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Abstrak :
ABSTRACT
Congenital hypothyroidism is the most treatable cause of mental retardation. It is also the most prevalent congenital endocrine disorder in childhood. A dramatic improvement can be made by early detection, diagnosis, and adequate treatment of levothyroxine in patients with congenital hypothyroidism. Severe cognitive impairment is associated with persistent disease in patients who have delayed or no treatment at all. In a modern era with complete healthcare facilities in a big city like Jakarta, the prevalence late-diagnosed congenital hypothyroidism is supposed to be very low. Since many districts have their own public healthcare facilities to screen and diagnose congenital hypothyroidism in children at very young age, a delayed diagnosis in adulthood is actually a rare case. In this medical illustration, we report a case of 21 year-old woman who came to our hospital with abdominal pain. She had mental retardation with no capability to communicate well with other person. She had a short stature (her height was less than 1 meter). She also had mongoloid face with big lips and a very big tongue. There was no goiter or lump on her neck. Her motoric performance was very weak and frail. During abdominal examination, we could see an umbilical bulging on her abdominal wall and on palpation, we could feel an umbilical hernia. By abdominal ultrasound, we could see the umbilical hernia. Unfortunately, no diagnosis of congenital hypothyroidism had been made when she was a newborn, there was also no past or known history of thyroid disease of her and her family. She had a diagnosis of mental retardation with no specific etiology since she was 5-years old. Based on the results of her laboratory examination, we had a confirmed diagnosis of primary hypothyroidism with T4 10,56 nmol/L (normal 60-120 nmol/L) and TSH > 100 mIU/mL. We provided her treatment using levothyroxine based on her body weight (25 mg daily). We arranged her to have abdominal CT Scan and digestive surgery as further management for her umbilical herniation. Some defects are correlated with congenital hypothyroidism when the disease is not treated properly and adequately. Neurocognitive, neuromotoric, growth, and development are some areas which can be disrupted by long-term hypothyroidism condition for patients who had the disease since their early years of life. Congenital hypothyroidism appears to be associated with an increased risk of congenital malformations. Several congenital malformations associated with congenital hypothyrodism are umbilical hernia, congenital heart disease, neurologic abnormalities, genitourinary malformations, cleft palate, and Downs syndrome. Studies concluded that severity of the congenital hypothyroidism has more important role than timing of treatment initiation on long-term cognitive and motor outcomes. Detrimental effects on developmental outcomes in congenital hypothyroidism patients may persist over time; however, early treatment for patients at very early ages may bring the best cognitive outcomes and neuromotoric development. Regardless of the treatment options, we can say that it is a loss case and a very late diagnosis and treatment of congenital hypothyroidism. The unusual age of detection, delayed diagnosis and treatment are some reminders for primary care physicians in our society to pay greater attention to screening programs. 6 Early detection and prompt treatment is an essential part of measures to reduce burden of mental retardation in our society. Delayed diagnosis of congenital hypothyroidism case, which is diagnosed at adulthood, indicates failure in screening program. Early diagnosis and treatment are necessary to prevent long-term catastrophic effects. This a wake-up call of attention and awareness for general public and primary care physicians in our country.

Abstrak :
ABSTRAK
Latar belakang: Hipotiroid kongenital merupakan suatu kelainan endokrin dimana terjadi penurunan sintesis hormon tiroid saat bayi baru lahir. Hipotiroid kongenital merupakan salah satu penyebab paling umum dari penurunan kecerdasaan intelektual retardasi mental yang sebenarnya dapat dicegah. Salah satu faktor risiko yang mendukung kejadian hipotiroid kongenital adalah status konsumsi garam beriodium ibu.Tujuan: Penelitian cross-sectional ini dilakukan untuk melihat apakah terdapat perbedaan antara nilai TSH neonatus dengan status konsumsi garam beriodium cukup ibu.Metode: Penelitian ini melibatkan 2.978 subjek yang terdiri atas bayi dan anak yang memperoleh uji saring hipotiroid kongenital di Rumah Sakit Umum Pusat Nasional RSUPN Dr. Cipto Mangunkusumo pada Bulan Mei hingga Bulan Juni 2017. Dari seluruh peserta uji saring hipotiroid kongenital tersebut, terdapat 1.687 subjek yang memenuhi kriteria inklusi dan eksklusi peneliti, kemudian dibagi menjadi dua kelompok, yaitu kelompok bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya rendah 90 . Jumlah sampel minimal yang harus dipenuhi oleh peneliti dengan menggunakan rumus besar sampel analitik numerik tidak berpasangan adalah 322 sampel. Setelah ditelaah, terdapat 149 subjek untuk kelompok bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya tinggi dan 173 bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya rendah. Sampel kemudian dianalisis menggunakan uji Mann-Whitney untuk diketahui hubungannya dengan nilai rerata TSH neonatus.Hasil dan Diskusi: Terdapat perbedaan bermakna nilai rerata TSH pada bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan persentase konsumsi garam beriodium cukup per rumah tangganya rendah dan kelompok bayi yang dilahirkan oleh ibu yang tinggal di daerah dengan tingkat konsumsi garam beriodium cukup per rumah tangganya tinggi.

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ABSTRACT
Background Congenital hypothyroidism is an endocrine disorder in which there is a decrease in thyroid hormone synthesis at birth. Congenital hypothyroidism is one of the most common causes of a decline in intellectual intelligence mental retardation that can be prevented. One of the risk factors that affects the incidence of congenital hypothyroidism is the consumption status of the mother 39 s iodized salt.Objective This cross sectional study was conducted to see if there was any difference between neonatal TSH value and iodized salt consumption status.Methods The study involved 2,978 subjects consisting of infants and children who received a congenital hypothyroid filter test at the National General Hospital RSUPN . Cipto Mangunkusumo from May to June 2017. From the congenital hypothyroid test participants, 1,687 subjects fulfilled the inclusion and exclusion criteria of the researcher, then divided into two groups, the group of neonates born to mothers living in the area with the percentage of consumption iodized salt per household is low 90 . The minimum number of samples that must be met by the researcher by using the formula of unpaired numerical analytic sample is 322 samples. Upon examination, there were 149 subjects for groups of neonates born to mothers living in areas with a high percentage of iodized salt intake per household and 173 neonates born to mothers living in areas with sufficient iodized salt intake percentage per household. The samples were then analyzed using the Mann Whitney test to be known to correlate with the mean values of neonatal TSH.Results and Discussions There was a significant difference in mean TSH values in neonates born to mothers living in areas with a moderate percentage of low iodized salt intake per household and neonates born to mothers living in areas with high iodized salt intake per household P 0.001 . This is in line with the theory that if the diet of iodized salt is adequate then TSH levels in the circulation will be normal, whereas if the iodized salt diet is inadequate then TSH levels in the circulation will be high, due to negative feedback of the least amount of thyroid hormones in the circulation due to the raw material of its formation , ie iodides derived from iodized salt are not met. Also there was a significant difference in mean birth weight of neonates born to mothers living in areas with a fairly low percentage of iodized salt intake per household and neontaes born to mothers living in areas with sufficient iodized salt intake per household P

Abstrak :
Latar Belakang: Beberapa penelitian terakhir menunjukkan adanya hubungan antara diabetes melitus tipe 2 (DMT2) dengan kejadian hipotiroid subklinis (HSK). Penelitian lain menunjukkan bahwa pada DMT2 yang disertai HSK, angka kejadian retinopati ternyata lebih tinggi dibanding pada DMT2 yang tanpa disertai HSK. Pasien HSK sendiri diketahui mempunyai risiko tinggi terhadap kejadian dislipidemia. Bagaimana hubungan antara dislipidemia dengan retinopati pada pasien DMT2 dengan HSK, sampai saat ini masih belum diketahui. Tujuan: Mengetahui proporsi HSK pada pasien DMT2, hubungan antara HSK dengan kontrol glukosa darah, HSK dengan dislipidemia, serta hubungan antara dislipidemia dengan kejadian retinopati pada pasien DMT2 dengan HSK. Metode: Desain penelitian yang digunakan adalah potong lintang. Sampel adalah pasien dewasa yang sudah didiagnosis DMT2 minimal 1 tahun, yang berobat ke poliklinik rawat jalan Divisi Metabolik Endokrin RSCM yang memenuhi kriteria inklusi. Data-data yang dikumpulkan adalah kontrol glukosa (HbA1c), profil lipid (kolesterol total, LDL, HDL, trigliserida), TSHs, fT4 dan data retinopati. Data diambil dari rekam medis maupun pemeriksaan laboratorium. Hasil: Proporsi penyakit HSK pada pasien DMT2 sebesar 7.2 % dan sebagian besar berusia di atas 60 tahun. Tidak didapatkan perbedaan proporsi antara lakilaki dan perempuan. Dari analisis didapatkan pasien DMT2 dengan kontrol gula darah yang buruk (HbA1c >7) memiliki risiko 3,664 kali lebih besar mengalami HSK dibanding dengan pasien DMT2 yang gula darahnya terkontrol baik (p:0,010). Pada pasien DMT2 dengan HSK yang disertai dislipidemia, risiko terkena retinopati 2,76 kali lebih besar dibanding pasien tanpa dislipidemia (p:0,014). Simpulan: Terdapat hubungan bermakna antara HSK dengan kontrol gula darah (HbA1c) pada pasien DMT2. Terdapat hubungan antara HSK dan dislipidemia pada pasien DMT2. Terdapat hubungan antara dislipidemia dengan kejadian retinopati pada pasien DMT2 dengan HSK. ...... Background: Some recent studies suggest that there is a link between type 2 diabetes mellitus (T2DM) and the incidence of subclinical hypothyroid (SCH). Other studies have shown that if a T2DM is accompanied SCH, the incidence of retinopathy was higher than in the T2DM without SCH. SCH patients themselves are known to have a high risk of occurrence of dyslipidemia. The the relationship between the incidence of dyslipidemia and retinopathy in patients with T2DM with SCH, is still unknown. Objective: To determine the proportion of SCH in patients with T2DM, the relationship between SCH and glycemic control (HbA1c), SCH with dyslipidemia, and dyslipidemia with the incidence of retinopathy in T2DM patients with SCH. Methods: The study design used is cross sectional. Sample were adult patients who have been diagnosed with T2DM at least 1 year, who went to the outpatient ward of Metabolic Endocrine Division, Cipto Mangunkusumo Hospital. Collected data include glycemic control (HbA1c), lipid profile (total cholesterol, LDL, HDL, triglycerides), TSHs, FT4 and retinopathy data. Data were retrieved from medical records and laboratory tests. Results: The proportion of SCH in patients with T2DM 7.2%, and mostly aged over 60 years. There were no differences in the proportion between men and women. From the analysis reveals the T2DM patients with poor blood sugar control (HbA1c >7) had 3.664 times greater risk of developing SCH compared with T2DM patients with well-controlled blood sugar (p:0.010). In patients with T2DM with SCH accompanied dyslipidemia, retinopathy risk 2.76 times greater than patients without dyslipidemia (p:0.014). Conclusion: There is a significant relationship between the SCH and glycemic control in patients with T2DM, SCH and dyslipidemia and also between dyslipidemia and retinopathy in T2DM patients with HSK.

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 :
ABSTRACT
Background: hypothyroidism is a common concomitant disease of non-alcoholic fatty liver disease (NAFLD). Previous studies regarding the relationship between subclinical hypothyroidism and NAFLD showed conflicting results, ranging from a strong association to not significant one. This case report aimed to investigate the risk of developing NAFLD in subclinical hypothyroidism patients. Methods: literature searching used ScienceDirect, PubMed, ProQuest, and Scopus. Filtering process of titles and abstracts by using inclusion and exclusion criteria yielded 4 eligible articles (1 systematic review, 1 prospective cohort, 1 retrospective cohort, and 1 case-control study) for answering the clinical question. Critical appraisal was conducted by using worksheets from Centre for Evidence-Based Medicine, University of Oxford. Results: the systematic review was considered invalid due to its less comprehensive search for relevant studies, inappropriate article selection to find a causal relationship between diseases, and statistical heterogeneity. The retrospective cohort was decided unimportant because it possessed a relative risk of 0.85 (95% confidence interval [CI], 0.72--1.00) which the upper limit of its CI included 1.00. The rest were valid and had important risk relative and odds ratio (1.27 [95% CI, 1.09--1.47], 3.41 [95% CI, 1.16--9.98]; respectively). The number needed to harm (5 - 17) indicated the clinically meaningful harm of the exposure since only a few patients with subclinical hypothyroidism is needed to obtain one additional NAFLD incidence. Those two articles were also suitable to be applied in our case. Conclusion: patients with subclinical hypothyroidism, compared to euthyroid patients, are at higher risk of developing NAFLD.