Krisis Tiroid

Ahmad Fariz Malvi Zamzam Zein

Definisi
 Hipertiroidisme
Peningkatan produksi hormon oleh
kelenjar tiroid

 Tirotoksikosis
Peningkatankonsentrasi hormon tiroid
oleh penyebab apapun
Etiologi

 Graves’ disease (Tersering)

 Adenoma toksis atau struma multinoduler toksik

 Penyebab jarang
 Karsinoma tiroid hipersekretorik
 Adenoma hipofisis dengan sekresi tirotropin

 Penyebab lainnya
 interferon alfa
 interleukin-2–induced thyrotoxicosis
Faktor Pencetus

 Systemic insults
 Pembedahan, trauma, MCI, pulmonary thromboembolism,
KAD, infeksi berat/sepsis
 Berhenti minum obat anti-tiroid
 Iodin berlebihan (eg, radiocontrast dyes,
amiodaron)
 Radioiodine therapy
 Pseudoephedrine and salicylate use
Manifestasi Klinis
Diagnosis 37.2 – 37.7ºC
7

Krisis Tiroid 40ºC

 Skor 45 atau lebih

 Sangat mendukung diagnosis

 Skor 25 - 44
 Mendukung

 Skor di bawah 25
 Kurang mendukung diagnosis

Adapted from Burch, HB, Wartofsky, L, Endocrinol

Metab Clin North Am 1993; 22:263.
LABORATORIUM
  free T4 dan free T3

 TSH

 Rasio T3/ T4
 > 20: Graves’ disease dan struma nodosa toksik
 < 15: tiroiditis, iodine exposure

 Hiperglikemi, hiperkalsemia, peningkatan alkalin fosfatase,

leukositosis, dan peningkatan enzim liver

 Kortisol 
Pemeriksaan Radiologi

 CXR atau CT –scan dada (sumber infeksi)

 Kedokteran nuklir ( uptake)
 Thyroid sonogram with Doppler flow
 Peningkatan flow
 Secreting excessive hormones

 Penurunan flow
 Subacute, postpartum, or silent thyroiditis
 Exogenous causes of hyperthyroidism
EKG

 Sinus takikardia (40 %)

 Atrial fibrillasi (10-20 %)
 Aritmia Supraventrikuler
Target Manajemen
Removal of excess circulating hormone
Plamapheresis
Inhibition of new hormone Charcoal plasmaperfusion
Thionamide (PTU, MMI)

Antiadrenergic agents
Reserpine
Guanethidine

Inhibition of T4-to-T3 conversion

PTU
Corticosteroids
Inhibition of hormone release Iopanoic acid,
Iodine amiodarone
Potassium iodide, Lugol’s solution, Beta-adrenergic
iopanoic acid blockade
Supportive Therapy
11Lithium carbonate Propranolol
Thionamide
Iodine therapy

‘‘Wolff-Chaikoff’’ effect
Beta-blockade
Glucocorticoids
 Dexamethasone and hydrocortisone
 Inhibit conversion of T4 to T3
 In severe thyrotoxicosis with hypotension
 100 mg Q8H
Terapi Alternatif
Terapi suportif dan penyebab

 Antipyretics (acetaminophen)
 External cooling measures
 Intravenous fluids with dextrose
 Multivitamins, particularly thiamine
 Antibiotics
Terima kasih