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Abstrak :
ABSTRAK
Latar Belakang. Prevalensi disfungsi tiroid lebih tinggi pada pasien diabetes dibandingkan populasi umum. Hipotiroidisme memperburuk komplikasi, morbiditas, mortalitas, dan kualitas hidup pasien diabetes melitus tipe 2 (DM tipe 2). Faktor risiko hipotiroidisme pada pasien DM tipe 2 selama ini masih kontradiktif dan belum dikaji secara lengkap. Keberadaan sistem skor hipotiroidisme pada pasien DM tipe 2 diperlukan untuk membantu diagnosis dan menapis pasien DM tipe 2 yang memerlukan pemeriksaan laboratorium fungsi tiroid sebagai baku emas diagnosis hipotiroidisme. Tujuan. Mengetahui prevalensi dan determinan hipotiroidisme pada pasien DM tipe 2. Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Divisi Metabolik Endokrin (Poliklinik Diabetes) RSCM pada Juli sampai September 2015 dengan metode sampling konsekutif. Subjek menjalani anamnesis, pemeriksaan fisis, dan pemeriksaan laboratorium (TSH dan fT4). Analisis data dilakukan dengan program statistik SPSS Statistics 17.0 untuk analisis univariat, bivariat, multivariat, dan Receiving Characteristics Operator (ROC) dan SPSS Statistics 20.0 untuk analisis bootstrapping pada Kalibrasi Hosmer-Lemeshow. Hasil. Sebanyak 303 subjek dianalisis untuk mendapatkan proporsi disfungsi tiroid dan 299 subjek dianalisis untuk mendapatkan determinan hipotiroidisme. Sebanyak 23 subjek (7,59%) terdiagnosis hipotiroidisme, terdiri dari 43,5% subjek hipotiroid klinis dan 56,5% subjek hipotiroid subklinis berdasarkan Indeks Zulewski dan/atau Indeks Billewicz, dengan 16,7% hipotiroid klinis dan 83,3% hipotiroid subklinis berdasarkan hasil pemeriksaan fT4. Determinan hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga dengan OR sebesar 4,719 (95% Interval Kepercayaan/IK 1,07-20,8, p = 0,04), keberadaan goiter dengan OR sebesar 20,679 (95% IK 3,49122,66, p = 0,001), kontrol glikemik yang buruk dengan OR sebesar 3,460 (95% IK 1,075-11,14, p = 0,037), dan adanya sindrom metabolik OR sebesar 25,718 (95% IK 2,21-299,99, p = 0,01). Simpulan. Proporsi hipotiroidisme pada pasien DM tipe 2 adalah 7,59%. Determinan diagnosis dan komponen sistem skor hipotiroidisme pada pasien DM tipe 2 adalah riwayat penyakit tiroid di keluarga, keberadaan goiter, kontrol glikemik yang buruk, dan adanya sindrom metabolik. Sistem skor yang diberi nama Skor Hipotiroid RSCM ini diharapkan menjadi alat bantu diagnosis hipotiroidisme pada pasien DM tipe 2. ABSTRACT
Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to general population. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type 2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are still contradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism in T2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergo thyroid function test as a gold standard diagnostic for hypothyroidism. Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients. Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient Clinic Cipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. All subjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysis was done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (Receiving Operator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshow Calibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299 subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as having hypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidism based on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinical hypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination. Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719 (95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95% CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and components of scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease, having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which is called RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism in T2DM patients.;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to general population. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type 2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are still contradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism in T2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergo thyroid function test as a gold standard diagnostic for hypothyroidism. Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients. Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient Clinic Cipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. All subjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysis was done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (Receiving Operator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshow Calibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299 subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as having hypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidism based on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinical hypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination. Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719 (95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95% CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and components of scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease, having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which is called RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism in T2DM patients. ;Background. Prevalence of thyroid dysfunction is greater in diabetes patients compared to general population. Hypothyroidism is worsening complications, morbidity, mortality, and quality of life in type 2 diabetes mellitus (T2DM) patients. Risk factors of hypothyroidism in T2DM patients are still contradictive and not assessed completely. Presence of scoring system to estimate hypothyroidism in T2DM patients are needed to help diagnosing and screening of T2DM patients who need to undergo thyroid function test as a gold standard diagnostic for hypothyroidism. Aim. To identify prevalence and estimators of hypothyroidism in T2DM patients. Methods. A cross-sectional study was conducted in Metabolic Endocrine (Diabetes) Outpatient Clinic Cipto Mangunkusumo Hospital from July-September 2015 with consecutive sampling method. All subjects underwent interview, physical examination, and laboratory testing (TSH and fT4). Analysis was done by using SPSS Statistics 17.0 for univariate, bivariate, multivariate, and ROC (Receiving Operator Characteristics) analysis and SPSS Statistics 20.0 for bootstrapping analysis in HosmerLemeshow Calibration. Results. 303 subjects included for proportion study of thyroid dysfunction and 299 subjects included for analysis of hypothyroidism determinants. 23 subjects (7,59%) are diagnosed as having hypothyroidism, consisted of 43,5% clinical hypothyroidism and 56,5% subclinical hypothyroidism based on clinical scoring index by Zulewski and Billewicz, and 16,7% subjects as having clinical hypothyroidism and 83,3% subjects as having subclinical hypothyroidism based on fT4 examination. Determinants for hypothyroidism in T2DM patients are family history of thyroid disease with OR 4,719 (95% Confident Interval/CI 1,07-20,8, p = 0,04), having goiter or difus struma with OR 20,679 (95% CI 3,49-122,66, p = 0,001), poor glycemic control with OR 3,460 (95% CI 1,075-11,14, p = 0,037), and metabolic syndrome with OR 25,718 (95% CI 2,21-299,99, p = 0,01). Conclusion. Proportion of hypothyroidism in T2DM patients is 7,59%. Determinants and components of scoring system of hypothyroidism in T2DM patients consist of family history of thyroid disease, having goiter or difus struma, poor glycemic control, and metabolic syndrome. Scoring system which is called RSCM Hypothyroid Score is expected to be a tool for helping diagnosis of hypothyroidism in T2DM patients.

Abstrak :
Latar Belakang. Kualitas hidup merupakan keluaran klinis yang seringkali terlupakan pada pengkajian pasien penyakit Graves. Saat ini belum ada kuesioner kualitas hidup pasien gangguan tiroid yang tervalidasi dalam Bahasa Indonesia. Penelitian terkait kualitas hidup belum pernah dilakukan pada pasien penyakit Graves di Indonesia. Metode. Penelitian ini menggunakan desain potong lintang yang terbagi ke dalam dua tahap yaitu (1) validasi kuesioner ThyPRO dalam Bahasa Indonesia dan (2) pengambilan data kualitas hidup pasien penyakit Graves dan faktor-faktor yang memengaruhinya. Studi ini dikerjakan pada bulan Maret sampai November 2022 di Poliklinik Endokrin Metabolik RSCM, Jakarta, Indonesia. Hasil. 50 subjek pasien gangguan tiroid dan 150 subjek pasien penyakit Graves berpartisipasi masingmasing pada tahap pertama dan kedua penelitian ini. Tahap pertama studi ini menghasilkan kuesioner ThyPROid (Thyroid-Related Patient-Reported Outcome Indonesian version) atau “Kuesioner Kualitas Hidup Pasien Tiroid Berbahasa Indonesia” yang secara keseluruhan valid dan reliabel. Kualitas hidup pasien penyakit Graves yang diperoleh pada penelitian ini adalah baik (72,7%) dan kurang (27,3%). Faktor-faktor yang memengaruhi kualitas hidup kurang pada penelitian ini adalah Indeks Wayne dengan skor di atas 19 dan oftalmopati derajat sedang-berat dan aktif. Riwayat sudah diobati, baik dengan obat anti-tiroid, pembedahan maupun terapi iodium radioaktif merupakan faktor protektif bagi kualitas hidup kurang. Kesimpulan. Menggunakan kuesioner ThyPROid yang sudah divalidasi dalam Bahasa Indonesia, sebagian besar pasien penyakit Graves memiliki kualitas hidup yang baik. Faktor yang memengaruhi kualitas hidup kurang adalah Indeks Wayne, oftalmopati derajat sedang-berat dan aktif. Riwayat sudah diobati, baik dengan obat anti-tiroid, pembedahan maupun terapi iodium radioaktif, merupakan faktor protektif kualitas hidup kurang. Kata kunci. Penyakit Graves, kualitas hidup, Indonesia, ThyPRO, Indeks Wayne, oftalmopati, pengobatan, obat anti-tiroid, pembedahan, terapi iodium radioaktif. ......Introduction. Quality of life is a clinical outcomes which frequently forgotten in any assessment of patients with Graves’ disease. There is currently no questionnaire for quality of life assessment for patients with thyroid disease which are validated in Bahasa Indonesia. Study about quality of life has never been conducted in patients with Graves’ disease in Indonesia. Methods. This cross-sectional study divided into two phases, that is: (1) ThyPRO questionnaire validation in Bahasa Indonesia, and (2) data collection on quality of life in patients with Graves’ disease and the factors affected it. This study was conducted on March to November 2022 in Endocrine & Metabolic Polyclinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Results. 50 subjects of patients with thyroid disease and 150 subjects of patients with Graves’ disease participated each in the first and the second phase of the study. First phase of the study resulted with ThyPROid questionnaire (Thyroid-Related Patient Reported Outcome Indonesian version) which overall is valid and reliable. Quality of life in patients with Graves’ disease that were obtained from this study was good (72,7%) and poor (27,3%). Factors that affected poor quality of life in this study was higher score of Wayne Index (total score > 19) and moderate-to-severe degree and active Graves’ ophthalmopathy. History of treatment, either with anti-thyroid medication, surgery, or radioactive iodine therapy, was protective factor for poor quality of life. Conclusion. Using ThyPROid questionnaire which were validated in Bahasa Indonesia, most of the patients with Graves’ disease in this study has good quality of life. Factors which affected poor quality of life was high Wayne Index and moderate-to-severe degree and active Graves’ ophthalmopathy. History of treatment, either with anti-thyroid medication, surgery, or radioactive iodine therapy, was protective factor for poor quality of life.

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.