thyroid& antithyroid. thyroid gland one of the largest endocrine glands one of the largest...
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THYROID& ANTITHYROID THYROID& ANTITHYROID
Thyroid GlandThyroid Gland One of the largest endocrine glandsOne of the largest endocrine glands Secretes three hormones essential for proper Secretes three hormones essential for proper
regulation of metabolismregulation of metabolism– Thyroxine (TThyroxine (T44))– Triiodothyronine (TTriiodothyronine (T33))– CalcitoninCalcitonin
Located near the parathyroid glandLocated near the parathyroid gland Involved in many bodily processes, growth, body Involved in many bodily processes, growth, body
temperature regulation, cardiovascular, endocrine temperature regulation, cardiovascular, endocrine & neuromuscular functions.& neuromuscular functions.
Iode from diet is responsible for the Iode from diet is responsible for the synthesis thyroglobulinesynthesis thyroglobuline
Hypothalamus secretes TSH that stimulates Hypothalamus secretes TSH that stimulates the thyroid to break down thyroglobulin the thyroid to break down thyroglobulin into T3(into T3(iodine 59%) & T4( & T4(iodine 65%) and is released into the circulationand is released into the circulation
Tahapan sintesa & sekresi :
1. uptake yodida2. oksidasi & yodinasi3. pembentukan T4 & T3 dari yodotirosin4. sekresi hormon tiroid5. konversi T4 T3 di jar. perifer enz.5-deyodinase dihambat oleh : malnutrisi, hipoglikemi, kortikosteroid, bloker, PTU, defisiensi Se dll.
tyroglobulin
I- I- peroxidase I* MIT, DIT, T3, T4
transport proteolisis I- tyr MIT, DIT exocytosis
T4, T3 (ikt.protein) darah
Jar. perifer : T4, T3
T3
Kel.tiroid
Mekanisme Kerja :Melalui reseptor tiroid di dlm sel regulasi gen
spesifik
pertumbuhan & metabolisme
1. Tiroid diperlukan unt.tumbuh kembang termsk CNS hipotiroid (hamil)kretinisme
2. Efek kalorigenik : T4 meningkatkan metabolisme, katabolisme, pembentukan kalori , termogenesis, vasodilatasi perifer, curah jantug .
3. CVS takhikardia, CO , SV , hipertropi
Hypothyroidism: Hypothyroidism: Deficiency in Thyroid HormonesDeficiency in Thyroid Hormones
Primary:Primary: abnormality in the thyroid gland abnormality in the thyroid gland itself. Most common cause is hashimoto’s itself. Most common cause is hashimoto’s thyroiditis.thyroiditis.
SecondarySecondary: results when the pituitary gland : results when the pituitary gland is dysfunctional and does not secrete TSHis dysfunctional and does not secrete TSH
Thyroid abnormalitiesThyroid abnormalities
CretinismCretinism: Hyposecretion of thyroid hormone during youth. : Hyposecretion of thyroid hormone during youth. Low metabolic rate, retarded growth and sexual development, Low metabolic rate, retarded growth and sexual development, possibly mental retardation possibly mental retardation
MyxedemaMyxedema: Hyposecretion of thyroid hormone as an adult. : Hyposecretion of thyroid hormone as an adult. Decreased metabolic rate, loss of mental and physical stamina, Decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair, firm edema, yellow dullness of the weight gain, loss of hair, firm edema, yellow dullness of the skinskin
GoiterGoiter: Enlargement of the thyroid gland. Results from : Enlargement of the thyroid gland. Results from overstimulation by elevated levels of TSH. TSH is elevated overstimulation by elevated levels of TSH. TSH is elevated because there is little or no thyroid hormone in circulationbecause there is little or no thyroid hormone in circulation
HypothyroidismHypothyroidism Common symptomsCommon symptoms
– Thickened skinThickened skin– Hair lossHair loss– ConstipationConstipation– LethargyLethargy– AnorexiaAnorexia
Thyroid PreparationsThyroid Preparations levothyroxine * levothyroxine * most commonmost common
– Synthetic thyroid hormone TSynthetic thyroid hormone T44
liothyronine liothyronine – Synthetic thyroid hormone TSynthetic thyroid hormone T33
Mechanism of ActionMechanism of Action Thyroid preparations are given to replace Thyroid preparations are given to replace
what the thyroid gland cannot produce to what the thyroid gland cannot produce to achieve normal thyroid levels.achieve normal thyroid levels.
Thyroid drugs work the same way as Thyroid drugs work the same way as thyroid hormonesthyroid hormones
IndicationsIndications
To treat all three forms of hypothyroidismTo treat all three forms of hypothyroidism levothyroxine is the preferred agent because its levothyroxine is the preferred agent because its
hormonal content is standardized; therefore, its hormonal content is standardized; therefore, its effect is predictableeffect is predictable
Also used for thyroid replacement in clients whose Also used for thyroid replacement in clients whose thyroid glands have been surgically removed or thyroid glands have been surgically removed or destroyed by radioactive iodine in the treatment of destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidismthyroid cancer or hyperthyroidism
Side EffectsSide Effects Cardiac dysrhythmia is the most significant Cardiac dysrhythmia is the most significant
adverse effectadverse effect May also cause:May also cause:
– Tachycardia, palpitations, angina, hypertension, Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, diarrhea, menstrual irregularities, weight loss, sweating, heat intolerance, otherssweating, heat intolerance, others
Hyperthyroidism Hyperthyroidism Excessive Thyroid Hormones:Excessive Thyroid Hormones:
free T3 & T4 free T3 & T4
Caused by several diseasesCaused by several diseases– Graves’ diseaseGraves’ disease– Toxic nodular diseaseToxic nodular disease– Multinodular diseaseMultinodular disease– Thyroid storm Thyroid storm – Thyroid cancerThyroid cancer– Pituitary hormonesPituitary hormones
HyperthyroidismHyperthyroidism Affects multiple body systems, resulting in an Affects multiple body systems, resulting in an
overall increase in metabolismoverall increase in metabolism– Wt lossWt loss
– DiarrheaDiarrhea – Fatigue– Fatigue
– FlushingFlushing – Palpitations– Palpitations
– Increased appetiteIncreased appetite – Nervousness– Nervousness
– Muscle weaknessMuscle weakness – Heat intolerance– Heat intolerance
– Sleep disordersSleep disorders – Irritability – Irritability
– Altered menstrual flowAltered menstrual flow
Antithyroid Antithyroid drugsdrugs
1. Prevent hormone thyroid synthesis
2. Prevent yodide ion transport/anion inhibitors
3. Yodides prevent synthesis & release thyroid hormone
4. Radioactive iodine
5. bloker
Treatment of HyperthyroidismTreatment of Hyperthyroidism Surgery to remove all or part of the thyroid glandSurgery to remove all or part of the thyroid gland
tyroglobulinI- I- peroxidase I* MIT, DIT, T3, T4
transport proteolisis I- tyr MIT, DIT exocytosis
T4, T3 (ikt.protein) darah
Jar. perifer : T4, T3
T3
Kel.tiroid
PTU
SCNClO4
Yod
bloker
1. Prevent hormone thyroid synthesis
contoh obat : PTU (propilthiourasil), Metimazol, Karbimazol, Metiltiourasil
Farmakokinetik :per oral, distribusi slrh tubuh, ekskresi mel. urin & ASI masa kerja pendek 8 jam (PTU)
Efek samping :demam, purpura, agranulositosis, ikterus, goiter pada fetus (dose dependent)
Sering digunakan bersama yodium untuk mengurangi vaskularisasi pra operasi
2. Prevent iodide ion transportDrug exp : thiocyanate (SCN-), perchlorate(ClO4-).Effect : block uptake iodideprevent thyroid functions
3. Yodide Drug exp : natrium yodida, kalium yodida
(lugol solution)Effect : inhibit release & organification thyroid horm decrease the size and vascularity of gland4. Radioactive iodineDrug exp. : I131
Effect : IEffect : I131 works by destroying the thyroid gland works by destroying the thyroid gland 5. BLOKER Prevent yodisation T4, clinical improvement
Tugas :
Buat ringkasan tentang hormon Paratiroid dan regulasi calcium
Sifat kimiaSintesa dan sekresiFungsi fisiologisRegulasi sekresiEfek pada organ : tulang dan ginjal