LAPORAN TUTORIAL BLOK 8 MODUL 3 PENYAKIT SISTEMIK YANG BERMANIFESTASI DI ORAL PENYAKIT PENYAKIT METABOLIK METABOLIK ENDOKRIN
KELOMPOK 8 : AN NISAA AMELIA RAHMAT RAHMAT HADI HAD I INDRA I NDRA TAMIA TAMIA AKHIRA AKHIRA RESTI KHAIRANI WIRA PUTRI WINATA KARINA NABILLA ATIKA FITRI ANGGINI ENDA MARKUS MUHAMMAD SETYO VICKY DEVEGA
FAKULTAS KEDOKTERAN GIGI UNIVERSITAS UNIVERSITAS ANDALAS ANDAL AS
MODUL 3
PENYAKIT METABOLIK ENDOKRIN
SKENARIO 3 : “TIDAK SEMANIS GULA” BAPAK Yusuf !"#$% s&'() &#u *+,-*'# .+ /-0&.0&(&. )&)& 1'( 2u0u# RSUP S+0'/','() 1+()'( .+0u$'( .+0u$'( s+2u' )&)& )+0&)& #+,'s' )-'$4 )us& 2u1'$ *+,1','$ 1'( ',-2' ('f's #+,'s' #&1'. +('. '() 2+2*u'# /'. Yusuf 2+,'s' .u,'() /+,5'' 1&,&6 D-.#+, )&)& 2+0'.u.'( /+2+,&.s''( s'2*&0 2+2*'5' 5'#'#'( 1& .',#u s#'#us4 #+,('#' /'. Yusuf #+0'$ 7 *u0'( &(& s+5',' ,u#&( *+,-*'# .+ /-0&.0&(&. .$us /+('.&# 1'0'2 *')&'( 2+#'*-0&. +(1-.,&( .',+(' 2+(1+,&#' 1&'*+#+s 2+0&#us #/+ 76 S+0'&( &#u /'. Yusuf u)' 2+()+0u$ s+,&() .+0u', .+,&()'# 2'0'2 1'( '(#u() s+,&() *+,1+*', *+,1+*',91+*', 91+*',66 D'#' /'1' /'1' .-(#,-0 .-(#,-0 T+.'('( 1,'$ 1,'$ ;"<=" 22H)4 N'1& ""<2+( 1'( uu() .u.u ,'/u$6 P'1' /+2+,&.s''( /+2+,&.s''( &(#,' -,'0 1&1'/'#.'( 1&1'/'#.'( )&)& 84 >4 7>4 784 384 3>4 ?> 1'( ?8 #+0'$ 1& +.s#,'.s&6 +.s#,'.s&6 G&)& '() #+,s&s' s+2u'(' )-'$ 1+,''# 7 1&s+,#'& '1'(' /+,&-1-(#'0 /-5.+# /'1' s+2u' ,+)&- )&)&4 )&()&@&#&s 1'( '() .$'s ',-2' ('f's /'. Yusuf 2+(+*',.'( *'u .+#-(6 B')'&2'(' s'u1',' 2+(+0's.'( '/' '() 1&'0'2& /'. Yusuf 1'( #'#'0'.s'(' #'#'0'.s'(' s+0'(u#('
L'().'$
: M+().0',&.'s& #+,2&(-0-)&
6 D&'*+#+s 2+0&#us : K+'1''( $&/+,)0&.-2&. .,-(&. 1&s+,#'& .+0'&('( 2+#'*-0&. '.&*'# .+0'&('( s+.,+s& $-,2-( &(su0&(4 2+()$'2*'# 2+#'*-0&s2+ .',*-$&1,'# 4 0+2'.4 1'( /,-#+&(6 76 As+#-( : Gu)us 1',& .+#-( 36 P+,&-1-(#'0 /-5.+# : Ru'() '(#',' )&()&@' 1'( )&)& 1&s+*'*.'( -0+$ /0'. '() 2+,us'. ',&()'( /+,&-1-(#'06 K+$&0'()'( /+,0+.'#'( 1&*''$ s+2+(#- +('2+0 u(5#&-(6 ?6 E(1-.,&( : S&s#+2 '() 2+()$'s&0.'( su'#u $-,2-( '() *+,'# '#'u u(#u. @&#'0 #u*u$ '() #+,1&,& 1',& .+0+(', 1'( s+06 !6 G-'$ 1+,''# 7 : K+)-'$'( 1',& )&)& 2+0+*&$& 22 1',& (-,2'0 1'0'2 ','$ 0'*&;6 Gu0' 1','$ /u's' : K'1', )0&.-s' 1'0'2 1','$ .+#&.' #&1'. '1' s'#u /u( 2'.'('( 2'su. .+1'0'2 #u*u$ s+0'2' "97 '26 Gu0' 1','$ (-,2'0 7"4 @+(' ""4 .'/&0+, ="6 Bu.'( )u0' 1,'$ 7""6 P'1' s''# 8'2 &.' 2+()&(1'/ DM 7;4 7; '#'u 0+*&$ /-s&#&f 2+()&(1'/ DM6 >6 U,&( ,+1u.s& : P+2+,&.s''( 0'*-,'#-,&u2 u(#u. 2+(+(#u.'( .'1', )u0' 1','$ 1'0'2 u,&(6 C-(#-$(' : ',(' &())' 1'( u()u6 86 Gu0' 1','$ 7'2 // : K'1', )u0' 1','$ 1&/+,&.s' s+#+0'$ 7'2 *+*'( )0u.-s' '#'u s+#+0'$ 2'.'(6 S+#+0'$ /'s&+( /u's' 8'24 >!),'2 )u0'4 s+#+0'$ 7'2 &#u 1&/+,&.s' .'1', )u0' 1','$6
L'().'$ 7 6 76 36 ?6 !6 ;6 >6 86 =6
: M+(+(#u.'( 2's'0'$
A/' s'' +(&s /+('.&# 2+#'*-0&. +(1-.,&( A/' s'' .0's&.'s& 1&'*+#+s 2+0&#us A/' s'' )+'0'9)+'0' 1&'*+#+s 2+0&#us B')'&2'(' 2'(&f+s#'s& -,'0 1',& 1&'*+#+s 2+0&#us A/' s'' f'.#-, /+(+*'* 1&'*+#+s 2+0&#us B')'&2'(' 5,' 2+(5+)'$ 1&'*+#+s 2+0&#us A/' s'' .-2/0&.'s& /+('.&# '() 1&s+*'*.'( -0+$ 1&'*+#+s 2+0&#us B')'&2'(' /+('#'0'.s'(''( /+(1+,&#' 1&'*+#+s 2+0&#us B')'&2'( #&(1'.'( '() 1&0'.u.'( 1,) s+*+0u2 #&(1'.'( /'s&+( 2+(1+,&#' 1&'*+#+s 2+0&#us "6B')'&2'(' ,+s&.- 1&'*+#+s 2+0&#us &.' 1&0'.u.'( #&(1'.'( 1,) 6B')'&2'(' 2+(1&')(-s&s s+s+-,'() /+(1+,&#' 1&'*+#+s 2+0&#us 76M+()'/' #+,'1& /+(u,u('( s#'#us .+s+$'#'( )&)& /'1' /+(1+,&#' 1&'*+#+s 2+0&#us 36M+()'/' ',-2' ('f's /'. Yusuf *'u .+#-( ?6A/'.'$ '1' $u*u()'( )&)& )-'$ 1+()'( 1&'*+#+s 2+0&#us !6A/'.'$ /+(+*'* uu() .u.u /'. Yusuf ,'/u$
L'().'$ 3 6 76 36 ?6 !6 ;6 >6
: M+()'('0&s' 2's'0'$
6 +(&s /+('.&# 2+#'*-0&. +(1-.,&( H&/+,/','#&,-&14 '1'0'$ +.s,+s& +(&2 )&('0 '() )')'06 H&/+,.-,#&s-0 s&(1,-2 5us$&()%4 '1'0'$ 2+(&().'#(' )0u.-#&,-&16 H&/+,#&,-&1 H&/-/,-#+&(+2&' H&/+,0&/+2&' D&'*+#+s 2+0&#us D&'*#+s &(s&/&1us
76 +(&s9+(&s 1&'*+#+s 2+0&#us 6 D&'*+#+s 2+0&#us #/+9 D&'*+#+s 2+0&#us &(& *+,)'(#u() /'1' &(su0&( '#'u 1&'*+#+s '('.9'('.6 76 D&'*+#+s 2+0&#us #/+97 D&'*+#+s 2+0&#us &(& #&1'. *+,)'(#u() /'1' &(su0&(6 36 D&'*+#+s )+s#'s&-('0 D&'*+#+s )+s#'s&-('0 '1'0'$ 1&'*+#+s '() #+,'1& /'1' &*u $'2&06 Mu(5u0 /'1' 2&())u .+97?6 T-0+,'(s& )0u.-s' (-,2'0 #+,'1& /'1' s+2+s#+, 3 .+$'2&0'(6 ?6 D&'*+#+s 2+0&#us #/+ 0'&( D&'*+#+s 2+0&#us #&/+ 0'&( &(& s+/+,#& )+(+#&. fu()s& s+0 *+#'4 +f+. )+(+#&. .+,' &(su0&( 1'( /+('.&# +.s-.,&( /'(.,+'s6
6 76 36 ?6 !6 ;6
36 G+'0' 1&'*+#+s 2+0&#us P-0&f')&4 '1'0'$ *'('. 2'.'( P-0&u,&4 '1'0'$ *'('. u,&( P-0&1&/s&4 '1'0'$ *'('. 2&(u2 L+su*+,'# *'1'( 1,'s#&s 2+(u,u( B+,.u,'()(' /,-1u.s& s'0&@' G'#'09)'#'0 /'1' .u0&#
?6 M'(&f+s#'s& -,'0 /+('.&# s&s#+2&. 6 D&'*+#+s 2+0&#us 9 L&1'$ .+,&() 9 P'/&0' '#,-/& 9 Mu.-s' ',(' 0+2*'u()4 s+,&() *+,1','$ 9 +,-s#-2&' 9 G&()&@&#&s 1'( /+,&-1-(#&s 9 D+(#'0 .',&+s 9 O,'0 #$,us$
76 H&/+,/','#&,-&1 9 Mu(5u0(' ,'1&-0us+( /'1' 2'J&0' 1'( 2'(1&*u0' 1&#+2u.'( *+,5'. /u#&$ /'1' #u0'() 0'2&(' 1u,' 36 H&/-/','#&,-&1 9 C'(1&1&'s&s 9 H/-/0's&' 9 K+)')'0'( +,u/s& )&)& 9 H&/-.0's+2&'
!6F'.#-, /+(+*'* 1&'*+#+s 2+0&#us 9 9 9 9 9 9 9 9 9 9 9
F'.#-, )+(+#&. F'.#-, us&'4 us&' ?! #'$u( 0+*&$ ,+(#'( #+,.+(' 1&'*+#+s T+.'('( 1','$ K-0+s#,-0 O*+s&#'s V&,us T-.s&( S&#-#-.s&( Ku(su2s& susu s'/& P-0' 2'.'( *u,u. S&(1,-2 5us$&()
;6P+(5+)'$'( 1&'*+#+s 2+0&#us 9 9 9 9
M+,+(5'('.'( u20'$ 2'.'('( 1&.-(su2s& 0+2'. L'#&$'( 's2'(& #+,'#u, D&*+,&.'( -*'# *+,.$'s&'# su0f-(&u,+' D&*+,&.'( /+(u0u$'(
>6K-2/0&.'s& 1&'*+#+s 2+0&#us 9 9 9 9 9 9 9 >6 86
K'(1&1&'s&s G&()&@&#&s A*s+s /+,&-1-(#'0 P+,&-1-(#&#&s K',1&-@'s.u0+, A2/u#'s& G')'0 )&('0 P+('#'0'.s'(''( 1&'*+#+s 2+0&#us
F',2'.-0-)& 9 9 9
P+2*+,&'( -*'# M+()$'2*'# s+.,+s& s'0&@' T+,'/& &(su0&(
P+('#'0'.s'(''( $&/+,#&,-&1 :
9 9
P+2*+1'$'( T+,'/& ,'1&-'.#&f
=6 9 9 6 76 36 ?6 !6 9
P+('#'0'.s'(''( 1&'*+#+s 2+0&#us &.' 1&0'.u.'( #&(1'.'( 1,) L'.u.'( '('2(+s' P'1' /'s&+( 1&'*+#+s ,&()'( *&s' 1&0'.u.'( #&(1'.'( s+/+,#& *+,&.u# : T'2*'0'( S5'00&() R'1&-),' E.s#,'s& s+1+,$'(' E.s#,'s& s+,)&.'0 P'1' /+(1+,&#' 1&'*+#+s 2+0&#us /','$ #&1'. *&s' 1&0'.u.'.( #&(1'.'(4 $',us 1&,uu. #+,0+*&$ 1'$u0u .+/'1' 1-.#+, s/+s&'0&s /+('.&# 1'0'26 D&'*+#+s 2+0&#us #+,.-(#,-04 #&1'. /+,0u /+2*+,&'( -*'# '(#&*&-#&. /,-0'.s&s6 D&'*+#+s 2+0&#us #&1'. #+,.-(#,-04 0'.u.'( /+2*+,&'( -*'# '(#&*&-#&. /,-0'.s&s6 S$-,#+'#&()4 2+(u,u(.'( )u0' 1','$ 1'0'2 '().' /+(1+.6
9 9 9
"6R+s&.- 1',& 1&'*+#+s 2+0&#us &.' 1&0'.u.'( #&(1'.'( 1,) 9 P+(1','$'(4 1','$ su.', *+,$+(#& 9 I(f+.s&4 .',+(' .'1', )u0' 1','$ #&())& 9 P+(+*'0'( /+2*u0u$ 1','$ 9 '0&,'( 1','$ 2+0'2*'# 9 )&()&@' .+.u,'()'( (u#,&s&
6D&')(-s&s 1&'*+#+s 2+0&#us 9 &.' .+0u$'( 1&#+2u.'( /+2+,&.s''( )0u.-s' 1','$ 9 P+2+,&.s''( .+#&.' )u0' 1','$ /u's' 9 T+s TTDO 9 P+2+,&.s''( u,&( ,+1u.s& % *+',(' &())' 1'( .+,u$4 ? *+',(' 2+,'$ *#' 1'( .+,u$4 7 *+',(' .u(&() 1'( +0's4 *+',(' $&'u 1'( +(1'/'( .u(&()6 9 P+2+,&.s''( .'1', $+2-)0-*&(4 (-,2'07"" 9 Gu0' 1','$ /u's' 4 GDP 9 H*' 76Tu,u((' .+s+$'#'( )&)& .',+(' 1&'*+#+s 2+0&#us 9 T&())&(' 5'&,'( s'0&@' 9 G&)& 2u1'$ #+,&(f+.s& .',+(' 2+(1+,&#' 1&'*+#+s 2+0&#us
36N'f's /'. Yusuf *'u .+#-( 9 K+#-'s&1-s&s4 )0u.-s' #&1'. *&s' 2+2+#'*-0&s2+4 #+,1'/'# .'1', )u0' 1','$ 1'0'2 #u*u$ 9 M+2&5u /+2*'.','( 0+2'. 9 Tu*u$ #&1'. 2+2/u('& +(+,)& '() 2+2+,0u.'( +(+,)& 0'&(
?6K+('/' )&)& )-'$ 1+()'( /+(1+,&#' 1&'*+#+s 2+0&#us !6M+()'/' uu() .u.u ,'/u$
SKEMA BAPAK YUSUF !"THN%
BEROBAT KE POLI GIGI
KELUHAN
GIGI GELIGI GOYAH4 BAU NAFAS4 ANTUNG BERDEBAR4 GUSI MUDAH BERDEBAR4 SERING KERINGAT MALAM
PEMERIKSAAN DM TYPE97
KONTROL URIN REDUKSI %4 GDP 7" M)<104 TD ;"<=" 22H)4 NADI ""
PENYAKIT METABOLIK ENDROKIN
DM
HIPERTIROID HIPERPARATIROID
9
9
L'().'$ !
KLASIFIKASI 9 ETIOLOGI 9 TANDA DAN GEALA 9 PATOFISIOLOGI 9 MANIFESTASI ORAL 9 KOMPLIKASI 9 PENATALAKSANAAN PEMERIKSAAN PENUNANG
: 2+2f-,2u0's&.'( #uu'( /+2*+0'','(
M'$'s&s' 2'2/u 2+(+0's.'( 1'( 2+()+#'$u& 2+()+('& 2+('.&# 2+#'*-0&. +(1-.,&( D&'*+#+s 2+0&#us4 H&/+,/','#&,-&14 1'( H&/+,#&,-&1 9 9 9 9 9 9 9 9
KLASIFIKASI ETIOLOGI TANDA DAN GEALA PATOFISIOLOGI MANIFESTASI ORAL KOMPLIKASI PENATALAKSANAAN PEMERIKSAAN PENUNAN
L'().'$ ; 0'&(
: M+()u2/u0.'( &(f-,2's& 1& /+,/us#'.''(4 &(#+,(+# 1'( 0'&(9
L'().'$ >
: S&(#+s' 1'( u& &(f-,2's& '() #+0'$ 1& /+,-0+$
LO DIABETES MELITUS D&'*+#+s 2+0&#us '1'0'$ su'#u /+('.&# '() 1&s+*'*.'( -0+$ .u,'()(' /,-1u.s& &(su0&(6 D&'*+#+s 2+0&#us &(& 2+,u/'.'( /+('.&# '#'u .+'1''( 1&2'(' .'1', )u0' 1','$ 0+*&$ 1',& (-,2'06 KLASIFIKASI : K0's&.'s& 1&'*+#+s 2+00&#us '() 1&'(u,.'( -0+$ PERKENI P+,.u2/u0'( E(1-.,&(-0-)& I(1-(+s&'% '1'0'$ '() s+su'& 1+()'( '(u,'( .0's&.'s& DM 2+(u,u# A2+,&5'( D&'*+#+s Ass-5&'#&-( ADA% ==> '1'0'$ s+*')'& *+,&.u# : '% D&'*+#+s 2+0&#us #&/+ I D'0'2 #&/+ &(&4 #u*u$ #&1'. 1'/'# 2+2/,-1u.s& &(su0&(4 s+$&())' #+,)'(#u() /'1' &(su0&(6 D&'*+#+s 2+00&#us #&/+ &(& 1'/'# 2u(5u0 /'1' 2's' .'('.9.'('. 1'( ,+2''6 T&/+ &(& 1'/'# 2u(5u0 /'1' u2u, '() 0+*&$ #u' '() 1&s+*'*.'( .',+(' .+,us'.'( /'(.,+'s -0+$ .',+(' '05-$-04/+('. -/+,'s& /'(.,+'s '#'u .+)')'0'( /,-),+s&f 1',& s+0 *+#' /'(.,+'s6 *% D&'*+#+s M+0&#us #&/+ II D&.+('0 1+()'( ('2' Non Insulin Dependent Diabetes Mellitus (NIDDM) 4 '() 1&s+*'*.'( -0+$ .-2*&('s& 1',& /'1' &(suf&s&+(s& s+0 /'(.,+'s 1'( ,+s&s#+(s& &(su0&( 1'0'2 ',&()'(4 #+,u#'2' 1&1'0'2 -#-# s.+0+#'0 1'( s+09s+0 $+/',6
5% D&'*+#+s M+0&#us #&/+ 0'&( A1' *+*+,'/' #&/+ 1&'*+#+s '() 0'&( s+/+,#& 1+f+. )+(+#&. fu()s& s+0 *+#'4 1+f+. )+(+#&. .+,' &(su0&(4 /+('.&# +.s-.,&( /'(.,+'s4 +(1-.,&(-/'#&4 .',+(' -*'# '#'u '# .&2&'4 &(f+.s&4 s+*'* &2u(-0-)& '() ','() 1'( s&(1,-2' )+(+#&. 0'&( '() *+,.'&#'( 1+()'( 1&'*+#+s 2+00&#us6 1% D&'*+#+s M+0&#us G+s#'s&-('0 T&/+ &(& #&2*u0 /'1' '(&#' $'2&0 '() .+2u1&'( )+'0' 2+()$&0'() s+#+0'$ 2+0'$&,.'( *'& *&'s'(' 1+()'( *+,'# *'1'( '() 0+*&$ *+s', 1&*'(1&() 1+()'( *'& 0'&( /'1' u2u2('6 W'(&#' '() #+0'$ 2+(1+,&#' G+s#'s&-('0 D&'*+#+s M+00&#us 2+(&().'#.'( f'.#-, ,+s&.- u(#u. #+,'1&(' 1&'*+#+s 2+00&#us #&/+ II
P'1' s''# s+-,'() '(&#' $'2&04 '1' *+*+,'/' $-,2-( '() 2+()'0'2& /+(&().'#'( u20'$6 M&s'0('4 $-,2-( .-,#&s-04 +s#,-)+(4 1'( human placental lactogen HPL%6 T+,('#'4 s''# $'2&04 /+(&().'#'( u20'$ $-,2-(9$-,2-( #+,s+*u# 2+2/u('& /+()',u$ #+,$'1'/ fu()s& &(su0&( 1'0'2 2+()'#u, .'1', )u0' 1','$ )0u.-s'%6 K-(1&s& &(& 2+(+*'*.'( .-(1&s& '() .+*'0 #+,$'1'/ &(su0&( '() 1&s+*u# s+*')'& &(su0&( ,+s&s#'(5+6 S''# fu()s& &(su0&( 1'0'2 2+()+(1'0&.'( .'1', )u0' 1'0'2 1','$ #+,)'())u4 u20'$ )u0' 1'0'2 1','$ /'s#& '.'( ('&.6 H'0 &(&0'$ '() .+2u1&'( 2+(+*'*.'( s+-,'() '(&#' $'2&0 2+(1+,&#' 1&'*+#+s )+s#'s&-('06
ETIOLOGI •
9
:
DIABETES TIPE F'.#-, )+(+#&.
P+(1+,&#' 1&'*+#+s #&1'. 2+',&s& 1&'*+#+s #&/+ &#u s+(1&,&4 #+#'/& 2+',&s& su'#u /,+1&s/-s&s& '#'u .+5+(1+,u()'( )+(+#&. .+ ','$ #+,'1& (' 1&'*+#+s 2+0&#us #&/+ 6 K+5+(1,u()'( )+(+#&. &(& 1&#+2u.'( /'1' &(1&@&1u '() 2+2&0&.& #&/+ '(#&)+( HLA6 9
F'.#-,9f'.#-, &2u(-0-)&
A1'(' ,+s/-( -#-&2u( '() 2+,u/'.'( ,+s/-( '*(-,2'0 1&2'(' '(#&*-1& #+,','$ /'1' ',&()'( (-,20 #u*u$ 1+()'( 5',' *+,+'.s& #+,$'1'/ ',&()'( #+,s+*u# '() 1&'())'/(' s+-0'$9-0'$(' s+*')'& ',&()'( 's&()6 Y'&#u -#-'(#&*-1& #+,$'1'/ s+09s+0 L'()+,$'(s 1'( &(su0&( +(1-)+(6 9
F'.#-, 0&().u()'(
V&,us '#'u #-.s&( #+,#+(#u 1'/'# 2+2&5u /,-s+s -#-&2u( '() 2+(&2*u0.'( 1+s#,u.s& s+0 *+#'6
TANDA DAN GEALA
:
6 P+(u,u('( *+,'# *'1'( BB% P+(u,u('( BB '() *+,0'()su() 1'0'2 '.#u ,+0'#&f s&().'# $',us 2+(&2*u0.'( .+5u,&)''(6 H'0 &(& 1&s+*'*.'( )0u.-s' 1'0'2 1','$ #&1'. 1'/'# 2'su. .+ 1'0'2 s+04 s+$&())' s+0 .+.u,'()'( *'$'( *'.', u(#u. 2+()$'s&0.'( #+(')'6 U(#u. .+0'()su()'( $&1u/4 su2*+, #+(')' #+,/'.s' 1&'2*&0 1',&
5'1'()'( 0'&( '&#u s+0 0+2'. 1'( -#-#6 A.&*'#(' /+(1+,&#' .+$&0'()'( ',&()'( 0+2'. 1'( -#-# s+$&())' 2+('1& .u,us6 76 P-0&u,&' P-0&u,&' '1'0'$ @-0u2+ u,&( '() *'('. 1'0'2 /+,&-1+ #+,#+(#u .',+('4 .'1', )0u.-s' 1','$ '() #&())& '.'( 2+(+*'*.'( *'('. .+(5&()6 K+(5&() '() s+,&() 1'( 1'0'2 u20'$ *'('. '.'( 36 P-0&1&/s&' R's' $'us '2'# s+,&() 1&'0'2& -0+$ /+(1+,&#' .',+(' *'('.(' 5'&,'( '() .+0u', 2+0'0u& .+(5&()6 K+'1''( &(& us#,u s+,&() 1&s'0'$#'fs&,.'( 1+()'( 2+(+*'*.'( ,'s' $'us .',+(' u1',' '() /'('s '#'u *+*'( .+,' '() *+,'# s+$&())' u(#u. 2+()$&0'().'( ,'s' $'us &#u /+(1+,&#' *'('. 2&(u26 ?6 P-0&f')&' K'0-,& 1',& 2'.'('( '() 1&2'.'(4 s+#+0'$ 1&2+#'*-0&s's&.'( 2+('1& )0u.-s' 1'0'2 1','$ #&1'. s+0u,u$(' 1'/'# 1&2'(f''#.'(4 /+(1+,&#' s+0'0u 2+,'s' 0'/',6
PATOFIOLOGI
:
P'(5,+'s '() 1&s+*u# .+0+(', 0u1'$ /+,u#4 '1'0'$ .+0+(', /+()$'s&0 &(su0&( '() #+,0+#'. 1& *+0'.'() 0'2*u()6 D& 1'0'2(' #+,1'/'# .u2/u0'( s+0 '() *+,*+(#u. s+/+,#& /u0'u /'1' /+#'4 .',+(' &#u 1&s+*u# /u0'u9/u0'u L'()+,$'(s '() *+,&s& s+0 *+#' '() 2+()+0u',.'( $-,2-(+ &(su0&( '() s'()# *+,/+,'( 1'0'2 2+()'#u, .'1', )0u.-s' 1','$6 I(su0&( '() 1&.+0u',.'( -0+$ s+0 *+#' #'1& 1'/'# 1&&*','#.'( s+*')'& '('. .u(5& '() 1'/'# 2+2*u.' /&(#u 2'su.(' )0u.-s' .+ 1'0'2 s+04 u(#u. .+2u1&'( 1& 1'0'2 s+0 )0u.-s' #+,s+*u# 1&2+#'*-0&s's&.'( 2+('1& #+(')'6 B&0' &su0&( #&1'. '1'4 2'.' )0u.-s' 1'0'2 1','$ #&1'. 1'/'# 2'su. .+ 1'0'2 s+0 1+()'( '.&*'# .'1', )0u.-s' 1'0'2 1','$ #&1'. 1'/'# 2'su. .+ 1'0'2s +0 1+()'( '.&*'# .'1', )0u.-s' 1'0'2 1','$ 2+(&().'#6 K+'1''( &(&0'$ '() #+,'1& /'1' 1&'*+#+s 2+00&#us #&/+ 6 P'1' .+'1''( 1&'*+#+s 2+00&#us #&/+ 74 u20'$ &(su0&( *&s' (-,2'04 *'$.'( 0+*&$ *'('.4 #+#'/& u20'$ ,+s+/#-, /+('().'/% &(su0&( 1& /+,2u.''( s+0 .u,'()6 R+s+/#-, &(su0&( &(& 1'/'# 1&&*','#.'( s+*')'& 0u*'() .u(5& /&(#u 2'su. .+ 1'0'2 s+06 P'1' .+'1''( DM #&/+ 74 u20'$ 0u*'() .u(5&(' .u,'()4 s+$&())' 2+s.&/u( '('. .u(5&(' &(su0&(% *'('.4 #+#'/& .',+(' 0u*'() .u(5&(' ,+s+/#-,% .u,'()4 2'.' )0u.-s' '() 2'su. .+ 1'0'2 s+0 s+1&. s+$&())' s+0 .+.u,'()'( *'$'( *'.', )0u.-s'% 1'( .'1', )0u.-s' 1'0'2 1','$ 2+(&().'#6 D+()'( 1+2&.&'( .+'1''( &(& s'2' 1+()'( .+'1''( DM #&/+ 4 *1'(' '1'0'$ /'1' DM #&/+ 7 1&s'2/&() .'1', )0u.-s' #&())&4 .'1', &(su0&( u)' #&())& '#'u (-,2'06 P'1' DM #&/+ 7 u)' *&s' 1&#+2u.'( u20'$ &(su0&( 5u.u/ '#'u 0+*&$ #+#'/& .u'0&#'s(' .u,'() *'&.4 s+$&())' )')'0 2+2*'' )0u.-s' 2'su. .+
1'0'2 s+06 D& s'2/&() /+(+*'* 1& '#'s4 DM u)' *&s' #+,'1& '.&*'# )'())u'( #,'(s/-,# )0u.-s' 1& 1'0'2 s+0 s+$&())' )')'0 1&)u('.'( s+*')'& *'$'( *'.', u(#u. 2+#'*-0&s2+ +(+,)6
MANIFESTASI ORAL : 6 G&()&@&#&s 1'( /+,&-1-(#&#&s G&()&@&#&s 2+,u/'.'( &('2's& /'1' )us& '() 2u1'$ u(#u. 1&s+2*u$.'(4 1&2'(' /'1' ',&()'( )&())&@' #+,0&$'# .+2+,'$92+,'$'( 1&s+,#'& /+2*+().'.'( 1'( *&0' 1&s&.'# 1+()'( s&.'# )&)& '.'( *+,1','$6 G&()&@&#&s '.'( 2+(&2*u0.'( #+,*+(#u.(' /+,&-1-(#'0 /-5.+# 1&s+,#'& '1'(' ,+s-,/s& #u0'()4 s+$&())' )&)& )-'() 1'( '.$&,(' #'())'06
G'2*', 767 : P+,&-1-(#&#&s /'1' /+(1+,&#' D&'*+#+s M+00&#us
G'2*', 763 : G&()&@&#&s /'1' /+(1+,&#' D&'*+#+s M+00&#us #&/+ II 76 +,-s#-2&' 1'( 1&sfu()s& .+0+(', s'0&@' H&/+,)0&.+2&' 2+()'.&*'#.'( 2+(&())&(' u20'$ u,&( s+$&())' 5'&,'( 1'0'2 #u*u$ *+,.u,'() 1'( s+.,+s& s'0&@' u)' *+,.u,'()6 D+()'( *+,.u,'()(' s'0&@'4 1'/'# 2+()'.&*'#.'( #+,'1&(' J+,-s#-2&6 D'0'2 ,-())' 2u0u# '()
s+$'#4 s'0&@' 2+()'(1u() +(&29+(&2 '(#&2&.,-*'4 2&s'0(' : L'5#-f+,&(4 /+,&-J&1's+4 0s-2+ 1'( $&s#&1&(+ '() *+,&(#+,'.s& 1+()'( 2u.-s' -,'0 1'( 1'/'# 2+(5+)'$ /+,#u2*u$'( .'(1&1' '() *+,0+*&$'(6P'1' .+'1''( 1&2'(' #+,'1&(' /+,u*'$'( /'1' ,-())' 2u0u# '() 1&s+*'*.'( *+,.u,'()(' '0&,'( s'0&@'4 s+$&())' +(&29+(&2 '(#&2&.,-*' 1'0'2 s'0&@' #&1'. *+,fu()s& 1+()'( *'&.4 2'.' ,-())' 2u0u# 2+('1& ,+(#'( #+,$'1'/ .+'1''( 2u.-s' '() *u,u. 1'( 2+(&2*u0.'( 0+s&90+s& '() 2+(&2*u0.'( ,'s' s'. P's&+( 1&'*+#+s 2+00&#us '() 2+()'0'2& 1&sfu()s& .+0+(', s'0&@' u)' 1'/'# 2+()'0'2& .+su0&#'( 1'0'2 2+()u('$ 1'( 2+(+0'( s+$&())' 2+()'.&*'#.'( ('fsu 2'.'( *+,.u,'() 1'( #+,'1&(' 2'0(u#,&s&6
G'2*', 76? : '.&*'# J+,-s#-2&'
G'2*', 76! : D, 2-u#$ &( 'u#-&22u(+ 1&s-,1+,s '(1 1&'*+#+s 36 I(f+.s& .'(1&1&'s&s K'(1&1&'s&s -,'0 2+,u/'.'( &(f+.s& *'.#+,& -/-,#u(&s#&. '() #+,'1& 1'0'2 .+'1''( $&/+,)0&.+2&' .',+(' .+'1''( #+,s+*u# 1'/'# 2+(+*'*.'( #+,'1&(' 1&sfu()s& '0&,'( s'0&@' .',+(' '1'(' .+$&0'()'( 5'&,'( 1',& #u*u$ 1'0'2 u20'$ '() *'('.4 s+$&())' '0&,'( s'0&@' u)' *+,.u,'()6 S+0'&( &#u4 u)' 2+(+*'*.'( .-2/0&.'s& *+,u/' microangiopathy '() /'0&() s+,&() 2u(5u0 /'1' /+(1+,&#' 1&'*+#+s 2+00&#us #+,.-(#,-0 '#'u #&1'. #+,.-(#,-06 O0+$ &#u4 K'(1&1&'s&s 1'/'# 1&#+2u.'( /'1' /+(1+,&#' 1&'*+#+s 2+00&#us *&0' 1&1u.u() *+,*')'& f'.#-, '() '1' /'1' /+(1+,&#' 1&'*+#+s 2+00&#us4 s+/+,#& #+,'1&('
1+s&+(s& &2u(4 *+,.u,'()(' '0&,'( s'0&@'4 .+'1''( 2'0(u#,&s& 1'( /+2'.'&'( )&)& #&,u'( 1+()'( -,'0 $)&+(+ '() *u,u.6
G'2*', 76; : K'(1&1&'s&s /'1' /+(1+,&#' D&'*+#+s M+00&#us #&/+ II
?6 S&(1,-2' 2u0u# #+,*'.', P's&+( 1+()'( s&(1,-2' 2u0u# #+,*'.', *&'s'(' 2u(5u0 #'(/' #'(1'9#'(1' .0&(&s4 '0'u/u( ,'s' s'.&# 1'( #+,*'.', s'()'# .u'#6 P'1' /'s&+( 1+()'( 1&'*+#+s 2+00&#us #&1'. #+,.-(#,-04 f'.#-, '() 2+(+*'*.'( #+,'1&(' s&(1,-2' 2u0u# #+,*'.', '&#u *+,u/' 1&sfu()s& .+0+(', s'0&@'4 .'(1&1&'s&s 1'( .+0'&('( /'1' s','f6 A1'(' .+0'&('( /'1' s','f '.'( 2+(1u.u() #+,'1&(' )+'0'9)+'0' paraesthesias 1'( tingling, ,'s' s'.&# < #+,*'.', '() 1&s+*'*.'( '1'(' /+,u*'$'( /'#-0-)&s /'1' s','f9s','f 1'0'2 ,-())' 2u0u#6 !6 I(f+.s& -,'0 '.u# P'1' /+(1+,&#' diabetes mellitus 1'/'# 2+(+*'*.'( *'('. .-2/0&.'s& 0'&( '() 2's&$ *+0u2 1&u2/'&4 $'0 &(& 2+2u().&(.'( #+,'1&(' 2+.'(&s2+ /'#-)+( '() *+,$u*u()'( 1+()'( &(f+.s&9&(f+.s& /+,&-1-(#'0 '() *+,/+,'( /+(#&() 1'0'2 /+,.+2*'()'(6 KOMPLIKASI : '6 K-2/0&.'s& '.u# K-2/0&.'s& '.u# #+,'1& &.' .'1', )0u.-s' 1','$ s+s+-,'() 2+(&().'# '#'u 2+(u,u( 1+()'( #''2 1'0'2 '.#u ,+0'#&f s&().'#6 6 H&/-)0&.+2&' 76 K+#-'s&1-s&s& 1&'*+#&59.-2' 1&'*+#&5 36 K-2' $&/+,-s2-0+, (-( .+#-#&. ?6 K-2' 0'.#-'s&1-s&s *6 K-2/0&.'s& .,-(&s 6 P+('.&# 2&.,-@'s.u0+, 76 N+u,-/'#& 36 R+(#'( &(f+.s& s+/+,#& #u*+,.u0-s&s /',u 1'( &(f+.s& s'0u,'( .+2&$ ?6 U0.us 1&'*+#&.u2 56 K-2/0&.'s& -f#'02-0-)&
PENATALAKSANAAN
:
6 '6 *6 76 '6 *6
F',2'.-0-)& T+,'/& &(su0&( O*'# $&/-)0&.+2&' N-( f',2'.-0-)& D&+# K-2/-s&s& s+&2*'() .',*-$&1,'# ;"9>" /+,s+(4 /,-#+&( "9! /+,s+(4 0+2'. 7"97! /+,s+(6 56 u20'$ .'0-,& 1&s+su'&.'( 1+()'( /+()$&#u()'( s#'#us )&&4 u2u,4 .+)&'#'( 's2'(& 1'( *+,'# *'1'(6 PEMERIKSAAN PENUNANG
:
6 G0u.-s' 1','$ s+'.#u 76 K'1', )0u.-s' 1','$ /u's' 36 T+s #-0+,'(s& )0u.-s'
HIPERTIROID
H&/+,#&,-&1 '1'0'$ su'#u .+'1''( 1&2'(' 1&1'/'#.'( .+0+*&$'( $-,2-( #&,-&1 .',+(' &(& *+,$u*u()'( 1+()'( su'#u .-2/0+.s s&-0-)&s 1'( *&-.&2&'& '() 1&#+2u.'( *&0' su'#u ',&()'( 2+2*+,&.'( $-,2-( #&,-&1 *+,0+*&$'(6 K+'1''( #&,-.s&.-s&s s+*')'& '.&*'# 1',& /,-1u.s& #&,-&1 '() 2+,u/'.'( '.&*'# 1',& fu()s& #&,-&1 '() *+,0+*&$'(6 PATOFISIOLOGI
:
H&/+,#&,-&1 1'/'# #+,'1& '.&*'# 1&sfu()s& .+0+(', #&,-&14 $&/-s&s '#'u $&/-#'0'2us6 P+(&().'#'( TSH '.&*'# 2'0fu()s& .+0+(', #&,-&1 '.'( 1&s+,#'& /+(u,u('( TSH 1'( TRF .',+(' u2/'( *'0&. (+)'#&f HT #+,$'1'/ /+0+/'s'( .+1u'('6 9 9 9 9 9 9 9 9
6 P+(+*'* u#'2' P+('.&# ),'@+ S-0&#', #-J&5 '1+(-2' 76 P+(+*'* 0'&( T&,-&1&#&s P+('.&# #,-*-*0's#&s H-,2-( #&,-&1 s+5',' *+,0+*&$'( P+2'.'&'( -1&u2 '() *+,0+*&$'( K'(.+, /&#u&#',& O*'#9-*'# '(
P+('.&# ),'@+4 /+(+*'* #+,s+,&() $&/+,#&,-&1 '1'0'$ su'#u /+('.&# -#-&2u( '() *&'s'(' 1&#'(1'& -0+$ /,-1u.s& -#-'(#&*-1& '() 2+2&0&.& .+,' 2&,&/ TSH /'1' .+0+(', -#-'(#&*-1& I)G &(& '() 1&s+*u# &22u(-)0-*u0&( /+,'()s'()
#&,-&14 2+(&().'#.'( /+2*+(#u.'( HT4#+#'/& #&1'. 2+()'0'2& u2/'( *'0&. (+)'#&f 1',& .'1', HT '() #&())&6 GEALA
:
6 P+(&().'#'( f,+.u+(s& 1+(u# '(#u() 76 P+(&().'#'( #-(us -#-#4 #,+2-,4 &,&*&0&#'s4 /+(&().'#'( .+/+.''( #+,$'1'/ .'#+0 .+0'2&( 36 P+(&().'#'( 0'u 2+#'*-0&s2+ *'s'04 /+2*+(#u.'( /'('s4 &(#-0+,'( #+,$'1'/ /'('s4 1'( .+,&()'# *+,0+*&$'( ?6 P+(u,u('( *+,'# *'1'(4 /+(&().'#'( ('fsu 2'.'( !6 P+(&().'#'( f,+.u+(s& *u'() '&, *+s', ;6 G-(1-.*&'s'('% '&#u /+(&().'#'( u.u,'( .+0+(', #&,-&1 >6 G'())u'( ,+/,-1u.s& 86 T&1'. #'$'( /'('s =6 C+/'# 0+#&$ "6H'&1 s+1&.&# 1'( #&1'. #+#'/ 6P+2*+s','( .+0+(', #&,-&1 76M'#' 2+0-#-# +J-/&#'0'2us% KOMPLIKASI
:
K-2/0&.'s& $&/+,#&,-&1 '() 1'/'# 2+()'(5'2 ('' '1'0'$ .,&s&s #&,-#-.s&.6 H'0 &(& 1'/' *+,.+2*'() s+5',' s/-(#'( /'1' /'s&+( $&/+,#&,-&1 '() 2+('0'(& #+,'/&4 s+0'2' /+2*+1'$'( .+0+(', #&,-&1 '#'u #+,'1& /'1' /'s&+( $&/+,#&,-&1 '() #+,1&')(-s&s6 A.&*'#(' '1'0'$ /+0+/'s'( HT 1'0'2 u20'$ '() s'()'# *+s', '() 2+(+*'*.'( #'.&.',1&4 ')&#'s&4 #,+2-,4 $&/+,#+2&'6 PENATALAKSANAAN 6 '6 9 9 9 9 76 9 9
:
K-(s+,@'#&f O*'# '(#&9#&,-&1 T$&-'2&1+ M+#$&2'-0+ P-##'ss&u2 &-1&1+ S-1&u2 &-1&1+ Su,)&5'0 R'1&-'.#&f &-1&(+ T&,&-1+.#-2&
O*'#9-*'# '(#&#&,-&1 : % C',*&2'-0+ .',*&2's-0% B+,.$'s&'# 1'/'# 2+()u,'()& /,-1u.s& $-,2-( #&,-&16 Mu0'92u0' 1-s&s(' *&s' s'2/'& 398 #'*0+# s+$',&4 #+#'/& *&0' su1'$ s#'*&0 *&s' 5u.u/ 93 #'*0+# s'' s+$',&6 O*'# &(& 5u.u/ *'&. u(#u. /+('.&# $&/+,#&,-&16 Ef+. s'2/&()(' '() ')'. s+,&us '1'0'$ #u,u((' /,-1u.s& s+0 1','$ /u#&$ '),'(u0-s&#-s&s% 1'( )'())u'( /'1' fu()s& $'#&6 C&,&95&,& '),'(u0-s&#-s&s '1'0'$ s+,&() s'.&# #+())-,-.'( '() #&1'. s+2*u$9s+2*u$ 1'( u)' 2u1'$ #+,.+(' &(f+.s& s+,#' 1+2'26 S+1'().'( 5&,&95&,& )'())u'( fu()s&
$'#& '1'0'$ ,'s' 2u'04 2u(#'$4 1'( s'.&# /'1' /+,u# s+*+0'$ .'('(4 s+,#' #&2*u0(' ',(' .u(&() /'1' *')&'( /u#&$ 2'#'4 .u.u4 1'( .u0 7% K'02+#$'s-(+ 2+()'(1u() '# '.#&f 1+.s'2+#'s-(% M+,u/'.'( -*'# $-,2-( .-,#&.-s#+,-&1 '() u2u2(' 1&/'.'& s+*')'& -*'# '(#& /+,'1'()'(6 O*'# &(& 1'/'# 1&)u('.'( u(#u. 2+()$&0'().'( /+,'1'()'( 1& .+0+(', #&,-&1 #$,-&1&#&s%6
MANIFESTASI ORAL 6 76 36 ?6 !6
:
Mu1'$ #+,'1& .',&+s P+('.&# /+,&-1-(#'0 T+,'1& /+2*+s','( ',&()'( )0'(1u0' #&,-&1 P+,5+/'#'( +,u/s& )&)& G+'0' 2u0u# #+,'s' #+,*'.',
PEMERIKSAAN PENUNANG 6 76 36 ?6 !6
:
P+2+,&.s''( .'1', .'0s&#-(&( B&-/s& ',u2 $'0us P+2+,&.s''( s&1&. #&,-&1 R'1&-0-)&s u(#u. 2+(5',& 2+#'s&#-s&s H&s#-/'#-0-)&
B+*+,'/' /+('.&# '() 2+(+*'*.'( H&/+,#&,-&1 '&#u : 6
P+('.&# G,'@+s
L+*&$ 1',& =! .'sus $&/+,#&,-&1 1&s+*'*.'( -0+$ /+('.&# ),'@+s4su'#u /+('.&# #&,-&1 'u#-&2u( '() '(#&*-1&(' 2+,'()s'() s+09s+0 u(#u. 2+()$'s&0.'( $-,2-(+ '() *+,0+*&$'(6 P+('.&# G,'@+s4 '() 1&s+*'*.'( -0+$ su'#u '.#&@&#'s '() *+,0+*&$'( 1',& .+0+(', #&,-&1 '() 1&s'2' ,'#'.'(4 '1'0'$ /+(+*'* '() /'0&() u2u2 1',& $&/+,#&,-&16 P'1' .-(1&s& &(&4 .+0+(', #&,-&1 *&'s'(' '1'0'$ /+().$&'('#4 '() *+,',#& &' #+0'$ .+$&0'()'( .+2'2/u'((' u(#u. 2+,+s/-( /'1' .-(#,-0 '() (-,2'0 -0+$ .+0+(', /&#u&#',& @&' TSH6 P+('.&# G,'@+s '1'0'$ 1&#u,u(.'(<1&',&s.'( 1'( '1'0'$ s'2/'& 0&2' .'0& 0+*&$ u2u2 1&'(#',' '(&#'9'(&#' 1',&/'1' /,&'9/,&'6 P+('.&# G,'@+s 1&/+,.&,'.'( '1'0'$ su'#u /+('.&# 'u#-&2u(4 1'( '(#&*-1&9'(#&*-1& '() '1'0'$ .','.#+,&s#&.9 .','.#+,&s#&. 1',& /+('.&# &(& 2u().&( 1&#+2u.'( 1'0'2 1','$6 A(#&*-1&9'(#&*-1& &(& #+,2'su. thyroid stimulating immunoglobulin (TSI antibodies), thyroid peroxidase antibodies (TPO), dan antibodiantibodi reseptor TS!" P+(5+#us9/+(5+#us u(#u. /+('.&# G,'@+ #+,2'su.: 9 9 9 9
S#,+s M+,-.-. R'1&'s& /'1' 0+$+, O*'#9-*'#'( 1'(
O,)'(&s2+9-,)'(&s2+ '() 2+(+*'*.'( &(f+.s& s+/+,#& @&,us9@&,us6 P+('.&# G,'@+s 1'/'# 1&1&')(-s&s 1+()'( su'#u s5'( #&,-&1 1+()'( -*'# (u.0&, '() s#'(1', '() 2+(u(u..'( s+5',' /'('() 0+*', /+()'2*&0'( '() 2+(&().'# 1',& su'#u -1&u2 '() 1&0'*+0 1+()'( ,'1&-'.#&f6 S+*')'& #'2*'$'(4 s+*u'$ #+s 1','$ 2u().&( 2+()u().'/ #&().'#9#&().'# TSI '() 2+(&().'#6 P+('.&# G,'@+ 2u().&( *+,$u*u()'( 1+()'( /+('.&# 2'#' (#ra$es% ophthalmopathy) 1'( 0u.'90u.' .u0&# 1+,2-/'#$%6 O/$#$'02-/'#$ 1'/'# #+,'1& s+*+0u24 s+su1'$4 '#'u /'1' s''# '() s'2' 1+()'( $&/+,#&,-&16 P'1' ''0('4 &' 2u().&( 2+(+*'*.'( .+/+.''( #+,$'1'/ 5'$'' 1'( su'#u /+,'s''( 1',& Q'1' /'s&, 1&1'0'2 2'#'92'#'Q6 M'#'92'#' 2u().&( 2+(-(-0 .+0u', 1'( /+()0&$'#'( )'(1' 1-*+0% 1'/'# #+,'1&6 D+,''# 1',& -/$#$'02-/'#$ 1&/+,*u,u. /'1' 2+,+.' '() 2+,-.-.6 '0'((' /+('.&# 2'#' s+,&().'0& #&1'. #+,)'(#u() 1',& /+('.&# #&,-&14 1'( #+,'/& s#+,-&1 2u().&( /+,0u u(#u. 2+()-(#,-0 /+,'1'()'( '() 2+(+*'*.'( -/$#$'02-/'#$6 S+*')'& #'2*'$'(4 &(#+,@+(s& s+5',' -/+,'s& 2u().&( 1&/+,0u.'(6 K-(1&s& .u0&# 1+,2-/'#$% '1'0'$ ','() 1'( 2+(+*'*.'( su'#u ,u'2 .u0&# '() #'(/' s'. 2+,'$4 #&1'. $'0us '() #'2/'. /'1' 2u.' 1',& .'.&9.'.&6 36 Fu(5#&-(&() A1+(-2' 1'( T-J&5 Mu0#&(-1u0', G-&#+, K+0+(', #&,-&1 s+/+,#& *'('. ',+'9',+' 0'&( 1',& #u*u$% 2+('1& 0+*&$ *+,)u2/'09)u2/'0 .+#&.' .&#' 2+(u'6 P'1' .+*'('.'( .'sus9.'sus4 )u2/'09 )u2/'0 &(& #&1'. 2+2/,-1u.s& $-,2-(9$-,2-( #&,-&1 1'( #&1'. 2+2+,0u.'( /+,''#'(6 A1'.'0'('4 su'#u *+(-0'( 2u().&( 2+('1& Q-#-(-2&Q4 '() *+,',#& *'$' &' #&1'. 2+,+s/-( /'1' /+()'#u,'( /&#u&#',& @&' TSH 1'( 2+2/,-1u.s& $-,2-(9$-,2-( #&,-&1 1+()'( *+*'s6 I(& 2+('1& 0+*&$ 2u().&( &.' *+(-0'( 0+*&$ *+s', 1',& 3 526 K+#&.' '1' su'#u *+(-0'( (-1u0+% #u())'0 '() 2+2/,-1u.s& s+5',' *+*'s $-,2-(9$-,2-( #&,-&14 &#u 1&s+*u# su'#u fu(5#&-(&() (-1u0+6 &.' '1' 0+*&$ 1',& s'#u fu(5#&-(&() (-1u0+4 &s#&0'$ #-J&5 2u0#&(-1u0', )-&#+, )-(1-.'(% 1&)u('.'(6 Fu(5#&-(&() (-1u0+s 2u().&( s&'/ 1&1+#+.s& 1+()'( su'#u #$,-&1 s5'(6 36
T-J&5 N-1u0', G-&#+,
B+(-0'( 0+$+, '.&*'# /+2*+s','( #&,-&1 '() *+,*+(#u. *&& /'1'#4 *&s' s'#u '#'u *'('.6 K'#' #-J&5 *+,',#& $&/+,#&,-&14 s+1'().'( (-1u0+ '#'u *&& &#u #&1'. #+,.-(#,-0 -0+$ TSH s+$&())' 2+2/,-1u.s& $-,2-( #&,-&1 '() *+,0+*&$'(6 ?6
P+2'su..'( $-,2-(9$-,2-( #&,-&1 '() *+,0+*&$'(
M+()'2*&0 #+,0'0u *'('. -*'# $-,2-( #&,-&1 s+*+(',(' '1'0'$ su())u$ u2u26 D-s&s91-s&s $-,2-(9$-,2-( #&,-&1 '() *+,0+*&$'( s+,&().'0& #&1'. #+,1+#+.s& 1&s+*'*.'( .u,'()(' f-00-9u/ 1',& /'s&+(9/'s&+( '() 2+2&(u2 -*'# #&,-&1 2+,+.'6 O,'()9-,'() 0'&( 2u().&( 2+('0'$)u('.'( -*'# 1'0'2 su'#u us'$' u(#u. 2+(5'/'& #uu'(9#uu'( 0'&( s+/+,#& 2+(u,u(.'( *+,'# *'1'(6 P's&+(9/'s&+( &(& 1'/'# 1&&1+(#&.'s&.'( 1+()'( 2+(1'/'#.'( su'#u /+()'2*&0'( -1&u2 *+,0'*+0 ,'1&-'.#&f '() ,+(1'$ ,'1&-&-1&(+% /'1' su'#u #$,-&1 s5'(6
!6
P+()+0u','( '*(-,2'0 1',& TSH
S+*u'$ #u2-, 1&1'0'2 .+0+(', /&#u&#',& 2u().&( 2+()$'s&0.'( su'#u /+()+0u','( 1',& TSH #$,-&1 s#&2u0'#&() $-,2-(+% '() #&())&(' '*(-,2'06 I(& 2+(u,us /'1' #'(1' '() *+,0+*&$'( /'1' .+0+(', #&,-&1 u(#u. 2+()$'s&0.'( $-,2-(9$-,2-( #&,-&16 K-(1&s& &(& '1'0'$ s'()'# ','() 1'( 1'/'# 1&.'&#.'( 1+()'( .+0'&('(9.+0'&('( 0'&( 1',& .+0+(', /&#u&#',&6 U(#u. 2+()&1+(#&.'s& .+.'5'u'( &(&4 s+-,'() +(1-5,&(-0-)&s# 2+0'.u.'( #+s9#+s #+,/+,&(5& u(#u. 2+(&0'& /+0+/'s'( 1',& TSH6 ;6
T&,-&1&#&s /+,'1'()'( 1',& #&,-&1%
P+,'1'()'( 1',& .+0+(', #&,-&1 2u().&( #+,'1& s+#+0'$ su'#u /+('.&# @&,us (subacute thyroiditis)" K-(1&s& &(& *+,$u*u()'( 1+()'( su'#u 1+2'2 1'( su'#u s'.&# 0+$+, '() s+,&().'0& s'.&# /'1' '.#u 2+(+0'(6 K+0+(', #&,-&1 u)' 0u('. &.' 1&s+(#u$6 Mu().&( '1' s'. s'.&# 0+$+, 1'( (+,&9(+,& '() 1&s'2' ,'#'.'(6 P+,'1'()'( .+0+(', 1+()'( su'#u '.u2u0's& s+09s+0 1','$ /u#&$ 1&.+('0 s+*')'& lymphocytes (lymphocytic thyroiditis) 2u().&( u)' #+,'1&6 P'1' .+1u' .-(1&s&9.-(1&s& &(&4 /+,'1'()'( 2+(&())'0.'( .+0+(', #&,-&1 Q*-5-,Q4 s+$&())' u20'$ $-,2-( #&,-&1 '() 2'su. .+ 1','$ 2+(&().'#6 L2/$-5#&5 #$,-&1&#&s '1'0'$ /'0&() u2u2 s+#+0'$ su'#u .+$'2&0'( 1'( 1'/'# s+*+(',(' #+,'1& /'1' s'2/'& 1+()'( 8 1',& '(&#'9'(&#' s+#+0'$ 2+0'$&,.'(6 P'1' .'sus9.'sus &(&4f's+ $&/+,#&,-&1 1'/'# *+,0'()su() 1',& ? s'2/'& 7 2&())u 1'( s+,&().'0& 1&&.u#& -0+$ su'#u f's+ $&/-#&,-&1 $'s&0 #&,-&1 '() ,+(1'$% '() 1'/'# *+,0'()su() s'2/'& ; *u0'(6 M'-,&#'s 1',& '(&#'9'(&#' '() #+,/+()',u$ .+2*'0& .+ su'#u .+'1''( fu()s& #&,-&1 '() (-,2'06 T&,-&1&#&s 1'/'# 1&1&')(-s&s 1+()'( su'#u #$,-&1 s5'(6 >6
P+2'su..'( Y-1&u2 '() *+,0+*&$'(
K+0+(', #&,-&1 2+())u('.'( -1&u2 u(#u. 2+2*u'# $-,2-(9$-,2-( #&,-&16 Su'#u .+0+*&$'( -1&u2 1'/'# 2+(+*'*.'( $&/+,#&,-&16 H&/+,#&,-&1 '() 1&/+()',u$&<1&&(1u.s& -0+$ -1&u2 *&'s'(' #+,0&$'# /'1' /'s&+(9/'s&+( '() #+0'$ 2+2/u('& .+0+(', #&,-&1 '*(-,2'0 '() 2+(1's',&('6 O*'#9-*'# #+,#+(#u4 s+/+,#& amiodarone (&ordarone), '() 1&)u('.'( 1'0'2 /+,''#'( /+,s-'0'(9/+,s-'0'( '(#u()4 2+()'(1u() su'#u u20'$ -1&u2 '() *+s', 1'( 2u().&( *+,.'&#'( 1+()'( .+0'&('(9.+0'&('( fu()s& #&,-&16
HIPERPARATIROID H&/+,/','#&,-&1 '1'0'$ su'#u .+'1''( 1&2'(' .+0+(',9.+0+(', /','#&,-&1 2+2/,-1u.s& 0+*&$ *'('. $-,2-( /','#&,-&1 1',& *&'s'('6 KLASIFIKASI : 6 H&/+,/','#&,-&1 /,&2+, H&/+,/','#&,-&1 /,&2+, 2+2/u('& .-(s+(#,'s& s+,u2 $-,2-( /','#&,-&1 '() #&())&6 K&,'9.&,' 8!/+,s+( 1',& .+s+0u,u$'( $&/+,/','#&,-&1 /,&2+, 1&s+*'*.'( -0+$ '1+(-2' #u())'0 !/+,s+( 0'&((' 2+0&*'#.'( *+,*')'& .+0+(',6 C-(#-$(' s+*')'& '1+(-2' '#'u $&/+,/0's&'6 S+1&.&# $&/+,/','#&,-&1 1&s+*'*.'( -0+$ /','#&,-&1 .',s&(-2'6 76 H&/+,/','#&,-&1 s+.u(1+, H&/+,/','#&,-&1 s+.u(1+, '1'0'$ /,-1u.s& $-,2-( /','#&,-&1 '() *+,0+*&$'( .',+(' ,'()s'()'( /,-1u.s& '() #&1'. (-,2'06 S+5',' .$usus .+0'&('( &(& *+,.'&#'( 1+()'( .+)')'0'( )&('0 '.u#6 P+(+*'* u2u2 0'&((' 1&s+*'*.'( -0+$ .+.u,'()'( @&#'2&( D6 36 H&/+,/','#&,-&1 #+,s&+, H&/+,/','#&,-&1 #+,s&+, '1'0'$ /+,.+2*'()'( 1',& $&/+,/','#&,-&1 s+.u(1+, '() #+0'$ 1&1+,&#' 0'2'6 P+('.&# &(& 1&#'(1'& 1+()'( /+,.+2*'()'( $&/+,s+.,+s& $-,2-( /','#&,-&1 1'( &(& '.'( 2+(+*'*.'( /+(&().'#'( .'0s&u2 1&1'0'2 1','$ '&#u $&/+,.'0s+2&'6
ETIOLOGI
:
M+(u,u# L',+(5+ K&24 MD 7""!
:
6 K&,'9.&, ' 8!/+,s+( 1',& .'sus $&/+,/','#&,-&1 /,&2+, 1&s+*'*.'( -0+$ '1+(-2' #u())'06
76 S+1'().'( !/+,s+( 0'&((' 2+0&*'#.'( *+,*')'& .+0+(',6 C-(#-$(' $/+,/0's&'6 B&'s'(' $+,+1&#+, 1'( f,+.u+(s& (' *+,$u*u()'( 1+()'( .+0'&('( +(1-.,&( 0'&(('6 36 B+*+,'/' '$0& 1'( *+1'$ /'#-0-)&s 2+0'/-,.'( *'$' /+2*+s','( 1',& .+0+(', '() 2u0#&/0+ u2u2(' +(&s '1+(-2' '() )'(1'6
PATOFISIOLOGI : H&/+,/','#&,-&1 /,&2+, 9
9
H&/+,/','#&,-&1 /,&2+, '&#u 1&s+*'*.'( -0+$ $/+,/0's&' '#'u (+-/0's2' '#'u s+.u(1+, 1&2'(' .'sus *&'s'(' *+,$u*u()'( 1+()'( )')')0 )&('0 .,-(&s6 P'1' 8"/+,s+( .'sus4 $&/+,/','#&,-&1 /,&2+, 1&s+*'*.'( -0+$ '1+(-2' /','#&,-&1 &('.4 8/+,s+( .'sus 1&s+*'*.'( -0+$ $/+,/0's&' .+0+(', /','#&,-&14 7/+,s+( .'sus 1&s+*'*.'( -0+$ .',s&(-2' /','#&,-&16
KOMPLIKASI 9 9 9 9 9 9
:
P+(&().'#'( +.s,+s& .'0s&u2 1'( f-sf-, D+$&1,'s& B'#u )&('0 H&/+,.'0s+2&' Os#+-.0's#&. Os#+&#&s *,-s' 5s#&5'
MANIFESTASI ORAL 9
9
:
T+,'1& /+,u*'$'( #u0'() '() 2+0&/u#& $&0'()(' 0'2&(' 1u,'4 1&.+2u.'.'((' “),-u(1 )0'ss” /'1' /-0' #,'*+.u0'4 /+(&/&s'( 1',& #u0'() .-,#&.0 1&*')&'( &(f+,&-, 5'('0&s 1+(#'06 P'1' /+,&'/&.'0 #+,0&$'# )&'(# 5+00 0+ss&-( *,-( #u2-,% /'1' )'2*','( ,'1&-0us+( 1&'(#',' &(s&s&@us *''$ '() #+0'$ 2+()'0'2& /+,)+s+,'(6
PENATALAKSANAAN
:
6 T&(1'.'( /+2*+1'$'( u(#u. 2+()'().'# ',&()'( /','#&,-&1 '() '*(-,2'06
76 D+$&1,'s& .',+(' )'())u'( /'1' )&('0 2u().&( #+,'1&6 D&'(u,.'( 2&(u2 s+*'('. 7"""204 5'&,'( u(#u. 2+(5+)'$(' #+,*+(#u.(' *'#u )&('06 36 M+2*+,&.'( f-sf'# /+,-,'0 2+(u,u(.'( .'1', .'0s&u2 /'1' /'s&+(6 ?6 D&+# 1'( -*'#9-*'#'(6
