THYROID

H M Nadjib Dahlan Lubis

Bag Patologi Anatomi Fak Kedokteran
USU/UISU

ECTOPIC

Lingual
Lingual + Normal
Sup Mediastinum
Thyroglossal cyst

Pit Thyrotrophin syntesa, jml & besar fol

Iodide Oxid + thyrosine mol MIT + Thyroglo
DIT
Thyroxine (T4) mayor
Triiodothyronine (T3)
Peripheral Met
T4 / T2 plasma protein; TBG, TB PA
99%: inactive
T4 : T3 : 40 : 1

Function

Basic energy Met: prot syn

oxidative posphorilation in mitochond
Pem Struktur
Klinis palpasi
Radiologi: - 125 I filling defect, cold nod low uptake
- USG cystic / solid
Biopsy
Pem Fungsi
Radioimmunoassay Protein bound
Free hormon
T4/T3 dipengaruhi: : peny liv, ren & Cong
: preg, oral cont
Ultrasensitive Serum TSH
TRH Stimulator Test

Ggn Sekresi
Excessive (Hyperthyroidism), Thyrotoxicosis
Aet: Grave Autoimm
Jarang : - Multi Nod
- Fol Ad fuct, Ca
- Thyrotrophin sec Pit Ad
- Germ cell Tum
- Thyroiditis
Cli: - Nerv, anxiety, insomnia, fine tremor
- BW
- Heat Intolerance, sweating
- Palp, Tachy, Car Arrh, Car Fail, Atr Fibr
- Amen, Infer
- Otot lemah, limb girdle (prox myopathy)
- Osteoporosis sakit

Hypothyroidism: - Child Cretinism\

- Adult Myxedema
Pbg: Pri
Sec Pit TSH
Cretinism
Aet: - Agenesis
- Synt ! def (iodized) : - preg
- after birth
- Goitrogen block synt : thyocyanate : cassava plant
- Autorec enzym def
Synt ! hyperplasia Pit Thyrotrophin Goitrous Creatinism
Cli: - Lethargy Somnolence, Hypothermia
- Hoarse cry, Hypotonia otot, large prot tongue
- Growth, mental reatrdation

Myxedema
Aet: - Hashimoto Autoimm Thyroiditis
- Pit failure
- Iaatrogenic : - anti thy drug
- Ablation / Rad
- Diet : - Iodine def
- Goitogen
Cli: - Lethargy
- Loss of hair: Scalp, eye bro
- Neuro : Ggn relax phase
- Anemia

- Pleural/Percard eff
- Serum Cholest
- Atherscl

Myxedema Mucopolysach Kulit nonpitting

Larynx Hoarseness
Heart >

Peny Thyroid: Immune

Grave: - Hyper thyroidism

- 15-40 yrs
- familial
- + pern ane, Hashimoto
Aet: Auto Ab IgG>< TSH Rec
Ab: - LATS
- LATS protector
- TSI (Ig)
]
- TSH binding inhibit. Ig (TBII) ] paling sering
Level serum Ig # severity
IgG Placenta Neonatal Hyperthyroidism

Path
>, sym, vasc
Fol Epit banyak, besar
Papill
Colloid sdkt, scalloped proteolytic thyroglobin
Lymhocyte / Lymphoid
Cli: - >
- Exopthalmous: starring gaze blinking
fungsi otot mata

Lab

Free Thyroxine T4 index

10% T4 N, Free T3 (T3 Toxicocic)
TSH serum
Exopthalmous - Lim
- Oed

- Mucopolysac
Infection

Blind
Pretibial Gatal

Hashimoto
Inc: - Middle age, F 10x M
- Histocomp HLA-DR S
Aet: Cytotox T cell med hypersens
- Serum Ab: - Anti thyroglob
- Anti microsomal
- >< coll lain dp thyroglob
- >< TSH rec
- Kadar Severity
Path: Keras, Rubbery, Bosselated atr, fibros
Mic: - Destr, Inf Lym
- Fol Epi besar, pink Hurtle cells.

Diagnose

Hist conc clinic

Hurtle (-) nonspe Lymph Thyroiditis
Clinic: - Euthyroid
- Mild Hypothy
The: - Replacement
- 5% mal: - Pap
- Cell B lymphoma

Inlammatory
Subacute Th is (Granulomatous, De Quervains)
Jarang, M & F
Virus upper resp
Auto Imm?: Ab anti thy: sementaa
Relation to Grave / Hash (-)
Path: - diffus, >, keras, lekat
- dest, fibr, mac, giant cells
Clin: - Acute, pain, fever, malaise, myalgia
- Gen Euthy, hyperthy: sementar
- Sel limited: 3 mo
- Not Hypothy

Riedel

Inc
Jarang, elder, F > M
Ab (-)
Hub: Fibr: retroper, mediast sistem fibroblast
Lymphocte, plasma
Woody
Cli: - sep mal, pain (-), rock
- Trachea Dyspnoe, Stridor
- Oes
Dysphagia
- N. Lar Hoarseness
- Euthy

Dif nontoxic & Multi Nodular Goiter

Mild def Hyperplasia compensatory
TSH N
Resp thd TSH ok depletion iodine dlm cell
K
Goiter = >> , any cause
Aet: - Endemic : - Def iod diet chr
- Pegunungan
- Seawater/seafoot
- F > M preg, lact
- Goiterogen: Cabbage, cassava
- Sporadic: - Demand : - puberty
- Preg

Path
Dif, > , nontox Multi Nod
Fol: small, tall coll sep Grave
Involusi: - Distention fol
- Flat / Cuboid
- Not Uniform
- Cut: gelatin / glistening
Cli: - Euthy
- Serum TSH Nm
- Surgery cosmetic
- Retrosternal
The: - Iodine / Thyroxin
- Surgery

- Fibrosis
- Hem
- Cyst
- Calcific

- Hyper thy > Hypothy ok ptb hyperpl nod

- Risk mal: small