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Abstrak :
ABSTRAK Dalam upaya penatalaksanaan penderita penyakit kelenjar tiroid, harus dibuat diagnosis anatomik atau etiologik untuk mengetahui penyebab yang mendasari penyakit dan diagnosis fungsional untuk mengetahui status produksi hormon tiroid. Pemeriksaan laboratorium sangat berguna dalam membedakan fungsi kelenjar tiroid tersebut termasuk hipotiroid, eutiroid atau hipertiroid. Penelitian ini bertujuan untuk mengetahui apakah pemeriksaan TSH-sensitif metode IRMA dan ICMA dapat membedakan dengan jelas penderita hipertiroidisme dan kontrol eutiroid, dengan kata lain apakah pemeriksaan tersebut dapat dipakai sebagai uji saring untuk hipertiroidisme. Disamping itu ingin mendapatkan nilai rujukan TSH-IRMA dan ICMA yang dapat dipakai di UPF Patologi Klinik FKUI/RSCM. Subyek penelitian adalah 35 penderita hipertiroidisme, terdiri atas 25 orang wanita dan 10 orang laki-laki, berusia 21-59 {30,2) tahun. Sebagai kontrol adalah 70 orang yang mempunyai fungsi kelenjar tiroid eutiroid, terdiri atas 40 laki-laki dan 29 perempuan, berusia 15-73 (37) tahun. Kriteria diagnostik didasarkan pada temuan klinik dan hasil pemeriksaan laboratorium FT4I. Terhadap subyek penelitian dan kontrol dilakukan pemeriksaan T4 total, T3U, TSH-IRMA (DPC) dan TSH-ICMA (Amerlite). Hasil pemeriksaan kontrol: T4=4,1-15,1 (9,28) ug/dL; T3U = 19,3-33,0 (27,3)%; FT4I=0,81-3,59 (2,53); TSH-IRMA=O,25-3,60 (1,38) mIU/L dan TSH-ICMA=0,54-3,12 (1,34) mIU/L. Terdapat korelasi terbalik antara nilai T4 total, T3U dan FT4I dengan TSH-IRMA maupun TSH-ICMA. Tidak terdapat perbedaan nilai TSH kontrol laki-laki dan perempuan. Tidak terdapat hubungan antara umur dan nilai TSH. Nilai rujukan TSH-IRMA = 0,39-3,63 mIU/L, dan TSH-ICMA = 0,49-2,97 mIU/L.Hasil pemeriksaan penderita hipertiroid: T4 = 16,0->24 ng/dL; T3U=30,3-43,7 (38,3)7.; FT4I = 5,36->10,49; 31 (88,51.) orang mempunyai nilai TSH-IRMA dan ICMA tidak terukur dan, 4 Orang mempunyai nilai TSH-IRMA 0,09; 0,12; 0,16; 0,18 dan TSH-ICMA 0,06; 0,12; 0,13; 0,14. Nilai TSH-IRMA dan TSH-ICMA penderita hipertiroid berbeda bermakna dengan kontrol eutiroid. Terdapat korelasi antara nilai TSH-IRMA dengan TSH-ICMA (r = 0,9922). Nilai TSH-ICMA lebih rendah 6,6% dibanding TSH-IRMA. Nilai batas deteksi TSH-IRMA = 0,09 mIU/L dan TSH-ICMA = 0,04 mIU/L. Biaya per tes TSH-IRMA lebih mahal dibanding TSH-ICMA, karena pemeriksaan TSH-IRMA harus dilakukan in duplo. Pemeriksaan TSH-IRMA dan TSH-ICMA sensitif secara analitik dan klinik untuk diagnosis hipertiroidisme. Kesimpulan penelitian ialah pemeriksaan TSH-IRMA dan TSH﷓ICMA mampu membedakan dengan jelas penderita hipertiroidisme dan kontrol eutiroid, dan dapat dipakai sebagai uji saring hipertiroidisme. Batas deteksi pemeriksaan TSH-ICMA lebih rendah dari pada TSH-IRMA. Nilai rujukan TSH-IRMA berbeda dengan TSH-ICMA. Disarankan untuk melakukan penelitian serupa dengan subyek penelitian dan kontrol (penderita rawat tinggal dan rawat jalan) yang lebih banyak agar dapat ditentukan nilai batas TSH untuk diagnosis hipertiroidisme, dan mendapatkan nilai rujukan yang lebih memenuhi syarat. Disarankan pula untuk menilai kemampuan pemeriksaan TSH untuk memantau pengobatan hipertiroidisme dan pengobatan hormon tiroid.

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In managing patients with thyroid diseases, an anatomical or etiological diagnosis should be made for knowing the basic causes, and functional diagnosis for knowing the thyroid hormone production. Laboratory tests are necessary to differentiate whether the condition is hypothyroid, euthyroid or hyperthyroid. The goal of this study was to know whether TSH-IRMA and ICMA tests can clearly differentiate hyperthyroid patients from euthyroid, and whether this test can be used as the first test for hyperthyroidism. More over, to determine the reference range of TSH-IRMA and ICMA which can be used in the Departement of Clinical Pathology, Dr Cipto Mangunkusumo hospital / Faculty of Medicine University of Indonesia. The subjects of this study were 35 patients with hyperthyroidism. They consist of 25 women and 10 men, who were 21-59 (30,2) years old. We took 70 people who were in euthyroid condition, about 15-73 (37) years old as controls. The criteria of diagnosis were based on clinical finding and FT4I test. Subjects and controls were examined for total T4, T3U, TSH-IRMA (DPC) and TSH-ICMA (Amerlite) levels. Values of the controls were T4 = 4,1-15,1 (9,28) ug/dL; T3U = 19,3-33,0 (27,3)%; FT4I = 0,81-3,59 (2,53); TSH-IRMA = 0,25-3,60 (1,3B) mIU/L and TSH-ICMA = 0,54-3,12 (1,34) mIU/L. There was negative correlation between total T4, T3U or FT4I level and TSH-IRMA or TSH-ICMA. There was no difference between TSH level in male and female controls. No correlation was found between age and TSH level. The reference value of TSH-IRMA was 0,39-3,63 mIU/L and TSH-ICMA was 0,49-2,97 mIU/L. The level of total T4, T3U and FT4I in hyperthyroid were 16,0->24 ng/dL, 30,3-43,7 (38,3)7 and 5,36-7.10,49 respectively. TSH-IRMA and TSH-ICMA value were undetectable in 31(88,5%) persons, and 4 persons have TSH-IRMA level of 0,09; 0,12; 0,16; 0,1B and TSH-ICMA level of 0,06; 0,12; 0,13; 0,14. TSH﷓IRMA and TSH-ICMA level in hyperthyroid were significantly lower than in euthyroid. There was a good correlation between TSH-IRMA and TSH-ICMA (r = 0,9922). T5H-ICMA was 6,6% lower than TSH-IRMA. The detection limit of TSH-IRMA was 0,09 mIU/L and TSH-ICMA was 0,04 mIU/L. One TSH-IRMA test was more expensive than one TSH-ICMA test, because TSH-IRMA test must be performed in duplicate. TSH-IRMA and TSH-ICMA assays were analytically and clinically sensitive and specific for diagnosing hyperthyroidism. In conclusion, TSH-IRMA and TSH-ICMA assays could clearly differentiate hyperthyroid from euthyroid patients, and suitable as screening tests for hyperthyroidism. The detection limit of TSH-ICMA was lower than T5H-IRMA. The reference range of TSH-IRMA was different from TSH-ICMA. Further study with more subjects is still needed to determine TSH lower limit value for diagnosing hyperthyroidism and a more acceptable reference value. We suggest another study to evaluate TSH values in controlling treatment of hyperthyroidism and thyroid hormones supplementation.

Abstrak :
Ketersediaan iodium dalam garam beriodium yang kurang atau berlebih dapatmenyebabkan penyakit gangguan tiroid. Penelitian ini bertujuan untukmengetahui faktor-faktor yang berhubungan dengan ketersediaan iodium dalamgaram beriodium merek ldquo;R rdquo; pada tingkat rumah tangga. Garam beriodium merek ldquo;R rdquo; merupakan salah satu produk garam beriodium yang telah terdaftar.Penelitian ini merupakan penelitian kuantitatif yang mengunakan desain crosssectional. Sampel penelitian adalah 124 rumah tangga yang didapatkan denganteknik purposive sampling. Hasil penelitian menunjukkan bahwa terdapathubungan yang signifikan antara wadah penyimpanan garam dengan ketersediaaniodium dalam garam beriodium p = 0,044 dan OR = 4,083 . Sebagian besarketersediaan iodium dalam sampel garam merek ldquo;R rdquo; berlebih sehingga dapatmemicu timbulnya penyakit hipertiroid. Sebaiknya pemerintah memberikanperhatian terhadap kemungkinan munculnya hipertiroidisme sebagai dampak dariprogram iodisasi garam. ......The availability of less or excessive iodine in iodized salt can cause thyroiddisorder disease. This study aimed to determine the factors associated with theavailability of iodine in the ldquo R rdquo branded iodized salt at the household level. The R branded iodized salt is one of the registered iodized salt products.This study isa quantitative research using cross sectional design. The sample of this study was124 households obtained with purposive sampling technique. The results showedthat there was a significant association between salt storage containers with iodineavailability in iodized salt p 0.044 and OR 4,083 . Most of the availability ofiodine in the ldquo R rdquo branded iodized salt samples were excessive, so it could lead tohyperthyroidism. The government should pay attention to the possibility ofhyperthyroidism as an impact of the salt iodization program.

Abstrak :
Background: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. Methods: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. Results: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. Conclusion: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients.

Abstrak :
ABSTRAK
Merokok berbahaya bagi perokok aktif maupun perokok pasif (Aditama, 2001). Asap rokok mengandung nikotin yang dapat memicu aktivitas kelenjar tiroid pada manusia (Utiger, 1998). Wanita lebih rentan mengalami hipertiroid (Greenspan and Baxter, 1994). Penelitian ini bertujuan untuk mengetahui hubungan antara status merokok dengan kejadian hipertiroid pada pasien wanita usia subur di Klinik Balai Litbang GAKI Magelang tahun 2013-2014. Penelitian dilakukan dengan disain kasus-kontrol. Penelitian melibatkan 51 responden pasien wanita usia subur penderita hipertiroid dan 102 responden pasien wanita usia subur dengan fungsi tiroid normal (eutiroid). Pengumpulan data dilakukan pada status merokok, umur, penggunaan kontrasepsi hormonal, melahirkan 1 tahun terakhir, tingkat stres, dan kebiasaan penggunaan garam beriodium rumah tangga responden. Data dianalisa menggunakan uji regresi logistik. Pasien wanita usia subur terpajan asap rokok baik perokok aktif atau pasif berisiko mengalami hipertiroid 2,05 kali dari risiko pasien wanita usia subur di Klinik Balai Litbang GAKI Magelang setelah dikontrol variabel kontrasepsi hormonal dan tingkat stres. Menggunakan kontrasepsi hormonal menurunkan risiko hipertiroid, sedangkan stres berat meningkatkan risiko hipertiroid. Wanita usia subur hendaknya menghindari pajanan asap rokok dan melakukan manajemen stres untuk mengurangi faktor risiko hipertiroid.

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ABSTRACT
Smoking is harmful to the active smokers and passive smokers (Aditama, 2001). Tobacco smoke contains nicotine, chemical that are known can lead hyperthyroidism in human (Utiger, 1998). This study aimed to determine the relationship between smoking status on hyperthyroidism in patients of childbearing age women in the Clinic of IDD (Iodine Deficiency Disorders) Research Center, Magelang in 2013-2014. The study was conducted with a casecontrol design. The study involved 51 childbearing-age women patients with hyperthyroidism patients and 102 childbearing-age women patients with normal thyroid function (euthyroid). Data collection was conducted on smoking status, age, hormonal contraceptive use, giving birth in the past one year, the level of stress, and the habits of the use of iodized salt in the household. Data were analyzed using logistic regression. Chiilbearing-age women patients who were active/passive smokers at risk of hyperthyroidism 2.05 times the risk of childbearing-age women patients in the Clinic of Iodine Deficiency Disorders (IDD) Research Center, Magelang after controlled by hormonal contraceptives and stress levels variables. Use of hormonal contraceptives reduce the risk of hyperthyroidism, whereas severe stress increases the risk of hyperthyroidism. Childbearing-age women should avoid exposure to cigarette smoke and do stress management to reduce risk factors for hyperthyroidism.

Abstrak :
Hipertiroidisme adalah suatu kondisi di mana kelenjar tiroid menghasilkan terlalu banyak hormon tiroid sehingga metabolisme menjadi lebih cepat dan menimbulkan berbagai gejala seperti penurunan berat badan, palpitasi, dan kecemasan. Metimazol (MMI) dan propiltiourasil (PTU) adalah dua obat yang umum digunakan dalam pengobatan hipertiroidisme. Tujuan dari penelitian ini adalah untuk menganalisis efektivitas-biaya MMI dibandingkan dengan PTU pada pasien hipertiroid rawat jalan di Rumah Sakit Umum Pusat Fatmawati pada tahun 2017–2022. Penelitian observasional ini menggunakan desain studi cross-sectional dengan teknik pengambilan data secara retrospektif. Pasien yang memenuhi kriteria inklusi berjumlah 140 pasien dan dibagi menjadi dua kelompok, yaitu 70 pasien menggunakan terapi metimazol dan 70 pasien menggunakan terapi propiltiourasil. Terapi dinyatakan efektif jika pasien memperoleh kadar T4 bebas (fT4) normal, yaitu < 1,76 ng/dL setelah menggunakan terapi selama 3 bulan. Terdapat perbedaan yang bermakna antara efektivitas MMI dan PTU, yakni 77,1% dan 60% (p = 0,045). Komponen biaya yang digunakan adalah total biaya langsung medis. Nilai Rasio Inkremental Efektivitas-Biaya (RIEB) yang diperoleh adalah Rp15.516/% efektivitas, yang artinya dibutuhkan tambahan biaya sebesar Rp15.516 untuk setiap peningkatan 1% pasien hipertiroid yang mencapai kadar fT4 normal jika ingin berpindah dari terapi propiltiourasil ke metimazol. ......Hyperthyroidism is a condition in which the thyroid gland produces an excessive amount of thyroid hormones, leading to an accelerated metabolism and various symptoms such as weight loss, palpitations, and anxiety. Methimazole (MMI) and propylthiouracil (PTU) are two commonly used drugs in the treatment of hyperthyroidism. The aim of this study was to analyze the cost-effectiveness of MMI compared to PTU in outpatient hyperthyroid patients at Fatmawati General Hospital from 2017 to 2022. This observational study employed a cross-sectional design with data collected retrospectively. A total of 140 patients who met the inclusion criteria were divided into two groups: 70 patients receiving methimazole therapy and 70 patients receiving propylthiouracil therapy. Therapy was considered effective if patients achieved a normal free T4 (fT4) level, i.e., < 1.76 ng/dL, after three months of treatment. There was a significant difference in effectiveness between MMI and PTU, namely 77.1% and 60% (p = 0.045), respectively. The cost components considered were the total direct medical costs. The calculated Incremental Cost-Effectiveness Ratio (ICER) was Rp15,516/% effectiveness, indicating that an additional cost of Rp15,516 was required to achieve a 1% increase in hyperthyroid patients who achieved normal fT4 levels when switching from propylthiouracil to methimazole therapy.