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THYROID& ANTITHYROID

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Page 1: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

THYROID& ANTITHYROID THYROID& ANTITHYROID

Page 2: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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.

Page 3: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 4: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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.

Page 5: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 6: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 7: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 8: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 9: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

HypothyroidismHypothyroidism Common symptomsCommon symptoms

– Thickened skinThickened skin– Hair lossHair loss– ConstipationConstipation– LethargyLethargy– AnorexiaAnorexia

Page 10: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

Thyroid PreparationsThyroid Preparations levothyroxine * levothyroxine * most commonmost common

– Synthetic thyroid hormone TSynthetic thyroid hormone T44

liothyronine liothyronine – Synthetic thyroid hormone TSynthetic thyroid hormone T33

Page 11: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 12: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 13: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 14: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 15: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 16: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 17: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 18: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 19: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

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

Page 20: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper
Page 21: THYROID& ANTITHYROID. Thyroid Gland One of the largest endocrine glands One of the largest endocrine glands Secretes three hormones essential for proper

Tugas :

Buat ringkasan tentang hormon Paratiroid dan regulasi calcium

Sifat kimiaSintesa dan sekresiFungsi fisiologisRegulasi sekresiEfek pada organ : tulang dan ginjal