Krisis Tiroid

Ahmad Fariz Malvi Zamzam Zein

SMF Ilmu Penyakit Dalam RSUD Waled
Definisi
Hipertiroidisme
Peningkatan produksi hormon oleh kelenjar
tiroid

Tirotoksikosis
Peningkatankonsentrasi hormon tiroid oleh
penyebab apapun

Krisis tiroid / Thyroid storm

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-2induced 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
 7
Diagnosis 37.2

Krisis Tiroid
37.7C

40C

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, Lugols solution, Beta-adrenergic
iopanoic acid blockade
Supportive Therapy
Propranolol
11 Lithium carbonate
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

Aplastic anemia and

nephrotic syndrome
Terapi suportif dan penyebab

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