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"Why Do I Still Have Thyroid Symptoms? was written to address the true causes of hypothyroidism and how to manage them. The vast majority of hypothyroid cases are being treated inappropriately or misdiagnosed by the standard health care model. Through exhaustive research and clinical experience, Dr. Kharrazian has discovered what really causes hypothyroidism and how to manage it"

"ABSTRACTThyroid 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."

"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. "

"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."

"Tesis ini merupakan penelitian pertama di Indonesia yang membahas pemanfaatan ultrasonografi tiroid dalam deteksi dini kelainan tiroid  pada kehamilan. Abnormalitas penanda tiroid pada kehamilan dapat mempengaruhi perkembangan janin. Rekomendasi dari American Thyroid Association tahun 2017 menganjurkan deteksi kelainan tiroid pada kehamilan berisiko. Biaya pemeriksaan penanda tiroid relatif mahal. Tujuan penelitian ini untuk melakukan analisis apakah pemanfaatan ultrasonografi dapat digunakan sebagai alternatif dalam rancangan alur prosedur deteksi dini kelainan tiroid pada kehamilan. Metoda penelitian ini adalah kualitatif deskriptif. Uji yang dilakukan adalah uji validitas dengan analisis sensitivitas dan spesifisitas, kesesuaian dengan pendapat pakar, dan analisis biaya. Hasil dari penelitian ini didapatkan 20 responden ibu hamil berusia 30-39 tahun, 12 orang trimester dua dan 8 orang trimester tiga, dengan faktor risiko terbanyak riwayat keluarga kelainan tiroid, didapatkan hasil USG abnormal 12 (60%) dan penanda tiroid abnormal 11 (55%). Analisis validitas menunjukkan sensitivitas sebesar 100 % dan spesifisitas sebesar 88,89 %, dengan prediktif negatif 100%. Pada analisis biaya ditemukan selisih pembiayaan sebesar Rp. 150.500,00 dibanding alur deteksi yang lama. Hal-hal yang dapat menimbulkan bias dalam penelitian ini adalah jumlah sampel yang kurang, terdapat sejumlah sampel (3 reponden; 15%) yang diambil pada waktu yang tidak seragam, ada sebagian sampel (5 sampel; 25 %) yang dikerjakan oleh laboratorium lain, dan faktor intrinsik peneliti sendiri pada saat pengerjaan ultrasonografi. Sensitivitas yang baik dan nilai prediktif negatif dari penelitian ini menyimpulkan bahwa pemanfaatan ultrasonografi tiroid mungkin dapat menjadi pilihan bagi rancangan alur prosedur alternatif deteksi dini kelainan tiroid pada kehamilan. Direkomendasikan pada peneliti selanjutnya untuk melakukan penelitian dengan jumlah sampel lebih besar, keseragaman pengerjaan sampel, dan melakukan pengujian keragaman interpretasi ultrasonografi oleh dua pakar sebelum penelitian untuk menyingkirkan bias, untuk selanjutnya dapat diajukan kepada pemangku kebijakan sehingga pemanfaatan ultrasonografi tiroid dapat menjadi alur prosedur alternatif deteksi dini kelainan tiroid pada kehamilan dalam panduan praktek klinis di rumah sakit.

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This thesis the first in Indonesia, discusses the utilization of thyroid ultrasound in early detection of thyroid disorders in pregnancy. Abnormalities of thyroid function in pregnancy can affect fetal development. Recommendations from the American Thyroid Association in 2017 recommend periodic thyroid screenings for pregnant woman whom at risk of thyroid disorders. The cost of thyroid examinations is relatively expensive. The purpose of this study was to analyze whether the utilization of ultrasound can be used as an alternative pathway in the design of early detection procedures for thyroid disorders in pregnancy. The method of this research is qualitative descriptive.The analysis is using validity tests with sensitivity and specificity analysis, conformity with expert opinion, and cost analysis. The results of this study were obtained by 20 respondents of pregnant women aged 30-39 years, 12 people in the 2nd trimester and 8 people in the 3rd trimester, with the most risk factors for a family history of thyroid disorders, with abnormal ultrasound results of 12 (60%) and abnormal thyroid markers 11 (55%). Validity analysis showed sensitivity and specificity 100% and 88.89% respectively, with 100% negative predictive value. There is a financing difference of Rp. 150,500.00 compared to the current pathway. The bias in this study could be because of the lack of the number of samples, there are 3 blood sampling (15%) taken at the different schedule time, there are 5 samples (25 %) sent to other laboratories, and intrinsic factors during capturing ultrasound figures. The good sensitivity and negative predictive value of the study concluded that the utilization of thyroid ultrasound may be an option for the design of alternative procedures for early detection of thyroid disorders in pregnancy. It is recommended in further researchers to conduct studies with a larger number of samples, to design the samples as homogeneous as possible, and conduct diversity testing of ultrasound interpretation by two experts before the study begin, to keep out the biases, and further be submitted to stakeholders so that the utilization of thyroid ultrasound could be a pathway of alternative procedures for clinical practice guidelines of early detection of thyroid disorders in pregnancy in hospitals."

"ABSTRAKDalam 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."