Faktor Risiko Dan Pencegahan Hipertiroid

LAPORAN BBDM 3.2 SKENARIO 3 BERAT BADAN MENURUN DENGAN BENJOLAN DI LEHER 

BBDM 1 AIDILLAH MAYUDA

22010113120001

OZI RAHMAT FIRDAUS

22010113120002

RECCI LABESA

22010113120003 22010113120003

ALFIAN SANTIKAT SANTIK ATMAKA MAKA

22010113520005 220101135200 05

TRI AGRINA

22010113120006 220101131200 06

 NOOR FADHILAH FADHILAH

22010113120079 22010113120079

JAMES OTNIEL

22010113120081

ALICE ALERIA

22010113120082

AHMAD REZA

22010113120083

ROSINONDANG DE DEOLITA SIMAMORA

2201011312008!

CLARIN HAYES

22010113130156

LUTFI AULIA RAHMAN

22010113130157

DELI "AHYU OKTAIANI USMA

22010113130158

RONA ELFIZA

220101131!0159

FITRI EKA "ULANDARI

220101131!0160

#ROGRAM #ENDIDIKAN SARJANA KEDOKTERAN FAKULTAS KEDOKTERAN UNIERSITAS DI#ONEGORO TAHUN AKADEMIK 201!

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1= E@%,'4-. > 4',' 4$%,%, '&$(' $(+()','( ,$'('( +(,&'%-$& '( $4$()''( %,%, %,%, 4',' 2= N'+ +&&$)-$& > +&'4' ('+ '() ,+' ,$&',-&  3= D+'&$ > -'() '+& $.'& ','- $$'.+ '() $($& $()'( &$-$(.+ $+/ '&+ 3@ .$/'&+ B. De(ine t&e )ro%e' •

 $(%'( + $/$& 

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BB 4$(-&-(

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D$4'4 :;< ('+ ,-&-(

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E@%,'4-.

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,+&%+ ,$&'- '('.$/+())' /+$&4$,'%+.4$

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H+$&,+&%+ 4$(+()','( $$''( '(,-() ,$&/'' ',$%'4+(.$/+())' $$','( '( $-','( '(,-() 4$(+()', .$/+())' ''( 4$(+()','( -&'/ '(,-()= S$&,' $$ '%&+)$(+ '' .+.,$4 '.-$&  4$($''( '.%+','.+ $&+$& .$/+())' 4$4'*' $$+/'( '('. $ $&4-''( ,--/

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D. Peta Kon,e)

GEJALA

 &$('

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FISIK 

PEMERIKS AAN

DIAGNO SIS

LABORATOR IUM

E. Sa,aran e%a$ar

'< I(.+$(.+ '( $,+%%)+ /+$&,+&%++.4$ '( /+%,+&%+  < #',%)$($.+. '( ',%+.+%%)+ G&'$. +.$'.$ < #$4$&+.''( +.+ '( $(-('() < T$&'+ $< F',%& &+.+% '( $($)'/'(

1. In,i!en,i Dan Etio%o#i Hi)otiroi!i,'e - Hi)ertiroi!i,'e

PENATALAKSA NAA

A. Hi)otiroi!

'= H+%,+&%++.4$ '', +'.++'.+'( .$')'+ :1< &+4$& :$)')''( ,+&%+< :2< .$-($& :,$&/'' $-&'()'( TSH /+%+.+.< ','- :3< ,$&.+$& :$&/--()'( $()'( $+.+$(.+ TRH /+%,''4-.<','- 4-()+( '&$(' :!< &$.+.,$(.+ $&+$&  ,$&/'' $&' /%&4%( ,+&%+= H+%,+&%++.4$ '', +'.++'.+'( .$')'+ )%+,$&  '( (%()%+,$& ,'+ '.++'.+ +(+ 4-()+( ,+' 4$4-'.'( '&$(' ,+&%++,+. H'.+4%,% '', 4$(+4-'( /+%,+&%++.4$ $()'( ','- ,'(' )%+,$&=  = I(.+$(. $&')'+ $($' /+%,+&%++.4$ ''( $&$'$' ,$&)'(,-() ',%& ',%& )$%)&'+. '( +()-()'( .$$&,+ +$, +%+' '( '.-'( '/'('/'( )%+,&%)$(+ +&++&+ )$($,+' '( %-'.+ '( +.,&+-.+ -4-& %-'.+ :'(' ','$*'.'<= Tae% Etio%o#i Hi)otiroi! Pri'er > T+&%++, +. H'.+4%,% > D$()'( )%+,$&  A,&%+ ,+&%+ ++%',+ +-)' .$')'+ .,'+- 4 '/+& $('+, , +&%+ '-,%4-( .$,$'/ ,+&%++,+. H'./+4%,% ','- $('+, G&'$.= T$&'+ +%+( &'+%',+ -(,- $('+, G&'$.= T+&%+$,'4+ .-,%,' -(,- $('+, G&'$. ','- )%+,$& (%-'&= A.-'( +%+$ $&$+/'( :$ ', *'&(' %(,&'.< T+&%++, +. .-'-,=

#$($' '() '&'() + A4$&+ ' S$&+',= '= D$+.+$(.+ +%+$= B'/'( )%+,&%)$(+ '+( .$$&,+ +, +-4 ,$&'+ $()'( %', '(,+,+&% += = K$'+('(  '*''( .+(,$.+. /%&4%( , +&%+= Sek"n!er > H+%+,-+,'&+.4$ '&$(' '$(% 4' /+%+.+. ,$&'+ ''.+ /+%+.+. ','- $.,&-.+ /+%+.+.= Ter,ier

 D+.-().+ /+%,''4-. :'&'()<=

Re,i,ten,i )eri(er ter&a!a) ker$a &or'on tiroi!. B. Hi)ertiroi!i,'e

#$('+, G&'$. .$'&'() +(+ +'('() .$')'+ $('+, '-,%+4-( '()  $($'(' ,+' +$,'/-+= T$&'', &$+.%.+.+ '4++' -', '' .$+,'& 15  '.+$( G&'$. 4$4-('+ $-'&)' $', $()'( $'+('( .'4' '( +&'+&' 50 $-'&)' '.+$( $()'( $('+, G&'$. 4$4-('+ '-,%'(,+%+ ,+&%+ '()  $&$'& + '&'/= "'(+,' ,$&$(' +&'+&' 5 '+ $+/ '(' '&+'' &+'= #$('+, +(+ '', ,$&'+ '' .$)'' -4-& $()'( +(.+$( -(' '' $%4% -4-& 20!0 ,'/-(=

2. Pato#ene,i, A. Hi)otiroi!i,'e D$+.+$(.+ /%&4%( ,+&%+ 4$4$()'&-/+ .$4-' '&+()'( ,--/ .$/+())' )$''(' $&4''4$&4''4= K$'+('( ',%%)+. '() '+() /'. '''/  $(-4-'( )+%'4+(%)+'($'(''( '.'4 /+'-&%(','' '&+()'( +(,$&.,+.+'= #$(-4-'( ', /+&%++ '( $(+()','( $&4$'++,'. '+$&  ,$&/'' '-4+( +(+ $&,'())-() '*' ,$&/'' ,$&'+(' $$4' +(,$&.,+.+' '() '+() $'. '' -+, %,%, '(,-() '( %,%, $&)'&+.= #$(-4-'( +(+ ,+'   $&/--()'( $()'( .+(,$.+. $&$+/ ,'+ $&/--()'( $()'( $(-&-('( $.,&-.+ )+%'4+(%)+'(= B. Hi)ertiroi!i,'e

#'' $('+, G&'$. +4%.+, T +.$(.+,+.'.+ ,$&/'' '(,)+ $( ''4 $$('& ,+&%+ '( 4$&'().'() +4%.+, B -(,- 4$(.+(,$.+. '(,+%+ ,$&/'' '(,+)$('(,+)$( +(+= S',- '&+ '(,+%+ +(+ +.' +,-(-'( ,$&/'' ,$4', &$.$,%& TSH '' 4$4&'( .$ ,+&%+ '( 4$4-('+ $4'4-'( -(,-  4$&'().'() .$ ,+&%+ ''4 /' $(+()','( $&,-4-/'( '( -().+ :TSHR  AB .,+4 = A'(' '(,+%+ ''4 '&'/ $&%&$'.+ %.+, + $()'( $('+, ',+ '( $'4-/'( $('+,= A' &$+.%.+.+ )$($,+ '() 4$('.'&+ ('4-( ,+' $ '. '' '() 4$($,-.'( $+.%$ '-, +(+= B$$&'' ',%& '() 4$(%&%() &$.%(. +4-( '' $('+, G&'$. +''/ :1< $/'4+'( /-.-.(' 4'.' (+'. :2< $$+/'( +%+' /-.-. + '$&'/ $+.+$(.+ +%+' + 4'(' $-&'()'( +%+' '', 4$(-,-+ $('+, G&'$. ',$( '' .'', $4$&+.''( :3< ,$&'+ +,+-4 4-()+( 4$'-+ $&-'/'( &$.%(.++,'. +4-( :!< +($.+ ',$&+' ','- +&' '( :5<$()/$(,+'( )-%%&,+%+= S+,%+( '() $&'.' '&+ +4%.+, ,$&.$(.+,'.+ +(+ '', 4$($''(  $&''()'( +&%'. %&+,' '( 4+% .+,+. %&+,' $&'+', $4$()''( %,%,%,%, %&+,' &%,%.+ %' 4',' '( +%+' .$')'+4'(' -)' 4$(+4-'( $4$&'/'( %()$.,+ '( $$4' %(-(),+' '( $&+%&+,' = #',%)$($.+. $&4%',+ ,+&%+ :4+.$$4' &$,++'< '( +('4'.+ .-$&+%.,$' '() '&' ()  '' '&+'&+ ,'()'( '( '+ :%.,$%',+ ,+&%+ 4-()+( -)' 4$+','( .,+4-'.+ .+,%+( +4%.+, '&+ +&%'. '' ,$4',,$4', +(+=

3. Mani(e,ta,i K%ini, A. Hi)otiroi!i,'e 1. Ba+i ar" %a&ir /Kretini,'e0  H+%,+&%++.4$ ($%(',-. '', +'+','( '&+ $)')''( ,+&%+ -(,-  $.$(.-. .$'4' $&+%$ $&$4'()'( $4&+%(+ '&+ '.'(' '' '.'& +'/ $ ,$4', .$/'&-.(' '' $/$& '*'/ '(,$&+%& '() $&'+', ,+4-(' $$('& ,+&%+ $,%+ '() -().+(' -&-= T&'(.$& '.$(,' TSHR A % '&+ +- '.+$( ,+&%++, +. H'./+4%,% $ $4&+% '', 4$(+4-'( ')$($.+. $$('& ,+&%+ '( &$,+(+.4$ ',+&$%,+= D$$ '*''( '' +%.+(,$.+. /%&4%( ,+&%+ 4$(+4-'( /+%,+&%++.4$ ($%(',-. ,$&4'.- $4$&+'( +%+' %', '(,+,+&%+ ','- &'+%',+ +%+( -(,- ,+&%,%.+%.+. .'', $/'4+'(= G$'')$'' /+%,+&%++.4$'' '+ '&- '/+& '''/ $.-'&'(  $&(''. .+'(%.+. +,$&-. $.-+,'( 4''( ,'()+.'( '.'& /$&(+' -4++'+. '( &$,'&'.+ $&', '( &$,'&'.+ $4','()'( ,-'() '() (','= E++.+. ,++'  &%.+4' '( $++.+. $4-& +.,' ,$&'', '' .$4-' '+ -- -'( $()'(  $&', ''( $+/ '&+ 2500 )= T+' ''(' $++.+. +(+ 4$&-''( -,+ -', ''(' /+%,+&%++.4$= 2. Anak 

H+%,+&%++.4$ '' '(''(' +,'('+ ''(' &$,'&'.+ $&,-4-/'( '( ,'(','(' &$,'&'.+ 4$(,'= #'' &$4'' -$&,'. &$% '', ,$&'+ '( 4-()+( '' $4$.'&'( .$' ,-&.+' + .'4+() %.,-& ,--/ $($= H' +(+ ,+' $&/--()'( $()'( ,-4%& /+%+.+. ,'+ 4-()+( $&/--()'( $()'( /+$&,&%+ /+%+.+. '() $&/--()'( $()'( &%-.+ TSH $&$+/'(=

3. Dea,a > #'' %&'() $*'.' )'4'&'( -4- 4 /+%,+&% ++.4$ ,$&4'.- 4-'/ $ '/ $(+ ) +('( $('4' /'( $&', ''( %(., +'.+ 4$(.,&-'.+ , +' ,$&', -& '( &'4 %,%,= #$4$&+.'' ( +.+ ,$& 4'.- -+, '()  +()+( '.'& -+, $& +() *''/ ' ( ,'()'( .$ 4' .-'&' '& '- ' ( '.'& &$$ . ' 4',= M$(-&-('( %($&.+ '&%, $( 4$('+ +, '4+( A ' ( $(+()',' ( '&%,$( ''4 '&'/ .$/+())' 4$4$&+'( *'&(' -(+() '' -+,= B. Hi)ertiroi!i,'e #'' +(++- '() $+/ 4-' 4'(+$.,'.+ '() -4-4 ,$&4'.- '+,'.+ $)$+.'/'( 4-'/ ''+ /+$&+($.+' '( +'&$ $&+()', '(' ,+' ,'/'(  '('. '( .$('() +()+(= S$&+() ,$&'+ $(-&-('( $&', ''( $'. ,'('  $(-&-('( ('.- 4''(= #$4$.'&'( ,+&%+ ,'(','(' ,+&%,%.+ '' 4','  '( ,'+'&+' &+()'( -4-4(' ,$&'+ '' -4-4(' ,$&'+= K$$4'/'( %,%, '( $&-&'()(' 4'.' %,%, '', .'()', $&', .$/+())' '.+$( ,+' '', $&+&+ '&+ -&.+ ,'(' '(,-'(=

#'' '(''(' ,$&'', $&,-4-/'( $', $()'( $4','()'( ,-'() '() $+/

$',= #'' '.+$('.+$( + ','. 60 ,'/-( 4'(+$., '.+ '&+%'.-$& '( 4+%',+ .$&+() $+/ 4$(%(% $-/'( '() '+() 4$(%(% '''/ '+,'.+ +.($'  '' ', +/'( ,&$ 4%& ($&%-. '( $(-&-('( $&', ''(= . Pe'erik,aan A. Hi)otiroi!i,'e K%4+('.+ FT! ','- FT!I .$&-4 '() &$('/ '( TSH .$&-4 4$(+()', '''/

+')(%.,+ ''(' /+%,+&%++.4$ &+4$& = K''& T 3  $&'&+'.+ '( '', $&'' ''4 ','. (%&4'= U+ %.+,+ ,$&/'' '-,%'(,+%+ ,+&%+ 4$()'&'/ ,+&%++,+. H'./+4%,% '() 4$('.'&+= #'' '.+$( $()'( 4+.$$4' /+%+.+. FT! ','FT! ''( &$('/ ,'+ TSH .$&-4 ,+' ''( 4$(+()',=

G'4'& = D+')(%.+. /+%,+&%++.4$= T+&%.+( $'. :FT !< 4'--( +($. ,+&%.+( $'. :FT!I< '', $&.'4' TSH -(,- $(+'+'(=

K$$('& ,+&%+ '() ,$&'' ','- 4$4$.'& '( -+ %.+,+ ,$&/'' '-,%'(,+%+ ,+&%+ ''( 4$()'&'/'( '' ''(' ,+&%++, +. H'./+4%,% '() 4$('. '&+ '' '.-. 4'(' ,$&'+ /'&-. +,$&-.'(= J+' '(,+%+ ,+' '' ,$&'+ /'&-. +/$(, +'( .$'4' 6 4+())-= M'.' $()/$(,+'( 6 4+())- +$&-'( '&$(' *',- '&-/ ,+&%.+( -- ' ('() :7 /'&+< '( 4$4-()+('( $$('& , +&%+ $($4-/'( $4'+ .$,$'/ $($'('( '() -- '4'= #%' $($4-/'( -().+ , +&%+ .$,$'/ $()/$(,+'( T! +)'4'&'( '' G'4'& !39= #'' +(++/+%,+&%+ TSH 4$('+ $ '. 4$(+()', '' 56 4+())- '( T ! ,$,' (%&4' $4-+'( $-'(' (%&4' .$,$'/ 6 4+())- '' $()'*'.'( $-,+&%+= B. Hi)ertiroi!i,'e Pe'erik,aan Laoratori"'  H'.+ $4$&+.''( '%&',%&+-4 '' /+%,+&%+ +.4$

$'/ +$'.'( '' ')+'( -+ ,+&%+= S$$('&(' %4+('.+ $(+()','( I ','-

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3

#'' $('+, G&'$. '*' '( &$-&$( T '', +.$&$.+'( '' -4'/ $&$+/ .$$-4 T !  '+ .$&-4 T ! '', (%&4' .$4$(,'&' T 3 4$(+()',= J'+ +' TSH +.-&$.+ '( FT ! I ,+' 4$(+()', 4'' T 3 /'&-. +--&= A-,%'(,+%+ +'.'(' '' ,$&-,'4' +4-(%)%-+( '() 4$(., +4-'.+ TSHR A .,+4= I(+ 4$&-''( -+ +')(%., + '() 4$4'(,- '' '.+$( ,+%&+ '() '',$,+ ','- '' '.+$( '() 4$()''4+ $.%,'4-. -(+',$&' ,'(' ,'(','(' '() $'. ','4'(+$.,'.+ '%&',%&+-4 ''(' $('+, G&'$.= A4+'( &'+%+%+( $&)-(' $,+' +-)' '' /+%,+&%++.4$ '4+'( &$('/ +(+ '', ,$&'+ '' '.$ .-'-, ','- ,+&%++,+. H'./+4%,%= J$(+. /+%$&,+&%++.4$ 123

+(+ .$&+()'+ .$4-/ .%(,'(= Scan technetium ','- I '', 4$4'(,- +' +-,-/'( -(,- 4$4$&+/','( --&'( $$('& '( 4$($,$.+ ''(' (%- '('. ','- +()+(= S$' -+ TSH -,&'.$(.+,+ '', 4$($,$.+ .-&$.+ TSH -+ TRH '( -+ .-&$.+ TSH '&'() +'(-&'(= E%)&'+ '( CT .'( %&+,' ,$'/ 4$(-(-'( ''(' $4$.'&'( %,%, '' $'(''( '.+$( $()'( $('+, G&'$. *''--( ,+' ,$&'', ,'(','(' +(+. %,'4%',+= #'' '.+$( $()'(,'(','(' +(+. %,'4%',+ $4$.'&'( %,%, %&+,' .$&+() .'()', 4$(%(%= . Tera)i A. Hi)otiroi!i,'e H+%,+&%++.4$ +%',+ $()'( $%,+&%.+( :T!< '() ,$&'', ''4 $(,-  4-&(+ '( .,'+ '( ,+' 4'/'= L$%,+&%.+( +%($&.+ 4$('+ T3 +

+(,&'.$-'& .$/+())' $-' /%&4%( .'4'.'4' +'','( ''4 ,--/ *''--( /'(' .',- $(+.= T+&%+ $&+() ,+' 4$4-'.'( '&$(' +.+ /%&4%((' '() $&4''44''4 '( ,&++%%,+&%.+( :.$')'+ +%,+&%(+(< ,+'  4$4-'.'( '&$(' '.%&.+(' '() $', '( *',- '&-/(' '() .+()', '( $$ .$4$(,'&'= "',- '&-/ $%,+&%.+( +&'+&' 7 /'&+ '+ /'(' $&+$&+'( .$'+ .$/'&+= #&$'&', +(+ +'.%&.+ $()'( ''& ''4 '&'/ 4-'/ +'(,'- $()'( '&' 4$()+-,+ FT !I ','- FT! '( ''& TSH .$&-4= A' $(+()','( T ! ','- FT!I +&'+&' 12 µ)?L :1326 (4%?L< '( +.$&,'+  $(-&-('( TSH .$'(' 12 µU?L :12 4U?L< 4-'+ ''4 2 '4 '( $&'/+&  .$,$'/ 810 '4 .$,$'/ %.+. $& %&' 01015 4) $%,+&%.+(= E(ek Tok,ik Tera)i Le4otirok,in T+' +'%&'( ''(' '$&)+ ,$&/'' $%,+&%.+( 4-&(+ *''- 4-()+( ''  '.+$( ,+4- '$&)+ ,$&/'' $*'&(' ','- $$&'' %4%($( ,'$,= R$'.+ ,%.+ -,'4' $$+/'( $%,+&%.+( '''/ )$'')$'' /+%,+&%++.4$ ,$&-,'4' )$'')$'' '(,-()'( %.,$%%&%.+.= G$'' ,+&%,%.+ '' '(,-() '''/ '&+,4+' /-.-.(' ,'+'&+' ',&+' &%.+4' ','- +&+'.+= I(.%4(+' ,&$4%& )$+.'/ '(

 '('. $&$+/ -)' '', 4$())'())-= D$()'( 4-'/ %.+. /'&+'( $%,+&%.+( +,+'''( -(,- 3 /'&+ '( $4-+'( $(-&-('( %..+ 4$()','.+ 4'.''/ +(+= #$(+()','( &$.%&.+ ,-'() '( %.,$%%&%.+. $&', ,$'/ +'+,'( $()'( /+$&,+&%++.4$ '() $&'().-() '4' '( ''( ,+4- '' '.+$( '() +%',+ $()'( $%,+&%.+( '()' '4'= H' +(+ '', +$)'/ $()'( $4'(,'-'( ,$&',-& '( $()'( 4$4$&,'/'('( ''& (%&4' .$&-4 FT ! '( TSH ''  '.+$( '() 4$('', ,$&'+ $())'(,+'( '()' '('()= B. Hi)ertiroi!i,'e 1.Tera)i Oat Antitiroi!  S$'&' -4-4 ,$&'+ $()'( %', '(,+,+&%+ '+()  $&)-(' '' '.+$('.+$( 4-' $()'( $$('& '() $+ '( $('+, &+()'(= O',%','( +(+ :&%+ ,+%-&'.+ ','4$,+4'%< +$&+'( .'4'+  $('+,(' 4$()''4+ &$4+.+ .%(,'(= I(+ ,$&'+ '' 20!0 '.+$( '() +%',+ -(,- 6 -'( .'4'+ 15 ,'/-(= "''--( +(+ 4$&-''( .',-.',-(' ,$&'+ '() 4$(+())''( $,$('& ,+&%+ '() -+-/ +(+ 4$4-,-/'( *', $()'*'.'( '() '4' '( +(.+$(. '4-/ ,+())+ 4-()+( 6080 4$.+-(  '' '.+$('.+$( ++/'(=

A()' $'4-/'( '', +,-&-('( $()'( 4$())-(''( &$)+4$(  $()/'4', ,+&%+ ,%,' '() ''( +$'.'( + '*'/= T$&'+ $()'( %',%','( '(,+,+&%+ +'.'(' +4-'+ $()'( %.+. $.'& ,$&')+ +' '.+$( ,$'/ 4$('+ $-,+&%+ .$'&' +(+. ,$&'+ &-4','( '', +''+ $()'( .-',- %.+. ,-())' '() $+/ $+ '' ')+ /'&+= S-',- &$)+4$( -4-4 ,$&+&+ '&+ &%+ ,+%-&'.+ 100 150 4) ,+' 6 '4 4-'4-'(' '( $4-+'( ''4 *',- !8 4+())4$(-&-('( %.+. .'4'+ 50200 4) .$'+ ','- -' '+ .$/'&+= #&%+,+%-&'.+ 4$4-('+ .',- $$+/'( +'(+() 4$,+4'% '(+ '/*' &%+ ,+%-&'.+ 4$()/'4', .$')+'( %($&.+ T !  '+ T3 .$/+())' $$,+ ''4 4$(-&-('( /%&4%( ,+&%+ ',+ $()'( $',= S$'+(' 4$,+4'%  4$4-('+ '4' $&' '() $+/ '('() '( $+/ $&)-(' +'  +()+('( ,$&'+ $()'( %.+. ,-())'= S-',- &%)&'4 ,++' ''( +4-'+ $()'( %.+. !0 4) 4$,+4'% ,+' ')+ .$'4' 12 -'( %.+. +(+ $4-+'( +,-&-('( 4$('+ 520 ,+' ')+ -(,- ,$&'+ &-4','(= U+ '%&',%&+-4 '() '+() $&(+'+ ''4 4$4'(,'- $&''('( ,$&'+ '''/ FT! .$&-4 '( TSH 2. Tera)i Be!a&  T+&%+$,%4+ .-,%,' '''/ ,$&'+ ++/'( -(,- '.+$( '.+$( $()'( $$('& '() .'()', $.'& ','- )%,+$& 4-,+(%-'&= #'.+$ ( +$&.+''( $()'( %', '(,+,+&%+ .'4'+ $-,+,%+ :+&'+&' 6 4+())-<= S$')'+ ,'4'/'( 4-'+ 2 4+())- .$$-4 /'&+ %$&'.+ '.+$( +$&+'( '&-,'( $(-/ '+-4 +%+' 5 ,$,$. 2 '+ .$/'&+= R$)+4$( +(+ .$'&' $4+&+. 4$(-(-'( '/*' '', 4$()-&'()+ '.-'&+,'. $$('& '( 4$4$&4-'/ %$&'.+=

T$&'', $,+'.$'','( ,$(,'() $&'' '(' '&+()'( ,+&%+ /'&-. +'()',= T+&%+$,%4+ ,%,' +'.'(' , +' $&- $-'+ +' '.+$( 4$4-('+ %,'4%',+  &%)&$.+ '() $&', = S$'+(' +' ,$&'- '(' '&+()'( ,+&%+ +,+())''(  $('+,(' ''( '4-/= K$'(''( '/+ $'/ 4$(+())''( 23 )&'4 '&+()'( ,+&%+ '' 4'.+()4'.+() .+.+ $/$&= "''--( $$&'' '.+$( ,+' 4$4$&-'( ,'4'/'( ,+&%+ .$,$'/ ,+&%+$,%4+ -(,- $('+, G&'$. $'(''( '.+$( 4$4$&-'(('= H+%'&',+&%++.4$ '( $&-''( ($&-. '&+()$-. &$-&$( ,$&'+ .$')'+ %4+'.+ $4$'/'( '' +&'+&' 1 '.-.= 3. Tera)i %o!in Ra!ioakti(  D+ A4$&+' S$&+', ,$&'+ $()'( (',&+-4 +%+' I131 '''/ ,$&'+ ,$&++/ -(,- $'(''( '.+$( + ','. 21 ,'/-(= #'' '(' '.+$( ,'(' '.'& $('+, '(,-() +%+( &'+%',+ '', .$)$&' +$&+'( $()'( %.+.

80120 µC+?)&'4 ,'.+&'( $&', ,+&%+ $()'( '.'& $4$&+.''( +.+ '( .'( &$,++($'& +%+'

123

I= D%.+. +%&$.+ -(,- '4+'( +%+( .$.-'

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#$($+,+'( A&+'(, + K'-',$( M'+-( ,'/-( 2005 $()'( .'4$ !0 '(' '() ,$&+&+ '&+ 20 '(' $($&+,' )%(% '( 20 '(' -'( $($&+,' )%(% 4$(-(-'( #R  GAKY 319  + D$.' G'+() :'$&'/ $($4+< '( 065  + D$.' M$'' :'$&'/ (%( $($4+<= Ho,t K'.-. .,&-4' $+/ .$&+() ,$&'+ '' $&$4-'( +'(+()'( '+'+ ('4-( $()'(  $&,'4'/ $&',(' $($4+ $&$''( .$. ,$&.$-, /'4+& ,+' ''= S,&-4' '', 4$($&'() $($&+,' '' .$)'' -4-& ('4-( -4-& '() .$4'+( ,-' ''( 4$(+()','( &$.+% $('+, $+/ $.'&= H' +(+ +.$''( '&$(' '' ,'/'( ,--/ '( +4-(+,'. .$.$%&'() '() .$4'+( 4$(-&-( .$+&+() $()'( $&,'4'/(' -.+'=

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Pen7e#a&an Hi)ertiroi! 1. Pen7e#a&an Pri'er #$($)'/'( &+4$& '''/ '()'/ '() /'&-. +'-'( -(,- 4$()/+('&+ +&+ '&+  $&')'+ ',%& &$.+%= B$$&'' $($)'/'( '() '', +'-'( -(,- 4$($)'/ ,$&'+(' .,&-4' '''/ > a. M$4$&+'( $-'.+ $'' 4'.'&'', ''4 /' 4$&-'/ %' $&+'- 4''( '( 4$4'.'&'','( $4''+'( )'&'4 %+-4 . M$()%(.-4.+ 4''('( '() 4$&-''( .-4$& %+-4 .$$&,+ +'( '-, 7. M$()%(.-4.+ %+-4 $()'( '&' 4$4$&+'( )'&'4 $&%+-4 .$,$'/ +4'.' ,+' +'(-&'( 4$4$&+'( )'&'4 .$$-4 4$4'.' -(,- 4$()/+('&+ /+'()(' %+-4 '&+ 4''('( !. I%+.'+ '+& 4+(-4 -(,- *+''/ ,$&,$(,- $()'( &$.+% ,+())+= C'&' +(+ 4$4$&+'( $-(,-()'( '() $+/ +'(+()'( $()'( )'&'4 '&$(' '', ,$&'()'- '$&'/ -'. '( ,$&$(+= I%+.'.+ +'-'( $()'( %+' +$&+'( ''4 .'-&'( '+&  ''4 +' %+' '() +$&+'( ''4 '+& '() 4$()'+& '( $('4'/'( %+' ''4 .$+''( '+& 4+(-4= e. M$4$&+'( '.- 4+(' $&%+-4 :++%%< '' $(-- + '$&'/ $($4+   $&', '( $($4+ .$'()= S'.'&'( $4$&+'((' '''/ .$4-' &+' $&-.+' 020 ,'/-( '( *'(+,' 035 ,'/-( ,$&4'.- *'(+,' /'4+ '( 4$(-.-+ '() ,+())' + '$&'/ $($4+. $&', '( $($4+. .$'()= D%.+. $4$&+'((' $&'&+'.+ .$.-'+ -4-& '( $'4+(= (. M$4$&+'( .-(,+'( %+-4 ''4 4+(' :++%% !0< +$&+'( 3 ,'/-( .$'+ $()'( %.+. -(,- $*'.' '( '(''(' + ','. 6 ,'/-( 1  '( -(,- '(' -&'() '&+ 6 ,'/-( 0208 = 2. Pen7e#a&an Sek"n!er #$($)'/'( .$-($& '''/ -'' 4$($,$.+ .$'&' +(+ .-',- $('+, 4$()-'''( %&'() '() ,$'/ .'+, ')'& .$4-/ 4$()/'4', &%)&$.++,'. $('+, '() +'-'( 4$'-+ $$&'' '&' '+,- > a. Dia#no,i, a.1. In,)ek,i I(.$.+ +'-'( %$/ $4$&+.' '() $&'' + $'( $($&+,' '() $&'' '' %.+.+ -- $()'( $'' .$++, $.+ ','- $/$& .$++, ,$&-'= J+' ,$&'', $4$()''( ','- (%- $&- +$&/',+'( $$&'' %4%($( '+,- %'.+ --&'( -4'/ (%- $(,- :+-. ','- (%-$& $+< )$&''( '' .'', '.+$( +4+(,' -(,- 4$($'( '( -'.+ '' $&4-''( $4$()''(= a.2. Pa%)a,i #$4$&+.''( $()'( 4$,%$ ''.+ +4'(' '.+$( +4+(,' -(,- -- $/$& ''4 %.+.+ $.+= #$4$&+.' $&+&+ + $''() '.+$( '( 4$&'' ,+&%+ $()'( 4$())-(''( +- '&+ $-' ,'()'( '' ,$()- $($&+,'=

a.3. Te, 6"n#,i Hor'on S,',-. -().+%(' $$('& ,+&%+ '', +'.,+'( $()'( $&'(,'&' ,$.,$. -().+ ,+&%+ -(,-  4$(+')(%.' $('+, ,+&%+ +'(,'&'(' ''& ,%,' ,+&%.+( '( ,&+%%,+&%+( .$&-4 +--&  $()'( &'+%+)'( '..'= T+&%.+( $'. .$&-4 4$()--& ''& ,+&%.+( ''4 .+&-'.+ '() .$'&' 4$,'%+ ',+= K''& TSH '.4' '', +--& $()'( '..' &'+%+4-(%4$,&+=

K''& TSH '.4' .$(.+,+ '', +$&'' .$')'+ +(+',%& -().+ ,+&%+= K''& ,+())+ ''  '.+$( /+%,+&%++.4$ .$'+(' ''& ''( $&'' + '*'/ (%&4' '' '.+$(  $(+()','( '-,%+4-( :/+$&, +&%++.4$<= U+ +(+ '', +)-(''( '' '*' $(+'+'( '.+$( '() +-)' 4$4+++ $('+, ,+&%+= T$. '4+'( %+-4 &'+%',+ :RAI< +)-(''( -(,-  4$()--& $4'4-'( $$('& ,+&%+ ''4 4$('()' '( 4$()-'/ %+'= a.. 6oto Ront#en %e&er #$4$&+.''( +(+ +4'.-'( -(,- 4$+/', .,&-4' ,$'/ 4$($'( ','- 4$(-4', ,&'$' :''( (''.<= a.. U%tra,ono#ra(i /USG0 A', +(+ ''( +,$4$'( + $'( $/$& '( )'4'&'( )%(% ''( ,'4' + ''& T= USG '', 4$4$&+/','( --&'( )%(% '( $4-()+('( ''(' +.,'?(%- '() 4-()+( ,+' ,$&$,$.+ *',- $4$&+.''( $/$&= K$'+('($'+('( '() '', ++')(%.+. $()'( USG '(,'&' '+( +.,' '$(%4' '( $4-()+('( '&.+(%4'= a.9. Si!ikan /S7an0 tiroi! C'&'(' $()'( 4$(-(,+'( .$-4'/ .-.,'(.+ &'+%',+ $&('4' ,$/($,+-4994 '( %+-4125?%+-4131 $ ''4 $4--/ '&'/= S$,$()'/ '4 $4-+'( $&'&+() +  '*'/ .-',- '4$&' '())+/ ,$&,$(,- .$'4' $$&'' 4$(+,= H'.+ $4$&+.''( $()'( &'+%+.%,% '''/ ,$&''( --&'( $(,- %'.+ '( '() -,'4' ''/ -().+ ')+'(')+'( , +&%+= a.:. Bio),i A,)ira,i Jar"' Ha%", D+'-'( /-.-. '' $'''( '() 4$(-&+)''( .-',- $)'('.'(= B+%.+ '.+&'.+ '&-4 , +' ($&+ /'4+& ,+' 4$($''( '/'' $($'&'( .$.$ )'('.= K$&-)+'(  $4$&+.''( +(+ '', 4$4$&+'( /'.+ ($)',+ '.- '&$(' %'.+ +%.+ -&'() ,$',= S$'+( +,- ,$(+ +%.+ -&'() $('& '( $4-','( &$'&', '() -&'() '+ ','- %.+,+   '.- '&$(' .''/ +(,&$$&,'.+ %$/ '/+ .+,%%)+= . Penata%ak,anaan Me!i, A' $$&'' 4''4 -(,- $(',''.'(''( 4$+. $(+.$(+. .,&-4' '(,'&' '+( .$')'+  $&+-, > .1. O)era,i;Pe'e!a&an #$4$'/'( 4$()/'.+'( /+%,+&%++.4$ $&4'($( '() -&'() .$&+() +'(+()'( $()'( %+-4 &'+%',+= T$&'+ +(+ ,$', -(,- '&' '.+$( /+%,+&%++.4$ '() ,+' 4'-

4$4$&,+4'()'( %+-4 &'+%',+ '( ,+' '', +,$&'+ $()'( %',%', '(,+ ,+&%+= R$'.+&$'.+ '() 4$&-)+'( '() +''4+ '( -(,- '.+$( /'4+ $()'( ,+&%,%.+%.+.  '&'/ ','- $'4-/'(=#'' *'(+,' /'4+ ','- *'(+,' '() 4$())-(''( %(,&'.$.+ /%&4%(' :.-(,+ ','- + KB< ''& /%&4%( ,+&%+ ,%,' ,'4' 4$(+()',= H' +(+ +.$''( 4'+( '(' ,+&%+ '() ,$&+', %$/ &%,$+( 4'' $&- +'-'( $4$&+.''( ''& T! .$/+())' '', +$,'/-+ $'''( -().+ ,+&%+= #$4$'/'( $()'( 4$()'()', .$')+'( $.'& $$('& ,+&%+ .$$-4 $4$'/'( ,+'   $&- $()%','( '( .$.-'/ $4$'/'( ''( +&'*', .$+,'& 3 /'&+= K$4-+'( +$&+'( %', ,+&%.+( '&$(' '&+()'( ,+&%+ '() ,$&.+.' 4-()+( ,+' -- 4$4&%-.+ /%&4%( ''4 -4'/ '() '$-', '( $4$&+.''( '%&',%&+-4 -(,- 4$($(,-'( .,&-4' +'-'( 3! 4+())- .$,$'/ ,+(''( $4$'/'(= . 2.
Y%+-4 &'+%',+ +$&+'( ''4 $(,- '.- ','- '+&'( '() /'&-. +4+(-4 + &-4'/ .'+, %', +(+ +(+ +'.'(' +$&+'( $4', 4+())- .$,$'/ %$&'.+ .$$-4 $4$&+'( %', ,+&%.+(= .3. Pe'erian Tirok,in !an oat Anti5Tiroi! T+&%.+( +)-(''( -(,- 4$(-.-,'( --&'( .,&-4' .$'4' +(+ +'+(+ '/*'  $&,-4-/'( .$ '($& ,+&%+ +$()'&-/+ /%&4%( TSH= O$/ '&$(' +,- -(,- 4$($'( TSH .$&$('/ 4-()+( +$&+'( /%&4%( ,+&%.+( :T+(+ -)' +$&+'( -(,- 4$()','.+ /+%,+&%++.4$ '() ,$&'+ .$.-'/ %$&'.+ $()'()','( $$('& ,+&%+= O', '(,+,+&%+ :,+%('4+< '() +)-(''( .'', +(+ '''/ &%+,+%-&'.+ :#TU< '( 4$,+4'.%?'&+4'.%= 3. Pen7e#a&an Tertier #$($)'/'( ,$&.+$& $&,--'( -(,- 4$()$4'+'( -().+ 4$(,' +.+ '( .%.+' $($&+,' .$,$'/ &%.$. $('+,(' +/$(,+'(= U'' '() '', +'-'( '''/ .$')'+ $&+-, > a. S$,$'/ $()%','( +$&-'( %(,&% ,$&',-&?$&'' -(,- 4$4'.,+'( '( 4$($,$.+ ''(' $'4-/'( ','- $($'&'(= . M$($'( 4-(-(' %4+'.+ '( $'','( 7. M$'-'( &$/'++,'.+ $()'( 4$4-', $($&+,' $+/ $&'' +&+ +.+ .$)'& '(  -)'& .$&,' $-'&)' '( 4'.'&'', '', 4$($&+4' $/'+&'((' 4$'-+ 4$'-'( +.+%,$&'+ '+,- $()'( &$/'++,'.+ +.+ .+%,$&'+ '+,- $()'( &$/'++,'.+ $+*''( .%.+' ,$&'+ '+,- $()'( &$/'++,'.+ .%.+' '( &$/'++,'.+ '$.,/$.+. '+,- '() $&/--()'( $()'( $'(,+'(=

DA6TAR PUSTAKA

1= B'&&$,, E=J= T/$ ,/&%+ )'(= I( B%&%( "F B%-'$ EL= M$+'  /.+%%)=A $-'& '( 4%$-'& '&%'/= I., E+,+%(= S'-($&.= #/+'$/+'= 2003 > 1035 10!8= 2= A/+ #$('+, D''4= 1996= Ilmu Penyakit Dalam= J''&,' > B''+ #$($&+, FKUI=

3= M')($& JA > T/&%+ .,+4-',+() /%&4%($> +%.(,/$.+. $ +%%) '(  +%',++,= E(%& R$ 1990 11>35!

!= G+(%$& D= R$)-',+%( % 4',$&(' E(%&+(% M$,' 199071> 276=

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6= "++( TJ= M$/'(+.4 % +.$'.$ > &$$,%& '-,%+44-(+, +( $(%&+($ +.%&$&.=  N E() J M$ 1990 323> 1318