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Penanganan pasien krisis tiroid menurut kriteria burch wartofsky score di intensive care unit



Abstract

Abstrak

Krisis tiroid adalah merupakan salah satu kegawatdaruratan pada tingkat pertama dalam bidang endokrin dengan angka morbiditas dan mortalitas yang sangat tinggi. Dimana insiden kasus ini dikatakan jarang sekali terjadi, namun saat seseorang sudah dinyatakan menderita penyakit ini maka disebutkan angka kematiannya tinggi. Oleh karena itu diperlukan penegakkan diagnosis harus secara dini dan pengelolaan pasien harus secara agresif, karena akan memberikan prognosis yang baik pada pasien apabila kita bisa mengelola pasien dengan secara agresif. Dimana diagnosis krisis tiroid itu didasarkan pada klinis pasien, bukan dari laboratoris. Krisis tiroid umumnya terjadi pada pasien dengan hipertiroid yang tidak diberikan terapi yang adekuat dan dipicu oleh adanya infeksi, trauma, pembedahan tiroid, atau diabetes melitus yang tidak terkontrol.

Pada laporan kasus kali ini kami menyampaikan kasus pasien yang dikonsulkan ke intensive care unit (ICU) dari sejawat penyakit dalam di Instalasi Gawat Darurat (IGD) yaitu pasien perempuan, umur 45 tahun dengan dignosis masuk Observasi Dyspneu ec impending Airway Obstruction et causa tumor tyroid suspect malignancy, suspect tyroid storm. Pasien dengan permasalahan penurunan kesadaran et causa gagal nafas et causa obstruksi CA tyroid. Dari pemeriksaan klinis dan pemeriksaan penunjang yang ada mendukung dengan krisis tiroid menurut kriteria  Burch Wartofsky score. Selama perawatan di ruang intensif pasien mendapatkan terapi farmakokinetik yang menurunkan sintesis dan sekresi hormon tiroid, menurunkan pengaruh perifer hormon tiroid, mencegah dekompensasi sistemik, dan pada hari ke delapan pasien dilakukan tiroidektomy dan trakeostomi oleh sejawat bedah, post operasi pasien masih dibantu dengan mesin alat bantu nafas (ventilator) dan mulai disapih, hari ke sembilan pasien sudah bisa menggunakan NRM melalui trakeostoma, hari ke dua belas pasien dipindahkan ke ruang perawatan. Target pengelolaan pasien yang menderita krisis tiroid meliputi menurunkan sintesis dan sekresi hormon tiroid, menurunkan pengaruh perifer hormon tiroid, mencegah dekompensasi sistemik, dan terapi penyakit pemicu. Terapi definitif penyebab disfungsi tiroid dilakukan bila kegawatan telah teratasi, dimana pengelolaan secara agresif dilakukan di Intensive Care Unit (ICU).

Kata Kunci :  krisis tiroid, kegawatdaruratan, skor kriteria Burch and Wartofsky, tidak menggunakan amiodaron

 

Abstract

               Thyroid crisis is one of the first levels of emergency in the endocrine field with very high morbidity and mortality. Where the incidence of this case is said to occur very rarely, but when a person has been declared to suffer from this disease, the death rate is high. Therefore, a diagnosis must be made early and the management of the patient must be aggressive, because it will provide a good prognosis for patients if we can manage patients aggressively. Where the diagnosis of thyroid crisis is based on the clinical patient, not from the laboratory. Thyroid crisis generally occurs in patients with hyperthyroidism who are not given adequate therapy and are triggered by infection, trauma, thyroid surgery, or uncontrolled diabetes mellitus            In this case report we present the case of patients who were consulted to the intensive care unit (ICU) from colleagues in internal medicine at the Emergency Department (IGD), namely female patients, aged 45 years with dignosis in. Observation Dyspneu ec impending Airway Obstruction et causa tyroid suspect tumor malignancy, suspect tyroid storm. Patients with a problem of decreased consciousness of et causa failure of breath from a thyroid CA obstruction. From clinical examinations and investigations there are supports with a thyroid crisis according to the Burch Wartofsky score criteria. During treatment in the intensive room the patient received pharmacokinetic therapy which reduced the synthesis and secretion of thyroid hormone, reduced the peripheral effects of thyroid hormone, prevented systemic decompensation, and on the eighth day the patient underwent thyroidectomy and tracheostomy by a surgical colleague, the postoperative patient was still assisted with assistive machines breath (ventilator) and began weaning, the ninth day the patient was able to use NRM through tracheostoma, the twelfth day the patient was transferred to the treatment room. The target of managing patients suffering from a thyroid crisis includes reducing the synthesis and secretion of thyroid hormones, reducing the peripheral effects of thyroid hormones, preventing systemic decompensation, and the treatment of trigger diseases. The definitive cause of thyroid dysfunction is done when the emergency has been resolved, where aggressive management is carried out in the Intensive Care Unit (ICU).Keywords: thyroid crisis, emergency, Burch and Wartofsky criteria score, no use amiodarone

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How to Cite

Sitalaksmi, R., Sinardja, I. K., & Wiryana, M. (2019). Penanganan pasien krisis tiroid menurut kriteria burch wartofsky score di intensive care unit. Medicina, 50(2). https://doi.org/10.15562/medicina.v50i2.622
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