ENDOCRINE AND

METABOLISM SYSTEM
MODUL I
DEGRADATION OF BODY
group IX
WEIGHT

9 th GROUP
Ai Kardi
Ari Achmad Buchori
Budi Pratama
Rio Insan Riady
Sayuti
Ajeng Woro Larasati
Ega Dianisya
Ernawati
Intan Olivia
Kiki Nur Aqidah
Mustika Rohdiniyanti
Nurul Maulidya

Keys Word
A woman, 35 y.o
Weight loss more than 10 kg
since 6 last month
Palpitation
Anxiety
The smarting eyes

SCENARIO

A Woman, 35 y.o comes to

the clinic with complain
weight loss more than 10
kg since 6 last month. She
complain too palpitation,
anxiety, and the smarting
eyes.

QUESTIONS
1.Explain about anatomy, physiology,
biochemistry, and histology that
relation with the scenario !
2.Explain the risk factor and the
pathomechanism of weight loss !
3.Explain the pathomechanism of
anxiety, palpitation, and the smarting
eyes !
4.Explain differential diagnostic from the
scenario !
5.Explain about diagnostic method for
this scenario !

ANATOMY

PHYSIOLOGY
TRH from
Hipothalamus

TSH from Hipofisis

S
E
C
R
E
T
I
O
N
OF

Secretion Thyroxin
(T4)

Convertion T4 to Triiodo-thyronin (T3)

Stimulating Glandula
Thyroid

Tri-iodo-thyronin active

T
H
Y
R
O
I
D
S
Y
S
T
E
M

CONTINUE
Thyroid Hormone Function
- Important for growth

- Increase basal metabolism and heat produce

- If thyroid hormone is increasing
-> decreasing Weight Body and its decreasing -> increasin
- Increasing heart-beat frequency
- Increasing blood volume
- Increasing lipolysis proccess
- Increasing O2 consumtion
- Increasing appetite
- Increasing gastrointestinal-action
- Men : If Hiperthyroidism -> Impotent
If hipothyroidism -> Loss of sex-libido
- Women : If hiperthyroidism -> Polimenorhe
If hipothyroidisme -> Oligomenorhe or amenorhe

CONTINUE
FEED BACK MECHANISM

Stimulating hipofisis with

TRH from hipothalamus

If 3 and T4 is enough,
glandula thyroid send a
mesaage to hipofisis

Decreasing TSH from

Hipofisis

Secretion TSH from hipofisis

and stimulating the glandula
thyroid

Secretion T4 and converting

to T3 as a active hormone

Decreasing TRH from

hipothalamus

BIOCHEMISTRY
1. Iodide Trapping
2. Iodine come into the
colloid and experience of
the oxidation
(enzyme peroksidase)
3. Iodinasi Tirosin,
4. Concatenation
Iodotironil
(enzyme
tiroperoksidase)
5. Hidrolisis
6. Tiroksin And
triiodotirosin go out from
follicle cell and come into
the blood
7. MIT And DIT which left
behind follicle cell will
experience of the
iodinasi,
(enzyme

HISTOLOGY

CONTINUE

a PATHOMECHANISM OF
WEIGHT BODY
In General :
In take and up take factor
BMR (Basal Metabolic
Rate
Hormon Factor
For Example Graves Disease :
TSH
hormone

TSI

stimulate tiroid
hipertiroidism

ANXIETY

Thyrotoxicosis

PALPITATION

Thyroid hormone
metabolism of tissue
Quicken Usage O2

Multiply release of amount of

metabolic end products from Tissue

Vasodilatation of tissue
Blood stream
Cardiac output

Palpitation

THE SMARTING EYES

Antibody formed to the eyes

muscle
Tyroglobulin from thyroid is
transporting to the orbital tissue and
happen immune response there.
( endocrinology )
The eyes have epitel cell that
normally will be followed to close
when we close our eyes, but there
was immunoglobulin that make an

DIAGNOSTIC METHODS
S
C
R
E
E
N
I
N
G

Kelainan tiroid ??
TSH sensitif

Meningkat

Normal

Tak terukur

Hipotiroidisme

Eutiroid

Hipertiroidisme?

FT4

Normal

FT4

Menurun

Meningkat

Normal
FT3

T
E
S
T

Hipotiroidisme
Subklinis

Hipotiroidisme
(nyata)

Hipertiroidisme

KET : Sebagai tes saring fungsi tiroid

urutannya sbb:
1. Tes TSHS 2. Tes FT4 3. FT3

Meningkat

Normal
Hipotiroidisme
subklinis

CONTINUE

Anamnesis
Graves Disease Symptoms:
Weight loss although have normal appetite
Weak, loss energy
Sweat and warm skin
Hot disable
Palpitation
Tremor
Sensitive (labil emotional, spitfire,e.t.c)
Enlarge of neck, hard to eat, hoarse,e.t.c
For , something have oligomenorhea
Vomitus
Diarhea
Eye disturbance (lakrimasi, eksoftalmus, eye
smarting, e.t.c)
For old age, something have cardiovascular

CONTINUE

Physic examination
general condition : patient looked thin
soft skin, warm, and moist
extremitas :
- hyperkinesis
- tremor delicate of the hand.
- increase of patella reflex and tendon achilles reflex
- sometimes : hypokalemik periodic paralysis
Neck : Struma (Swelling)
Eyes :
- Exopthalmus
- Stellwag Sign : rare to shut and open by turns
- Von Graefe Sign : superior palpebra not to follow
oculi when looked to under, lidlag
- Morbus Sign : hard to convergency
- Joffroy Sign : cant to forehead wrinkled
- Ressenbach Sign : Tremor palpebra if closed the
eye
Cardio :
- hard sound of cardio
- high blood pressure

SUPPORT EXAMINATION
Thyroid function test : increase of T4
and T3 and decrease of TSH
Blood test : Autoantibody thyroid
peroksidase tiroid and antitiroglobulin
indicated to autoimmune etiology
CT scan : To differential graves
disease (usually : diffus) with struma
multinodular (hot spot multiple). For
eksoftalmus, CT scan in the orbita show
hypertrofi of eyes muscle outside

DIFFERENTIAL DIAGNOSE
GRAVES
DISEASE

GOITER
NODULAR
TOKSIK

A
Woman,35
y.o

Weight
Loss
Anxiety
Palpitation
Smarting

V
V
V

V
V

Differrential
Diagnose

Graves Disease

Goiter Nodular
Toksik

Definition

Autoimun
Antibody like TSH
(thyroid)

Enlargement thyroid
gland, its cause yodium
deficiency

Prevalention

- 30 - 40 years oled
- Women : Men 7 : 1
- Familier Predisposition

More find at the old

patient by complication
goiter nodular chronic.

Etiology

Autoimmune

- Iodium deficiency
- Autoimmune
- Goitrogenes
-Idiopathic

Sign and Symptomps

Signs :
Hyperfunction from
Thyroid Gland
Infiltrative
opthalmopathy
(Exopthalmus)
Infiltrative dermopathy
(myxedema)
Symptomps :
Fatigue, Increase of
apetite, Tremor, Worry

General Status
- Eyes : ex.
Exophthalmia, etc.
- Cardio : ex.
Tachycardia, etc.
Locals Region Coli Ant.
Status
- Inspection : swelling,
colour, surface, be
active when swelling

PATHOMECHANISM OF GRAVES DISEASE

Antibody

Reseptor of TSH
or membran of
plasma thyroid

stimulate the tiroid

function over and
over on cAMP

Hipertiroidism

PATHOMECHANISM OF GOITER
NODULAR TOXIC
Hyperthyroidism

Autoimmune

thyroid activity and

Very active

Yodium Deficiency

Nothing help
thyroids work

Fatigue enlargement
thyroid gland

Complication

Atrium Fibrilation
Paralysis
Hypocalemia
Hypercalsemia &
nefrocalsinosis
Deacrease of libido
Impotensi
Decrease of Sperma
Gynecomastia

a. Short period
- Bleeding from a.
tiroidea superior
- Dispneu
- Crisis of thyroid
b. Long period
- Rough voice because
damage of n. reccurent
laryngeus
- Lifted up of paratiroid
gland that cause
hipocalsemia than
happen a tetani
(Sindrom carpo-pedal :
focal stiff at hand and
foot), that happen after
2 years

Prognosis

- Worst, if going to
thyroid crisis
- Can be releapse

- Ths patient,
hiperthyroidism happen
very slow, and a clinic
manifestation more .......
Than Graves Disease.
- A Patient may be
complain aritmia and

Treatment

1.

Antithyroid drug therapy

Propylthiouracil
(PTU),methimazole,
and
carbimazole
-Inhibit synthesis of thyroid
hormone.
-PTU
menghambat
sebagian
deiodinasi T4men
jadi

T3 di perifer sedangkan
methimazole dan
Carbimazole tidak.
-Side
effect
:
rash,
Agranulositosis
2. Surgical treatment
subtotal thyroidectomy
Complication : Hypothyroidism,
recurent
Laryngeal nerve injury
3. Radioactive iodine therapy
Dosis : 2-10 miliCuri
Complication : hypothyroidism
4. Other
-Corticosteroid for ophtal
Mopathy
-Beta-Blocker for disturbance
of heart

1. Conservative
- Indication : old age,
residive stuma
- Struma non toksik :
jodium, ekstrak tiroid 3020 mg/dl
- Struma toksik :
PTU (propiltiourasil)
100-200 mg
( gol thiouracil)
Lugol 5-10 tetes
2. Operative
Indikasi :
1. Enlargement thyroid
gland by symptom of
pressure, ex :
Swallow disorder
Respiration disorder
Husky voice
2. Ferocity of thyroid
gland
3. Struma nodus dan
diffusa toxica
4. Cosmetic
3. Radiation : extern and
intern
4. Chemotherapy : by

REFERENCES
Dorland, W.A. Newman.2002. Kamus
edokteran Dorland Edisi 29. Jakarta: EGC.
Farmakologi dan Terapi. 2007.
Departemen farmakologi dan terapeutik
Fakultas Kedokteran Universitas Indonesia.
Gleadle Jonathan, At a Glance
ANAMNESIS DAN PEMERIKSAAN FISIK,
Hipertiroidisme hlm.140, jakarta : EMS
Haznam, M.W. Endokrinologi. Bandung.
Haznam MW, Endokrinologi, Penyakit
Graves , hlm. 126, Bandung :Angkasa Ofset.
Olson, James. Belajar Mudah
Farmakologi. 2004. Jakarta : EGC.
www.cerminduniakedokteran.com
www.medicastore.com
www.google.com

Thank you