Etiologi krisis tiroid

In the past thyroid storm was frequently associated with surgery for hyperthyroidistomy, with
symtomps beginning a few hours after thyroidectomy in patients prepared for surgery with
potassium iodine alone. Most of these cases occured in patients who were not appropriately
prepared for surgery by current standards. Certain clinical and sosioeconomic factors have also been
suggested to be associated with complicated hyperthyroidism, including the lack of insurance, age
younger than 30 or older than 50, and serum T4 concentrations greater than twice the upper limit of
normal. Because of better recognition of the disease, preoperative treatement thionamides to
deplete the gland of thyroid hormon prior to surgery, and improved perioperative management with
beta-blockade, thyroid stormnow is rarely a postoperative complication of thyroid surgery.

Currently, thyroid storm appears most commonly following infection, causing the thyrotoxic state to
decompensate. Pneumonia, upper respiratory tract infections, and enteric infections are common
precipitating infections. Other precipitating factors include stress, trauma, non thyroidal surgery,
diabetic ketoacidosis, labor, heart disease, ane iodinated contrassstudies in the unrecognized or
partially treated hyperthyroid patien. Iatrogenic thyroid storm has been reported due to thyroid
hormone overdose. Thyroid storm occuring after I therapy is extremely rare, especially considering
the frequency of the use of radioiodine in the definitive treatment of hyperthyroidism. When
reported, radiodine-induced thyroid storm usually occurs if there was no pretreatment with
antithyroid drugs.

1. Surgery
- Thyroidal
- Nonthyroidal
2. Infections
- Pneumonia
- Upper respiratory
- Enteric
- Other
3. Stress
4. Trauma
5. Diabetic ketoasidosis
6. Labor
7. Cardiac disease
8. Iodinated intravenoous contrast agent
9. Radioactive iodine therapy

Etiologikomamiksedema

As mentioned, cold stress is a common precipitation to myxedema coma. Other common

precipitation factors include pulmonary and urinary tract infections, cerebrovascular accident,
trauma, surgery, congestive heart failure, and intravascular volume loss from acute or chronic
gastrointestinal bleeding or overuse of diuretics. The clinical course of lethargy proceedingto stupor
and then coma is often hastened by drugs,especially sedative, narcotics, antidepressants, and
transquilizers. Indeed, many cases of myxedema coma have occurred in the undiagnosed
hypothyroid patient who has been hospitalized for other medical problem.

Etiologi :

1. Cold stress
2. Infection :
- Pneumonia
- Urinary tract
3. Stroke
4. Congestive heart failure
5. Trauma
6. Burns
7. Surgery
8. Intravascular volume contraction :
- Gastrointestinal blood loss
- Diuretic use
9. CNS-active drugs :
- Analgesics / narcotics
- Sedatives/hypnotics
- Transquilizers
- Anesthetic agents
(Jean & Vincent, 2011)
ETIOLOGI KRISIS TIROID
Dalam krisis tiroid sering dikaitkan dengan operasi untuk hyperthyroidistomy, dengan timbul
gejala dimulai beberapa jam setelah tiroidektomi pada pasien dipersiapkan untuk operasi
dengan kalium iodine saja. Sebagian besar kasus ini terjadi pada pasien yang tidak tepat
disiapkan untuk operasi dengan standar saat ini.
Faktor klinis dan sosial ekonomi dapat dihubungkan dengan masalah
hipertiroidisme, termasuk kurangnya asuransi, usia yang lebih muda dari 30 atau lebih tua
dari 50, dan konsentrasi serum T4 lebih besar dari dua kali batas atas normal. Saat ini, krisis
tiroid muncul paling sering setelah infeksi sehingga menyebabkan thyrotoxic untuk
dekompensasi. Pneumonia, infeksi saluran pernapasan atas, dan infeksi enterik adalah infeksi
pencetus umum. Faktor pencetus lainnya termasuk stres, trauma, operasi non thyroidal,
diabetic ketoacidosis penyakit jantung, studi contrass iodinasi. Krisis tiroid iatrogenik dapat
disebabkan oleh kelebihan hormone tiroid. Krisis tiroid dapat juga terjadi setelah terapi
radioiodium dalam pengobatan definitif hipertiroidisme. Terapi induksi radiodine dapat
menyebabkan krisis tiroid jika tidak ada pretreatment dengan obat antitiroid .
Berikut etiologi krisis tiroid :
1. Bedah
- Thyroidal
- Nonthyroidal
2. Infeksi
- Pneumonia
- Pernapasan atas
- enterik
- Lainnya
3. Stres
4. Trauma
5. ketoasidosis diabetik
6. Penyakit Jantung
7. Iodinasi agen kontras intravenoous
8. Terapi yodium radioaktif
ETIOLOGI KOMA MYXEDEMA
Stres yang sangat adalah penyebab umum komamyxedema . Faktor penyebab umum lainnya
termasuk paru dan infeksi saluran kemih , kecelakaan serebrovaskular , trauma , operasi ,
gagal jantung kongestif , dan kehilangan volume intravaskular dari perdarahan
gastrointestinal akut atau kronis atau terlalu sering menggunakan diuretik . Perjalanan klinis
koma myxedema dipercepat oleh obat-obatan , terutama sedatif , narkotika , antidepresan ,
dan transquilizers . Banyakkasus komamyxedema terjadi pada pasien hipotiroid yang tidak
terdiagnosis(bersifatakut).
1. Stress berat
2. Infeksi :
- Pneumonia
-Saluran kemih
3. Stroke
4. Gagal jantung kongestif
5. Trauma
6. Luka bakar
7. Bedah
8. intravaskular kontraksi volume :
- Kehilangan darah gastrointestinal
- Penggunaan diuretik
9. obat SSP - aktif :
- Analgesik / narkotika
- Obat penenang / hipnotik
- Transquilizers
- Agen anestesi
(Jean & Vincent, 2011)

SUMBER :
Jean, & Vincent, L. (2011). Textboof of Critical Care-6th ed. ELSEVIER SAUNDERS.