MODUL 1

Grace is worried
 2. EPIDEMIOLOGY
Often found in mountainous areas (MIDS Working Pape, 1993)
Alps, the Himalayas, Mount row, etc.
survey epidiemiologi endemic goitre classification or
modification of the pressed, 1960
Grade 0: no palpable
grade 1: palpable and visible only with the head tilt
grade 1a: not palpable or if palpable no bigger than a normal
thyroid gland
grade 1b: clearly palpable, enlarged but not terlhat though
generally not in the head tilt
grade 2: easy to see the head of the normal position
grade 3: visible from some distance
tujauan surevey endemic goitre
1. assess the severity of iodine deficiency
2. follow the impact of substance treatment and prophylaxis of
iodine in the community
 3. Tyroiditis
TYPE CAUSE CLINICAL DIAGNOSIS DURATION
FEATURE AND
RESOLUTION
Hashimoto’s Anti-thyroid Hypothyroidis Thyroid Hypothyroidis
thyroidits antibodies, m, rare cases of function tests, m is usually
autoimmune transient thyroid permanent
disease thyrotoxicosis antibody tests
Subacute Possible viral Painful thyroid, Thyroid Resolves to
thyroiditis cause thyrotoxicosis function tests, normal thyroid
(de Quervain’s followed by sedimentation function
thyroiditis) hypothyroidism rate, within 12-18
radioactive months, 5%
iodine uptake possibility
of permanent
hypothyroidism
.
Silent Anti-thyroid Thyrotoxicosis Thyroid Resolves to
thyroiditis, antibodies, followed by function tests, normal thyroid
Painless autoimmune hypothyroidis thyroid function
thyroiditis disease m. antibody tests, within 12-18
radioactive months, 20%
iodine possibility of
uptake permanent
hypothyroidis
m.
Post partum Anti-thyroid Thyrotoxicosis Thyroid Resolves to
thyroiditis antibodies, followed by function tests, normal thyroid
autoimmune hypothyroidism thyroid function
disease . antibody tests, within 12-18
radioactive months, 20%
iodine possibility of
uptake permanent
(contraindicate hypothyroidism
d if the
women is
breast-feeding)
Drug induced Drugs include: Either Thyroid Often continues
amiodarone, thyrotoxicosis function tests, as long as the
lithium, or thyroid drug
interferons, hypothyroidis antibody tests is taken
cytokines m.
Radiation Follows Occasionally Thyroid Thyrotoxicosis is
induced treatment with thyrotoxicosis, function tests transient,
radioactive more hypothyroidism is
iodine for frequently usually
hyperthyroidis hypothyroidism permanent
m or .
external beam
radiation
therapy
for certain
cancers.
Acute Bacteria Occasionally Thyroid Resolves after
thyroiditis, mainly, but any painful thyroid, function tests, treatment of
Suppurative infectious generalized radioactive infectious
thyroiditis organism illness, iodine uptake, cause, may cause
occasional fine needle severe illness
mild aspiration
hypothyroidism biopsy
 HYPERTHYROID
A. DEFINITION
• The term hyperthyroidism refers to any condition in which
there is too much thyroid hormone in the body. In other
words, the thyroid gland is overactive.
B. SYMPTOMS
• nervousness, irritability, increased perspiration, heart
racing,
• Hand tremors, anxiety, difficulty sleeping, thinning of your
skin, fine brittle hair,and muscular weakness—especially in
the upper arms and thighs. You may have more frequent
bowel movements, but diarrhea is uncommon.
• You may lose weight despite a good appetite and, for
women, menstrual flow may lighten and menstrual periods
may occur less often.
3.CAUSES
• The most common cause (in more than 70% of people) is
overproduction of thyroid hormone by the entire thyroid
gland. This condition is also known as Graves’ disease (see
the Graves’ Disease brochure for details). Graves’ disease is
caused by antibodies in the blood that stimulate the
thyroid to grow and secrete too much thyroid hormone.
This type of hyperthyroidism tends to run in families, and it
occurs more often in young women.

• Little is known about why specific individuals get this

disease. Another type of hyperthyroidism is characterized
by one or more nodules or lumps in the thyroid that may
gradually grow and increase their activity so that the total
output of thyroid hormone into the blood is greater than
normal. This condition is known as toxic nodular or
multinodular goiter.
C. DIAGNOSIS
• If your physician suspects that you have hyperthyroidism, diagnosis
is usually a simple matter. A physical examination usually detects an
enlarged thyroid gland and a rapid pulse. The physician will also
look for moist, smooth skin and a tremor of your fingertips. Your
reflexes are likely to be fast, and your eyes may have some
abnormalities if you have Graves’ disease.

• The diagnosis of hyperthyroidism will be confirmed by laboratory

tests that measure the amount of thyroid hormones— thyroxine
(T4) and triiodothyronine (T3)—and thyroid-stimulating hormone
(TSH) in your blood. A high level of thyroid hormone in the blood
plus a low level of TSH is common with an overactive thyroid gland.
If blood tests show that your thyroid is overactive, your doctor may
want to obtain a picture of your thyroid (a thyroid scan). The scan
will find out if your entire thyroid gland is overactive or whether you
have a toxic nodular goiter or thyroiditis (thyroid inflammation). A
test that measures the ability of the gland to collect iodine may be
done at the same time.
D. TREATMENT