TIROID

Team based learning tahap 2

ate) and T3 sulfate (to T2 sulfate). Type II MDI [pre- a predominance of type III enzyme activity (particularly
ominantly located in brain, pituitary, placenta, skeletal in liver, kidney, and placenta), accounting for the in-
muscle, heart, thyroid, and brown adipose tissues (BATs)] creased circulating levels of rT3 observed in the fetus. 18,41
s a low-Km enzyme insensitive to propylthiouracil and However, the persistence of high circulating rT3 levels

APA ITU HORMON TIROID ?

nhibited by thyroid hormone. Types I and II MDI con-
ribute to circulating T3 production, whereas type II acts
s well to increase local tissue levels of T3.34-36 An inner
for several weeks in the newborn indicate that type III
MDI activities expressed in nonplacental tissues are im-
portant to the maintenance of high circulating rT3 levels.
tyrosyl) ring iodothyronine monodeiodinase (type III The mixture of type II and type III MDI activities in the

ig u r e 6 -4 . Th e d e io d in a t io n o f t h yro xin e b y typ e s I, II, a n d III io d o th yro n in e m o n o d e io d in a se e n zym e s. Th e t yp e I e n zym e is a lso

a p a b le o f in n e r rin g m o n o d e io d in a t io n , p a rt icu la rly o f t h e su lfa t e d co n ju g a t e s (n o t sh o w n ).
SINTESIS HORMON TIROID
Perkembangan Kelenjar Tiroid
METABOLISME TIROID
FETUS
 REGULASI
HORMON
TIROID

• Hipotalamus-
Pituitari-Tiroid

• Mekanisme umpan
balik negatif
FISIOLOGI TIROID NEONATAL
 FISIOLOGI TIROID NEONATAL
• Terdapat TSH surge
(lonjakan TSH)
– 30 menit pertama
kehidupan
• TSH 80mU/mL
– Minggu pertama: turun ke
kadar normal (TSH <
10mU/mL)
– Menyebabkan
peningkatan T3 & T4
• Dapat mencapai kadar
hipertiroid Sperling M (ed) Pediatric Endocrinology, 2014
FUNGSI HORMON
TIROID:
METABOLISME
TUBUH
HASIL TES
 PEMERIKSAAN LAB
SKRINING
Primary TSH With Backup T4
• Uji TSH dilanjutkan FT4 jika TSH tinggi
• Tidak mendeteksi :
Delayed TSH elevation
 BBLR (<2500 gr) dan BBLSR (<1500gr)
 Defisiensi thyroid-binding globulin (TBG)
 Hipothyroidisme sentral
 Hipotiroksinemia
• Pemeriksaan < 48 jam  diulang
 PEMERIKSAAN LAB
SKRINING

Primary T4 With Backup TSH

• Pemeriksaan T4 dilanjutkan TSH jika FT4 rendah
• Mendeteksi primer dan sentral HK, Defisiensi
TBG dan hipertiroksinemia .
• Tidak dapat mendeteksi pada hasil awal T4
normal dengan delayed TSH elevatio
Kombinasi Primary TSH Plus T4
• Ideal
 Pemeriksaan Radiologi
Ultrasonografi
• Ada atau tidaknya kelenjar tiroid
• Ukuran, tekstur ekogenik, struktur
• Ektopik (-)

Foto genu
Usia Tulang
• Ada / tidak epifisis femoral
• Lamanya HK dan tibia
• Beratnya HK
 Pemeriksaan
Skintigrafi Radiologi
• Etiologi