Endocrine system

thyroid
Dr. Muhartono, M.Kes, Sp.PA

hypertyroidism
Hypermetabolic state caused by
elevated circulating level of free T3
dan T4
Causes primary and secondary
Primary grave disease, toxic
multinodular, toxic adenoma
Secondary TSH-screting pituitary
adenoma

 Clinical manifestation
Constitutional symptom skin soft, warm, flashed,
heat intolerance, excess sweating;weight loss
Gastrointestinal hypermotility, malabsorbsion,
diare
Cardiac Tachycardia, CHF
Neuromuscularnervousness, tremor, irritable,
myopaty proximal muscle
Occular manifestation opthalmopaty
Thyroid storm medical emergency peningkatan
acut katekolamin meninggal karena aritmia

Histopatologi

 Diagnosis
Klinis dan laboratorium
Lab TSH rendah; T3 dan T4 tinggi

Grave disease
1835 robert graves
Endogen hypertyroidism
Trias: thyrotoxicosis, opthalmopathy,
dermopathy
20-40 tahun
HLA DR3
Autoantibodi TSH TSI

Hypotyroid
Hypothyroid is caused by any
structural or functional derangement
that interferes with the production of
adequate levels of thyroid hormon.

 Penyebab
Defisiensi parenkim tyroid
Hilang karena operasi/radiasi
Auto imun
agenesis

Hipotyroidism goitrous
Hashimoto
Difesiensi yodium endemik
Bahan goitrogenik

Kelainan supratyroid
Hipopituitarism

 Manifestsi klinis
Kritinism
Myxedema

 Critinism
Hipotyroid
Anak-anak
Pegunungan
Difesiensi yodium
Retardasi perkembangan mental dan fisik
Perkembangan lambat, pendek,
pertumbuhan gigi lambat, wajah kasar, lidah
menonjol
Kulit kering perut menonjol

Cretinism

 Mixedema
Dewasa
Bengkak
Lethargi
Tidak tahan dingin
Haid deras
Kulit dingin dan kasar
konstipasi

Goiter

Pembesaran tyroid
Endemic
Sporadic
Iodine difesiensi

Morfologi

Hiperplasia sel folikel tyroid

Difuse
Koloid banyak
Single-multinodular

 Clinical features
Efek pembesaran okstruksi jalan
napas, dispagia, kompresi pembuluh
darah besar
Sedikit toxic Plummer syndrome
Hipotyroid
Biasanya normotyroid

thyroiditis
Chronic lymphocytic (Hashimoto)
tyroiditis
Sub acute (de Quarvain ) thyroiditis
Reidel tyroiditis
Palpation tyroiditis

Hashimotos thyroiditis

Hypotyroid
Autoimun
Defect T cell
Morfology
Kelenjar kecil-kecil dilapisi oxyphil cell
bersebukan limfosit

Klinis
45-65 tahun
Wanita> laki10:1
Hypotyroid
Resiko lymphoma

Sub acute granulomatous (de

Quarvain) thyroiditis

30-50 tahun
Wanita> laki
ISPA virus?
Morfologi
Terdapat kerusakan folikel tyroid
Ekstravasasi koloid
Limfosit, sel plasma, machrofage, giant
cell
Radang dan fibrosis

Bengkak dan nyeri

Demam
Malaise
Pembesaran tyroid

gross

Mikros

Tumor tyroid
Adenoma
Carcinoma
Papilary
Follicular
Medulary
Anaplastic

Adenoma
From follicular epithelium
Solitary
Sulit dibedakan dengan folikular
carcinoma

 Morfologi
Kapsul masih intak
Folikel bervariasi dominan kecil
Sel folikel oxyphil /hurtlehurtle cell
adenoma

 Nodul tyroid hot nodul; cold nodul

Tidak nyeri
10% cold nodul malignant

Papillary carcinoma
80%
Radiasi ionisasi
Morfology
Struktur papil
Inti ground glass appearance; nuclear
groove, pseudoinclusion
Psamoma bodies
Kalsifikasi

 Clinical features
Massa di leher
Sering metastasis di kgb leher
Porgnosis sangat baik

Gross

Ground glass appearance

nuclear

Psamoma bodies

Pseudoinclusion nuclear

Nuclear groove

Varian folicular

Follicular carcinoma thyroid

15 %
Middle adult
Iodine diffesiensi
Morfology
Invasi ke kapsul
Invasi ke pembuluh darah

 Clinical features
solitary cold
Cenderung metastasis ke pembuluh
darah

Medullary carcinoma

Neuroendocrine
C cell, parafolicular cell
Mensekresi kalsitonin
Sporadic 80%; familial 20%
Familial Multiple endocrene
neoplasm (MEN) 2A dan 2B
Mutasi RET

 Morfology
Solitary-multiple
Amyloid deposit

 Clical features
Compression effect dysphagia,
hoarseness
Sekresi hormon peptide diarrhea
Calcitonin
RET mutation
C cell hiperplasia, multisentrik, MEN2B,
lebih muda MEN associated MTC

Anaplastic carcinoma
Undifferentiated thyroid carcinoma,
typically presents as rapidly growing
tumor in elderly patients.

 Clinical Features
Usually elderly
Presentation:
rapidly growing mass
hoarseness
dysphagia
dyspnea
usually extrathyroidal extension

Rapid evolution:
massive growth in neck
infiltration of ribbon muscles, esophagus, trachea, skin, and
contiguous bones
commonly nodal and distant metastases
cause of death usually involvement of vital structures in the neck

 Pathogenesis
Usually a result of anaplastic transformation of a
pre-existing well-differentiated tumor (or a
metastatic focus):
commonly papillary carcinoma
also follicular carcinoma, Hrthle cell carcinoma, and
insular carcinoma
spindle cell squamous cell carcinoma develops from the
tall cell variant of papillary carcinoma

Mutations of p53 gene appear to:

occur after development of papillary carcinoma
play a role in tumor progression

 Gross Pathology
Highly necrotic and hemorrhagic
solid tumor mass

 Histopathology
Two major categories that sometimes coexist:
squamoid:
does not make follicles, papillae, trabeculae, or nests
an unmistakable epithelial appearance morphologically and immunohistochemically
may blend with clearcut foci of keratinization
an unusual subset has a lymphoepithelioma-like appearance, but does not seem to be related to
Epstein-Barr virus
sarcomatoid: spindle cell and giant cell:
composed of two patterns, often seen together
may exhibit:
a fascicular or storiform growth pattern
heavy neutrophilic infiltration
prominent vascularization
cartilaginous/osseous metaplasia
may be osteoclast-like multinucleated giant cells:
giving an appearance reminiscent of giant cell tumor of bone or soft tissues
probably:
non-neoplastic
reactive cells of monocytic/histiocytic lineage derived from mononuclear cells through cell
fusion

Prognosis
Mortality rate >95%
Mean survival <6 months
Slightly better chance of cure if
undifferentiated component is a focal
change in an otherwise welldifferentiated neoplasm

Parathyroid
Hyperparathyroid
hypoparathyroid

 Hyperparathyroid
Primary
Secondary

Primary parathyroidism
Primary hyperthyroidism
Sering
Hypercalcemia
Adenoma parathyroid
Hyperplasia primer kelenjar
Sporadic dan famillial
Familial MEN
PTH meningkat bone reception; renal
disease; hypercalcemia

 Morfologi
= thyroid adenoma/carcinoma

Efek organ lain

Osteitis fibrosa cystica
Brown tumor
Nefrolithiasis

Adenoma parathyroid

 Clinical features
Peningkatan kalsium darah dengan
komplikasinya
Gastrointestinal distrubances:
konstipasi, nause, peptic ulcer,
pancreatitis, gall stone
CNS alteration: depresion, lethargy
Neuromuscular abnormalities;
weakness, hypotonia

Secondary parathyroidism
Associated with a chronic depresion
in the serum calcium level.
Chronic renal failure

Hypoparathyroid
Surgical ablation
Congenital absence
Autoimun

 Clinical features
Increased neuromuscular irritability
Cardiac arytmia
Seizure
Tekanan intrakranial meningkat

Sekian dan trimakasih