma IntratorakalStruma Intratorakal

-- EksoftalmusEksoftalmus

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3. Sidik ( Scan ) Tiroid denganradionuklid ( 99mTc, 123 I )

- Lokal- Seluruh tubuh

- Untuk : - Nodul : Soliter / multi,

panas, dingin, hangat- Intratorakal- Tiroid ektopik- Bentuk, ukuran

- Metastase

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.radioaktif

- Setelah 2,6, 8 ,24 jam I131

oral- o : Defisiensi Iodium,Hipertiroidism

- q : Hipotiroid

5. Uji SupresiNormal T4 Eksogen

TSH q Uptake q

Otonom ( hiper )

Uptake tidak q

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. ro g eso ut on- Bentuk , besar

- Nodul- Kista, solid

- Ganas

7. Biopsi- Core Biopsy

Jarum besar Histopatologi

- Biopsi Aspirasi Jarum Halus ( BAJH )

Sitologi

: Keganasan 

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 (Klinis)

1. Indeks Diagnosis Klinik (wayne) berdasarkanskor total symptoms (gejala dan sign (tanda)� Hipertiroid : skor total �+20

� Meragukan : skor total +10 sp +19

� Tidak hipertiroid : skor total � +92. Indeks Diagnosis New Castle (hanya untuk

wanita)� Toksik : skor total + 40 sp +80

� Meragukan : skor total + 24 sp +39

� Eutiroid : skor total -11 sp +23

 

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Diagnostik Pasti Hipertiroid- T3 ( FT3 ) o- T4 ( FT4 ) o

- TSHs q

Hipertiroid Subklinik :- T3 ( FT3 ) normal- T4 ( FT4 ) normal

- TSHs q 

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Diagnosis Graves :

1. Indeks Diagnostik klinis2. FT4 o, TSHs q

3. TSH ² R Ab (s) 

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Diagnosis Adenoma Toksika /

Struma NodosaToksika :

- Eksoftalmus ( - )- Dermopathi ( - )

- TSH-R Ab ( - ) 

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Diagnosis Tiroiditis ( Subakut,Hashimoto )

- Struma kenyal padat, nyeri + / -.- Hipertiroid transient, disusul

hipotiroid- RAI ² uptake o pada subakut- Anti TPO Ab ( + ), Anti TG Ab

(+) pada Hashimoto. 

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Diagnosis Struma Nodosa Non

Toksika

- Palpasi / USG : Nodul +- Test Faal tiroid normal- BAJAH : Adenoma / Struma

Nodosa 

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Diagnosis Ca Tiroid

- Pembesaran Noduler, keras,

lengket, tidak nyeri- Riwayat radiasi dileher / kepala- Test faal tiroid biasanya normal

- BAJAH : Sitologi 

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Diagnosis Struma Endemik :

- Daerah defisiensi Iodium

( Ekskresi iodium urinq

)- Prevalensi > 10 %- Kretin ( + )

- Bisa hipotiroid 

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Struma Simpleks

- Struma difus / nodular- Tidak hiper / hipotiroid- Tidak autoimun

- Tidak radang 

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Diagnosis HipotiroidKlinik :

Kelelahan, intoleransi dingin,konstipasi, berat badan

meningkat, suara serak, kulitkering, bradikardi, reflek tendonmelambat, depresi.

Labor :T4 q, TSH o

RAI ² uptake q

Kolesterol o 

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Gambar : Algoritma penegakan diagnosis penyakit-penyakit tiroid

TSH

T4

TSH:N

T4: 

TSH :N

T4 : N

Tidak Ya

Struma

multinodosa

Adenoma toksika

Penyak it 

Graves

Tidak Ya

Gejala

Graves

N

T3

Tirotoksikosis

Primer

TSH :

T4 : N

TSH :

T4 :

Hipertiroid

subklinik 

Follow-up

4-6 bln

Tirotoksi-

kosis T3

NormalAdenoma

hipof isisTSH

Resist HT

Struma

nodosa

toksika

Tiroiditis (destr)

Kelebihan I

KelebihanHT

Lain : CGH

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