PENGUKURAN ARAS HORMON TIROID PADA PESAKIT HIPOTIROIDSME DI HOSPITAL LIMBANG PADA TAHUN APRIL 2013 OKTOBER 2013

CHARLES GEORGE GAJIM 110 201003 0019

NAMA PENYELIA : FAUZIAH ZAINUDDIN

DIPLOMA TEKNOLOGI MAKMAL PERUBATAN PUSAT TEKNOLOGI DAN PENGURUSAN LANJUTAN SABAH 2013

ISI KANDUNGAN

BAB 1 : PENGENALAN PENDAHULUAN OBJEKTIF AM OBJEKTIF KHUSUS KEPENTINGAN KAJIAN BAB 2 : KAJIAN PERPUSTAKAAN PENGENALAN PUNCA SIMPTOM DIAGNOSIS RAWATAN PENCEGAHAN BAB 3 : KAEDAH DIAGNOSTIK PRINSIP 1 PRINSIP 2 PRINSIP 3 KAEDAH PENGUMPULAN DATA KAEDAH ANALISIS DATA CARTA GRANT

HALAMAN

INTRODUCTION

OBJEKTIF Tajuk : Pengukuran hormon tiroid dalam pesakit hipotirodisme Umum : Mengenalpasti teknik pengukuran hormon tiroid dalam hipotirodisme Khusus 1: mengetahui teknik yang digunakan dalam mendiagnos

KAJIAN PERPUSTAKAAN Hypothyroidism is a common medical condition that affects many more women more than men. Most hypothyroidism is a result of an inflammation of the thyroid called thyroiditis. This may be a result of a viral infection, or a type of "autoimmune" process during which the body actually fights itself. Another example of this type of disease is rheumatoid arthritis
Richard Gracer, M.D.

At times the symptoms are severe and obvious. Often however, they are vague and can be downright subtle. The classic symptoms of a low thyroid are fatigue and sluggishness, feeling cold, cold hands and feet, infertility, heavy menstrual periods, constipation, dry skin and hair, weight gain without increased appetite or increased calorie intake, swelling of the soft tissues, depression, and the early development of heart disease.
Richard Gracer, M.D.

The thyroid gland is located inside the neck, just below your Adams apple. It produce s two thyroid hormones, triiodothyronine (T3) and thyroxine (T4), which regulate how the body uses and stores energy. This is sometimes called your metabolism. How well the thyroid works is controlled by another gland called the pituitary, which is located in your brain. The pituitary produces thyroid-stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4.
David Cooper, MD,Michael McDermott,MD and and Leonard Wartofsky, MD

SIMPTOM

Early hypothyroidism is often asymptomatic and can have very mild symptoms. Subclinical hypothyroidism is a state of normal thyroid hormone levels, thyroxine (T4) and triiodothyronine (T3), with mild elevation of thyrotropin, thyroid-stimulating hormone (TSH). With higher TSH levels and low free T4 levels, symptoms become more readily apparent in clinical (or overt) hypothyroidism. Author Hilary Mantel wrote a memoir, Giving up the Ghost, which describes amongst other things the effects on her of thyroid failure, which was treated by permanent medication once belatedly diagnosed. Hypothyroidism is the most common thyroid disorder. It occurs more often in women, it increases with age, and it runs in families. Symptoms include:

Tiredness Mental depression Sluggishness Feeling cold Weight gain (only 5-10 pounds) Dry skin and hair Constipation Menstrual irregularities

DIAGNOSIS Blood tests can measure your levels of thyroid-stimulating hormone (TSH) and thyroid hormone (T4). You have hypothyroidism when you have high TSH and low T4 levels in your blood. In very early or mild hypothyroidism, the TSH level will increase above normal level before the T4 drops below normal. Of the two blood tests, TSH is more important. Your doctor will pay more attention to the TSH level to make a diagnosis. When the cause of hypothyroidism is Hashimotos disease, anti-thyroid antibodies that attack the thyroid can also be measured in the bloodstream. Because severe hypothyroidism requires months or years to develop, wide variability in clinical presentation may delay or confound diagnosis. 13 In typical practice, multisystem signs and symptoms of a hypometabolic state involving numerous organs in a lethargic, chilly, poorly functioning patient, coupled with a TSH level far exceeding 20 mU/L and depressed T4 concentration, confirm the presence of severe hypothyroidism. More specific manifestations include cold intolerance, fatigue, depression, mental dullness, constipation, coarse skin, hoarseness, puffy eyelids, bradycardia, and delayed AJRP. Marked stupor, confusion, hypothermia, hypoventilation, bradycardia, and somnolence indicate the presence of myxedema coma and require immediate treatment in an intensive care setting. Published scoring systems derived from patients known to be hypothyroid may assist clinicians in clarifying the wide ranging symptoms and findings common in practice. The only validated test to diagnose primary hypothyroidism, is to measure thyroidstimulating hormone (TSH) and free thyroxine (T4).[45] However, these levels can be affected by non-thyroidal illnesses. High levels of TSH indicate that the thyroid is not producing sufficient levels of thyroid hormone (mainly as thyroxine (T4) and smaller amounts of triiodothyronine (T3)). However, measuring just TSH fails to diagnose secondary and tertiary hypothyroidism, thus leading to the following suggested blood testing if the TSH is normal and hypothyroidism is still suspected: Free triiodothyronine (fT3) Free thyroxine (fT4) Total T3 Total T4 Additionally, the following measurements may be needed:

Free T3 from 24-hour urine catch[46] Antithyroid antibodies for evidence of autoimmune diseases that may be damaging the thyroid gland Serum cholesterol which may be elevated in hypothyroidism Prolactin as a widely available test of pituitary function Testing for anemia, including ferritin Basal body temperature.

RAWATAN Hypothyroidism is treated with the levorotatory forms of thyroxine (levothyroxine) (L-T4) and triiodothyronine (liothyronine) (L-T3). Synthroid, produced by Abbott Laboratories, is the brand name counterpart to the generic Levothyroxine. Synthroid is also the most common pill prescribed by doctors that has the synthetic thyroid hormone in it, and it is taken by over 40% of people with hypothyroidism.[15] This medicine can improve symptoms of thyroid deficiency such as slow speech, lack of energy, weight gain, hair loss, dry skin, and feeling cold. It also helps to treat goiter. It is also used to treat some kinds of thyroid cancer along with surgery and other medicines. Both synthetic and animal-derived thyroid tablets are available and can be prescribed for patients in need of additional thyroid hormone. Thyroid hormone is taken daily, and doctors can monitor blood levels to help assure proper dosing. Levothyroxine, the generic form of synthroid, is best taken 3060 minutes before breakfast, as some food can diminish absorption. Calcium can inhibit the absorption of levothryoxine.[47] Compared to water, coffee reduces absorption of levothyroxine by about 30 percent.[48] Some patients might appear to be resistant to levothyroxine, when in fact they do not properly absorb the tablets a problem which is solved by pulverizing the medication.[49] There are several different treatment protocols in thyroid-replacement therapy: T4 only This treatment involves supplementation of levothyroxine alone, in a synthetic form. It is currently the standard treatment in mainstream medicine.[50] T4 and T3 in combination This treatment protocol involves administering both synthetic L-T4 and L-T3 simultaneously in combination.[51] Desiccated thyroid extract Desiccated thyroid extract is an animal-based thyroid extract, most commonly from a porcine source. It is also a combination therapy, containing natural forms of L-T4 and LT3.[52] [edit]Treatment controversy The potential benefit from substituting some T3 for T4 has been investigated, but no conclusive benefit for combination therapy has been shown.[53][54] The 2002 Laboratory Medicine Practice Guidelines of the National Academy of Clinical Biochemistry state that during pregnancy, "The L-T4 dose should be increased (usually by 50 mcg/day) to maintain a serum TSH between 0.5 and 2.0 mIU/L and a serum FT4

in the upper third of the normal reference interval." Doctors however often assume that if your TSH is in the "normal range", sometimes defined as high as 5.5 mIu/L, it has no effect on fertility. Healthy pregnant women however have a TSH level of around 1.0 mIU/L. [edit]Subclinical hypothyroidism There is a range of opinion on the biochemical and symptomatic point at which to treat with levothyroxine, the typical treatment for overt hypothyroidism. Reference ranges have been debated as well. As of 2003, the American Association of Clinical Endocrinologists (ACEE) considers 0.33.0 mIU/L within normal range.[55] There is always the risk of overtreatment and hyperthyroidism. Some studies have suggested that subclinical hypothyroidism does not need to be treated. A 2007 metaanalysis by the Cochrane Collaboration found no benefit of thyroid-hormone replacement except "some parameters of lipid profiles and left-ventricular function."[56] A 2002 meta-analysis looking into whether subclinical hypothyroidism may increase the risk of cardiovascular disease, as has been previously suggested,[57] found a possible modest increase and suggested further studies be undertaken with coronary-heart disease as an end point "before current recommendations are updated."[58] [edit]Alternative treatments Compounded slow-release T3 has been suggested for use in combination with T4, which proponents argue will mitigate many of the symptoms of functional hypothyroidism and improve quality of life. This is still controversial and is rejected by the conventional medical establishment.[59] Hypothyroidism is treated with thyroid hormone medication. Levothyroxine is the drug of choice. It is a synthetic (laboratory-made) form of T4 that is the same as the T4 the thyroid naturally makes. Not all thyroid hormone medicines are the same. If possible, you should stay with the same brand. Thyroid hormone replacement is usually needed for life. If for any reason the medicine needs to be changed, it is important to have blood tests for TSH done again. Your dose will be adjusted based upon your TSH tests. Over time, doses of thyroid hormone that are too high can lead to bone loss, abnormal heart function, and abnormal heart rhythms. Doses that are too low may not relieve your symptoms.

Dose adjustment may be necessary during pregnancy and at other times, and can be discussed during your regular check-ups with your doctor.

KAEDAH DIAGNOSTIK

RUJUKAN

CARTA GRANT