Treatment

Hypothyroidism is best treated with hormone replacement therapy (HRT). The

desired clinical outcome of therapy is normal TSH levels. Levothyroxine, a synthetic
product routinely used to treat hypothyroidism, is available under various brand
names (e.g., Levothroid, Levoxyl, Synthroid, Unithroid).11 In adults, a daily dose of
1.6 mcg/kg of levothyroxine is recommended. In patients with ischemic heart
disease, a low initial thyroxine dose is recommended (12.5-50 mcg/day) to avoid
exacerbating angina.12 The half-life of levothyroxine is 1 week. Therefore, after 3 to
5 weeks, dose adjustment may be necessary. In most cases, symptoms of
hypothyroidism start to improve within a week after initiation of HRT. Levothyroxine
is an FDA pregnancy category A medication, which means that it is safe for use
during pregnancy, although a dose increase may be necessary. Levothyroxine also
is safe for use in breastfeeding women (the drug passes into breast milk, but is not
expected to harm the nursing infant).
Pengobatan
Hipotiroidisme paling baik diobati dengan terapi pengganti hormon. Hasil klinis yang
diharapkan setelah terapi adalah kadar TSH yang normal. Levothyroxine, produk
sintetik yang sering digunakan untuk mengobati hipotiroidisme, tersedia dalam
berbagai nama dagang contohnya seperti, Levothroid, Levoxyl, Synthroid,
Unithroid. Pada orang dewasa, dosis harian levothyroxine yang direkomendasikan
adalah 1,6 mcg/kg. Pada pasien dengan penyakit jantung iskemik, dosis inisial
thyroxine yang rendah di rekomendasikan (12.5-50 mcg/hari) untuk menghindari
angina yang lebih parah. Half-time levothyroxine adalah 1 minggu. Maka dari itu,
setelah 3-5 minggu, penyesuaian dosis perlu dilakukan. Dalam sebagian besar
kasus, gejala hipotiroidisme akan mulai membaik setelah 1 minggu pemberian
terapi pengganti hormon. Levothyroxine aman diberikan pada wanita hamil, dan
tidak berbahaya bagi anak yang menyusu.

Secondary hypothyroidism is characterized by decreased secretion of TSH, most commonly

owing to pituitary failure.6 Sometimes, decreased TRH production by the hypothalamus results
in decreased TSH production by the pituitary (tertiary hypothyroidism).8 In some patients, TSH
is mildly elevated when levels of free thyroid hormones are normal (subclinical hypothyroidism).
This situation indicates a possibility of the initial stage of thyroid failure.
Hypotiroidism sekunder

Diagnosis
Measuring TSH and T4 concentrations in the blood is the most efficient way to diagnose
hypothyroidism. Increased TSH concentrations and decreased thyroid hormone concentrations
indicate primary hypothyroidism. Normal serum TSH and T4 values vary slightly between
laboratories. An individual with no symptoms of abnormal thyroid function is
represented by serum TSH in the range of 0.4 to 4.0 mU/L.9 Serum TSH values greater than this
indicate primary hypothyroidism. Certain drugs (e.g., lithium, antithyroid medications,
dopamine) may interfere with serum TSH. A typical normal serum T4 value is in the range of 4.5
to 11.2 mcg/dL. Lower-than-normal serum T4 indicates hypothyroidism. Certain drugs may
interfere with serum T4; for example, birth control pills, clofibrate, estrogen, and the like are
known to increase T4; lithium, propranolol, androgens, and so on are known to decrease T4. The
cost-effectiveness of hypothyroidism screening is more favorable for women and the elderly
population; this is strongly influenced by the cost of TSH measurement. The American Thyroid
Association recommends routine screening in men and women aged 35 years and over.10
As mentioned previously, HT is an autoimmune disorder in which autoantibodies are produced
against TPO and Tg; therefore, it is diagnosed by additional tests that identify the presence of
these autoantibodies. The normal range for TPO autoantibodies is between 42 and 100 IU/mL,
whereas the normal range for Tg autoantibodies is between 67 and 115 IU/mL. Values greater
than these are considered positive.7
Diagnosa
Mengukur konsentrasi TSH dan T4 dalam darah adalah cara yang paling efektif
untuk mendiagnosa hipotirodisme. Kenaikkan konsentrasi TSH dan penurunan
konsentrasi hormone tiroid mengindikasikan hipotiroidismee primer. Konsentrasi
normal TSH dalam darah berkisar antara 0.4 sampai 4.0 mU/L, apabila lebih dari ini, maka

itu hipotiroidismee primer. Beberapa obat seperti lithium, obat antitiroid, dan dopamine, dapat
mempengaruhi konsentrasi TSH. Kosentrasi normal T4 berkisar antara 4.5 sampai 11.2 mcg/dL,
dan apabila lebih rendah dari ini, maka itu hipotirodisme. Beberapa obat dapat mempengaruhi
kosentrasi T4 dalam darah seperti, pil KB, clofibrate, estrogen, dan sejenisnya dapat
meningkatkan konsentrasi T4; sedangkan lithium, propranolol, androgen, dan sejenisnya dapat
menurunkan konsentrasi T4. American Thyroid Association mengrekomendasikan setiap pria dan
wanita berusia 35 tahun keatas untuk melakukan pemeriksaan rutin. Hashimoto thyroiditis
merupakan penyakit autoimmune, dimana antibodi melawan TPO dan Tg akan terbentuk; maka
dari itu, diagnosa dapat ditegakkan dengan pemeriksaan tambahan untuk mencari autoantibodi
ini. Konsentrasi normal autoantibodi TPO berkisar antara 67 sampai 115 IU/mL. Kadar yang
lebih dari ini dianggap positif.

The clinical presentation includes fever, tachycardia, hypertension, and neurological and GI
abnormalities. Hypertension may be followed by congestive heart failure that is associated with
hypotension and shock. Because thyroid storm is almost invariably fatal if left untreated, rapid
diagnosis and aggressive treatment are critical.
Presentasi klinisnya termasuk demam, takikardi, hipertensi, abnormalitas neuro dan abnormalitas
gastrointestinal. Hipertensi dapat diikuti oleh gagal jantung kongestif yang berhubungan dengan
hipotensi dan syok. Karena thyroid storm hamper selalu fatal jika tidak diobati, diagnosa yang
cepat dan pengobatan agresif adalah kritis.
Diagnosis is primarily clinical, and no specific laboratory tests are available.
Diagnosa dapat ditegakkan terutama dari klinis, dan tidak terdapat pemeriksaan
laboratorium yang spesifik.

Heat intolerance and diaphoresis are common in simple thyrotoxicosis but manifest
as hyperpyrexia in thyroid storm. Extremely high metabolism also increases oxygen
and energy consumption. Cardiac findings of mild-to-moderate sinus tachycardia in
thyrotoxicosis intensify to accelerated tachycardia, hypertension, high-output
cardiac failure, and a propensity to develop cardiac arrhythmias. Similarly, irritability
and restlessness in thyrotoxicosis progress to severe agitation, delirium, seizures,
and coma.[1] GI manifestations of thyroid storm include diarrhea, vomiting,
jaundice, and abdominal pain, in contrast to only mild elevations of transaminases
and simple enhancement of intestinal transport in thyrotoxicosis.
Intoleransi panas dan diaphoresis (keringat berlebihan) sudah umum terjadi dalam
thyrotoxicosis biasa, tetapi pada thyroid storm itu mewujudkan diri sebagai
hiperpireksia. Metabolisme yang sangat tinggi akan meningkatkan konsumsi
oksigen dan tenaga. Gejala jantung dari sinus takikardi ringan, hingga sius
takikardi berat, hipertensi, gagal jantung high-output, dan aritmia, dapat terjadi.
Iritasi dan kegelisahan dalam thyrotoxicosis dapat berkembang menjadi agitasi
berat, delirium, kejang, dan koma. Gejala gastrointestinal pada thyroid storm
termasuk diare, muntah, kuning, dan nyeri, dibandingkan pada thyrotoxicosis hanya
kenaikan transaminase ringan dan meningkat kelancaran transportasi intestinal.