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"Concurrently, there have been a number of recent advances in surgical treatment, as well as diagnostic modalities that allow us to detect small amounts of residual local and metastatic disease. Additionally, a reexamination of past treatment regimens has led to new recommendations regarding the use of radioactive iodine, and to new therapeutic options, such as targeted therapy which have supplanted the use of more toxic chemotherapy for metastatic cancer. Multiple academic organizations have developed consensus guidelines for the management of thyroid cancer, occasionally with conflicting recommendations. In Thyroid cancer, a renowned group of authors presents a broad overview of the pathology, pathophysiology, diagnosis, and management of thyroid cancer, with an emphasis on recent evidence-based information. "

"Angka kejadian kanker tiroid terus meningkat tiap tahunnya. Pola makan, paparan radiasi, dan genetik dapat menjadi faktor risiko terjadinya kanker tiroid. Untuk menangani kasus kanker tiroid biasanya dilakukan tindakan pembedahan. Pasien pasca pembedahan di area leher memiliki resiko terjadi kontraktur. Kontraktur dapat terjadi karena aktivitas yang kurang. Kontraktur dapat menyebabkan deformitas dan keterbatasan gerak pada pasien. Salah satu cara untuk mencegah komplikasi tersebut adalah dengan neck exercises. Neck exercises dapat dilakukan untuk meningkatkan rentang pergerakan sendi dan mencegah kontraktur. Sebagai perawat, mencegah terjadinya komplikasi merupakan salah satu asuhan keperawatan yang harus dilakukan. Pencegahan ini dilakukan untuk memaksimalkan pencapaian kesejahteraan pasien dengan lebih maksimal.

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The incidence of thyroid cancer has increased. Diet, exposure to radiation, and genetic can be a risk factor for thyroid cancer. To handle cases of thyroid cancer, surgery is usually performed. Patients after surgery in the neck area has a risk of contractures. Contractures can occur due to lack of activity. Contractures can lead to deformity and limitation of motion in patients. One way to prevent these complications is the neck exercises. Neck exercises can be done to improve range of motion and prevent contractures. As a nurse, prevent complications is one of the nursing care that must be done. Prevention is done to maximize the achievement of well-being of patients."

"ABSTRAKV600E adalah perubahan genetik yang paling banyak terjadi pada kanker tiroid, dan telah menjadi penanda diagnostik penting pada jenis histopatologi ganas, khususnya karsinoma papiler. Tujuan dari penelitian ini adalah untuk mengembangkan dan memvalidasi teknik screnning BRAF V600E pada kanker tiroid menggunakan metode high resolution melting (HRM). Sebanyak 57 pasien dengan kelainan nodul tiroid dikumpulkan secara retrospektif di Rumah Sakit Kanker Dharmais yang dikoleksi dari tahun 2012-2014. Mutasi gen BRAF V600E dianalisis dari sampel fine needle aspiration biopsy (FNAB) menggunakan teknik HRM reagen MeltDoctor HRM Master Mix (Applied Biosystem) yang divalidasi dengan teknik Sanger Sequencing. Penelitian ini berhasil mengoptimalisasi metode HRM dengan membedakan melting curve sampel kontrol positif mutasi gen BRAF V600E dengan sampel normal. Berdasarkan hasil validasi dengan teknik Sanger Sequencing, diperoleh hasil gambaran elektroferogram pada gen BRAF ekson 15 yang mengalami mutasi titik pada basa nukleotida ke 1799 T>A (V600E). Hasil screening menunjukkan bahwa terdapat 13 sampel terdeteksi positif mutasi gen BRAF V600E pada jenis histopatologi ganas karsinoma tiroid papiler (12) dan karsinoma anaplastik (1). Tidak ditemukan satu pun mutasi gen BRAF V600E pada sampel dengan histopatologi jinak ataupun kontrol normal. Berdasarkan hasil tersebut, dapat disimpulkan bahwa teknik HRM dapat digunakan untuk screening mutasi gen BRAF V600E pada kanker tiroid.

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ABSTRACTBRAF V600E gene mutation is the most common genetic alteration that found in thyroid cancer and has been an important diagnostic marker for malignant histopathology, specifically papillary carcinoma. The aim of this study is to develop and validate BRAF V600E gene mutation screening technique on thyroid cancer patients using high resolution melting (HRM) method. Retrospectively 57 patients with thyroid nodules abnormalities were collected in Dharmais Cancer Hospital collected in 2012-2014. Mutation in BRAF V600E gene were analyze from fine needles aspiration biopsy (FNAB) using MeltDoctor HRM Master Mix (Applied Biosystem) as the HRM reagen and validated using Sanger sequencing. This Study have optimalize HRM method by differentiating positive control BRAF V600E gene melting curve mutaion with normal sampel. Validation using Sanger sequencing depict electropherogram of BRAF gene on exon 15 point mutation on nucleotide 1799 T>A (V600E). Screening shows 13 samples detected positive on BRAF V600E gene mutation on malignant histopathology thyroid papillary carcinoma (12) and anaplastic carcinoma (1). No mutation found on benign histopathology samples and normal samples. The conclusion of this study is HRM technique can be use to screen mutation BRAF V600E on thyroid cancer. "

"Latar Belakang Kelenjar tiroid merupakan salah satu kelenjar endokrin terbesar yang terletak di bawah kartilago tiroid. Kanker tiroid merupakan keganasan yang muncul dari sel parenkim tiroid yang mana sel sel tumbuh secara tidak normal dari jaringan kelenjar tiroid juga berpotensi menyebar ke bagian tubuh lainnya. Berdasarkan World Health Organization (WHO), data kanker tiroid di dunia pada tahun 2020 secara keseluruhan mencapai 586.202 kasus. Sementara, di Indonesia sendiri, kasus kanker tiroid pada tahun 2020 mencapai 13.114 dengan angka kematian mencapai 2.224 yang mana lebih banyak terjadi pada perempuan dengan jumlah 9.053 kasus. Berdasarkan penelitian, prevalensi kanker tiroid pada anak adalah 0,2-5 % dibandingkan dengan sekitar 30% pada orang dewasa. Melihat permasalahan ini, penelitian ini bertujuan untuk mengetahui prevalensi kanker tiroid pada anak di RSUPN Dr. Cipto Mangunkusumo yang belum ada datanya terutama berdasarkan karakteristik dan faktor risikonya. Metode Penelitian ini menggunakan metode observasional deksriptif dengan pendekatan cross sectional. Sampel yang digunakan berupa total sampling pada penderita kanker tiroid anak di RSCM periode 2016 hingga 2022.Hasil Hasil penelitian ini mendapatkan prevalensi kanker tiroid pada anak di RSCM pada Tahun 2016 – 2022 sebsar 1,4%. Dengan karakteristik sosiodemografi, 95,7% berusia 11 hingga 18 tahun, 78,3% berjenis kelamin perempuan dan 21,7% berjenis kelamin laki- laki, serta 65,2% tinggal di perkotaan. Hasil lainnya menunjukkan 95,7% riwayat keluarga tidak ada dan 47,8% mempunyai BMI ideal. Hasil karakteristik klinis, 78,3% pasien dengan jenis kanker tiroid papilar, 87% pasien stadium1, 43,5% mengalami T2, 39,1% mengalami N1, dan 13% dengan M1. Terapi utamanya operasi sebanyak 86,9% dengan jenis total tiroidektomi sebesar 60%. Tidak terdapat perbedaan karakteristik antara jenis kanker tiroid papilar dan folikular. Kesimpulan Penelitian ini memberikan angka prevalensi serta data deskriptif terkait persentase dan frekuensi masing-masing variabel yang dapat dijadikan acuan untuk penelitian selanjutnya berupa analitik terkait prognosis dan mortalitas serta hubungan setiap variabel.

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Introduction The thyroid gland is one of the largest endocrine glands which is located under the thyroid cartilage. Thyroid cancer is a malignancy that arises from thyroid parenchyma cells in which the cells grow abnormally from the thyroid gland tissue which also has the potential to spread to other parts of the body. Based on the World Health Organization (WHO), data on thyroid cancer in the world in 2020 reached 586,202 cases. Meanwhile, in Indonesia alone, cases of thyroid cancer in 2020 reached 13,114 with a death rate of 2,224 which was more common in women with a total of 9,053 cases. Based on research, the prevalence of thyroid cancer in children is 0.2 – 5% compared to about 30% in adults. Seeing this problem, this study aims to determine the prevalence of thyroid cancer in children at RSUPN Dr. Cipto Mangunkusumo for which there is no data, mainly based on the characteristics and risk factor.

Method This study used a descriptive observational method with a cross sectional approach. The sample used was total sampling in children with thyroid cancer at RSCM for the period 2016 to 2022.

Results The results of this study found that the prevalence of thyroid cancer in children at RSCM in 2016 - 2022 was 1.4%. With sociodemographic characteristics, 95.7% were aged 11 to 18 years, 78.3% were female and 21.7% were male, and 65.2% lived in urban areas. Other results showed that 95.7% had no family history and 47.8% had an ideal BMI. Results of clinical characteristics, 78.3% of patients had papillary thyroid cancer, 87% of patients had stage 1, 43.5% had T2, 39.1% had N1, and 13% had M1. The main therapy was surgery for 86.9% with total thyroidectomy at 60%. There are no differences in characteristics between papillary and follicular types of thyroid cancer.

Conclusion This research provides prevalence figures as well as descriptive data regarding the percentage and frequency of each variable which can be used as a reference for further research in the form of analytics related to prognosis and mortality as well as the relationship between each variable."

"Pendahuluan. WHO menyatakan bahwa kanker adalah salah satu penyebab utama kematian di seluruh dunia. Radiasi dapat menyebabkan leukemia, kanker payudara, dan kanker tiroid. Untuk kondisi yang lebih spesifik, radiasi pada masa kanak-kanak meningkatkan risiko kanker tiroid dan peningkatan risiko kanker payudara telah diamati setelah radiasi pada wanita pra-menopause. Berdasarkan data kanker Organisasi Kesehatan Dunia (WHO) pada tahun 2020, kanker tiroid termasuk dalam 10 besar penyakit keganasan di Indonesia. Pekerja radiasi medis terpapar radiasi di tempat kerjanya dan pekerja tersebut pasti mempunyai kompetensi profesional/sertifikat terkait pengetahuan paparan radiasi, sehingga paparan radiasi harus dikendalikan dan Serendah yang Dapat Dicapai (ALARA). Sejauh ini hanya sedikit yang diketahui tentang etiologi kanker tiroid; paparan radiasi pengion (terutama selama masa kanak-kanak) adalah salah satu dari sedikit faktor risiko karsinoma tiroid. Meskipun International Agency for Research on Cancer (IARC) telah menyatakan bahwa radiasi bersifat karsinogenik pada kanker tiroid, pengetahuan terkini mengenai radiasi dan kanker tiroid didasarkan pada penelitian terhadap paparan akut tunggal (penyintas bom atom). Namun, dampak paparan radiasi di tempat kerja yang berkepanjangan dan berdosis rendah terhadap petugas layanan kesehatan masih belum jelas. Tujuan dari makalah ini adalah untuk mengevaluasi hubungan antara petugas kesehatan yang terpapar dan tidak terpapar radiasi dengan risiko kanker tiroid. Metode. Pencarian literatur dilakukan melalui PubMed dan ProQuest dan juga dilengkapi dengan pencarian tangan. Kriteria inklusi adalah tinjauan sistematis, kohort dan kontrol kasus, melibatkan petugas kesehatan, artikel teks lengkap tersedia, dan dalam bahasa Inggris. Kriteria eksklusi adalah artikel yang tidak dapat diakses dan tidak relevan. Artikel-artikel yang dipilih dari pencarian online dinilai secara kritis untuk mengevaluasi apakah penelitian tersebut memenuhi aspek validitas, kepentingan dan penerapan pada pasien menggunakan kriteria yang relevan untuk studi etiologi oleh Oxford Centre for Evidence-based Medicine. Hasil. Terdapat tiga artikel terpilih yang sesuai kriteria inklusi dan eksklusi, semuanya merupakan penelitian kohort. Salah satunya dilakukan di Norwegia pada perawat Norwegia yang tidak menunjukkan hubungan yang jelas antara paparan radiasi pengion di tempat kerja dan risiko kanker tiroid. Penelitian lain dilakukan di Finlandia pada dokter yang bekerja dengan radiasi dibandingkan dengan dokter yang tidak terpapar radiasi. Rasio risiko kanker tiroid adalah 1,5 (0,4-6,3) untuk dokter yang dimonitor radiasi dibandingkan dengan dokter yang tidak dimonitor radiasi. Artikel terakhir dilakukan di Tiongkok pada pekerja rontgen diagnostik medis yang dibandingkan dengan spesialis medis lainnya. Tidak terdapat peningkatan risiko paparan radiasi terhadap kanker tiroid secara signifikan [Risiko Rasio 1,6 95% CI (0,9 - 2,6)]. Kesimpulan. Bukti saat ini menunjukkan bahwa, jika dibandingkan dengan kelompok yang tidak terpajan,pekerja medis dengan paparan radiasi di tempat kerja tidak mengalami peningkatan risiko kanker tiroid. Kesimpulan ini dibuat dari tiga studi kohort (bukti tingkat 2b).

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Introduction. WHO stated that cancer is one of the leading causes of death worldwide Radiation could cause leukaemia, breast cancer, and thyroid cancer. For more specific conditions, radiation during childhood increase the risk of thyroid cancer and increase in breast cancer risk has been observed after irradiation of pre-menopausal women. Based on cancer data from World Health Organization (WHO) in 2020, thyroid cancer included in the top 10 malignancies in Indonesia. Medical radiation workers exposed to radiation in workplace and these workers definitely have professional competences / certificates related to radiation exposure knowledge, so the radiation exposure should be controlled and As Low As Reasonably Achievable (ALARA). Little is known about thyroid cancer etiology so far; exposure to ionizing radiation (especially during childhood) is one of few well-established risk factors for thyroid carcinomas. Despite of International Agency for Research on Cancer (IARC) had stated that radiation as carcinogenic for thyroid cancer, the current knowledge of radiation and thyroid cancer are based on studies of single acute exposures (A-bomb survivors). However, the effects of protracted and low dose occupational radiation exposure in healthcare workers remains unclear. The purpose of this paper is to evaluate the associations between exposed and non-exposed radiation of healthcare workers and the risk of thyroid cancer. Method. Literature search was conducted through PubMed and ProQuest and also complemented with the hand searching. The inclusion criteria were systematic review, cohort and case control, involving healthcare workers, full text article available, and in English. The exclusion criteria were inaccessible and irrelevant articles. The selected articles from online search were critically appraised to evaluate whether the study meet the aspect of validity, importance and applicability to the patient using relevant criteria for etiological study by the Oxford Center for Evidence-based Medicine. Result. There were three selected articles that fit the inclusion and exclusion criteria, all of them are cohort studies. One was conducted in Norway among Norwegian nurses which showed no clear association between nurses’s occupational exposure to ionizing radiation and risk of cancers of thyroid. Another one was conducted in Finland among physicians working with radiation was compared to that of unexposed physicians. The risk ratio for thyroid cancer was 1.5 (0.4-6.3) for physicians monitored for radiation compared to physicians not monitored for radiation. Last article was conducted in China among medical diagnostic x-ray workers who are compared with other medical specialists. There was no significant increase of radiation exposure risk to thyroid cancer [Risk Ratio 1.6 95% CI (0.9 - 2.6)]. Conclusion. The current evidences show that, when compared with the unexposed group, medical workers with occupational radiation exposure was not in an increased risk of thyroid cancer. The conclusion was made from three cohort studies (evidence level 2b)."

"Kanker adalah pertumbuhan sel baru yang tidak terkontrol, mampu menyebar dan menginvasi sehingga mengancam kehidupan. Insiden kanker dilaporkan dari tahun ke tahun terjadi peningkatan. Berbagai upaya telah dilakukan untuk menurunkan morbiditas dan mortalitas kanker. Karya Ilmiah Akhir (KIA) ini adalah sebagai laporan praktik residensi keperawatan medikal bedah peminatan onkologi di RS Kanker Dharmais Jakarta. Karya ilmiah ini berisi tentang: (1) penerapan teori Peaceful End of Life (PEOL) pada pasien kanker tyroid, (2) penerapan RIDcancerPain untuk menurunkan nyeri sebagai Evidence Based Nursing Practice (EBNP), (3) proyek inovasi integrasi ESAS kedalam pengkajian pasien rawat inap. Kesimpulan: bahwa teori peaceful end of life tepat digunakan dalam perawatan paliatif pasien kanker. Intervensi edukasi dengan pendekatan RIDcancerPain dapat digunakan sebagai salah satu alternatif pilihan manajemen nyeri nonfarmakologi. Instrumen ESAS memerlukan kompilasi dengan instrumen pengkajian lain agar mendapatkan data yang komprehensif.

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Cancer is an uncontrolled new growth of the cell which capable of metastasis and invasion that threatens host survival. The incidence of cancer reported from year to year there was an increase. Various attempts have been made to decrease the morbidity and mortality of cancer.

Method: The paper is a report medicalsurgical nursing practice residency specialization in oncology at Dharmais Cancer Hospital in Jakarta. Its consists of: (1) a report on the nursing care of thyroid cancer patients with peaceful end of life theory approach focused on not being in pain, experience of comfort, experience of dignity and respect, being at peace, and closeness to significant others. (2) the application of RIDcancerPain to reduce pain as the evidence based nursing practice (EBNP), (3) the innovation project of the integration of an ESAS into assessment inpatients.

Conclusion: The peaceful end of life theory is suitable for used in the palliative care. Educational intervention with RIDcancerPain approach can be used as an alternative of the non-pharmacological pain management. ESAS is requires compilation with other assessment instruments in order to obtain comprehensive data."

"This highly illustrated book, complete with comprehensive clinical references and annotated images, will serve as a leading text to educate head and neck surgeons, endocrinologists, and radiologists on the basics and nuances of thyroid and parathyroid ultrasound. It emphasizes the use of ultrasound as an office-based modality by clinicians and radiologists who actively care for this special set of patients. This text uniquely combines the collaboration between a clinician/surgeon and radiologist who share their extensive experience in head and neck ultrasound."

"This book is a unique in-depth and comprehensive reference that covers all surgically relevant thyroid and parathyroid diseases and presents the latest information on their management. International authorities discuss operative techniques and treatments in detail and explain the rationales for their favored approaches. The topics of this second edition include the description of surgically relevant pathologies, preoperative surgical evaluation, decision making, and operative strategies for the various thyroid and parathyroid diseases. In addition, experts present the molecular basis for thyroid neoplasia, review the current understanding of the genetics of inherited thyroid and parathyroid diseases, and discuss the management of recurrent and locally invasive thyroid cancer. Evolving modern operative techniques such as neuromonitoring and minimally invasive (videoscopic) approaches to the thyroid and parathyroids are also covered."

"Thyroid nodule is a health problem which commonly found in daily practice, therefore clinical guidance is needed. This guideline was compiled by a multidisciplinary team and expected to be a guideline in diagnosing thyroid nodules on daily clinical practice.

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Nodul tiroid merupakan masalah kesehatan yang sering dijumpai dalam praktik sehari-hari, sehingga diperlukan panduan klinis. Pedoman ini dibuat oleh tim multidispilin, dan diharapkan dapat dijadikan panduan dalam melakukan pendekatan diagnosis nodul tiroid yang komprehensif dalam praktek klinis sehari-har"

"Metilasi DNA merupakan perubahan epigenetik yang umum terjadi sebagai penyebab inaktivasi gen pada tumor suppressor genes (TSGs). Metilasi pada promoter TSG memiliki asosiasi dengan pembentukan kanker tiroid. Metode methylation-specific multiplex ligation dependent-probe amplification (MS-MLPA) merupakan salah satu metode berbasis PCR yang dapat melakukan identifikasi metilasi pada beberapa gen dan analisis copy number variant secara simultan. Tujuan dari penelitian ini adalah untuk mengoptimasi metode MS-MLPA dan mengidentifikasi metilasi TSG pada kanker tiroid dengan metode MS-MLPA. Sebanyak 40 sampel fine needle aspiration biopsy (FNAB) dikumpulkan secara retrospektif di Rumah Sakit Kanker Dharmais. Sampel FNAB berasal dari pasien yang memiliki kelainan nodul tiroid. Metilasi TSG dianalisis dengan metode MS-MLPA menggunakan probemix Tumour Suppressor Mix 1 ME001-C2 (MRC-Holland). Sampel FNAB dibandingkan dengan reference sample berupa sampel darah yang berasal dari individu sehat. Penelitian ini berhasil mengoptimasi metode MS-MLPA dan mendeteksi metilasi pada 4 jenis tumor suppressor genes, yaitu gen RASSF1A, gen CASP8, gen FHIT, dan gen CHFR. Hasil identifikasi menunjukkan bahwa terdapat 20 sampel tumor ganas dan 2 sampel tumor jinak mengalami metilasi.

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DNA methylation is a common epigenetic change that causes gene inactivation in tumor suppressor genes (TSGs). TSGpromoter methylation has an association with the formation of thyroid cancer. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) is a PCR-based method that can identify methylation in several genes and copy number variant simultaneously. The aim of this study is to optimize methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) and to identify tumor suppressor genes methylation of thyroid cancer using MS-MLPA. Retrospectively 40 Fine Needle Aspiration Biopsy samples were collected in Dharmais Cancer Hospital. FNAB samples were collected from patients with thyroid nodules abnormalities. Tumor suppressor genes methylation were analyzed using Tumour Suppressor Mix 1 ME001-C2 probemix (MRC-Holland) as MS-MLPA reagents. FNAB samples were compared with reference sample from blood that were collected from healthy people. This study has successfully optimizing MS-MLPA method and detecting 4 methylated tumor suppressor genes, RASSF1A, CAPS8, FHIT and CHFR. Methylation identification shows 20 malignant histopathology samples and 2 benign histopathology samples were methylated.

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