BAB V KESIMPULAN DAN SARAN
5.2 Saran
Masih diperlukan penelitian lebih lanjut mengenai hubungan β-hCG dengan fungsi tiroid seperti mencari nilai cut off pointkadarβ-hCG yang dapat mempengaruhi fungsi hormon tiroid. Selain itu, hasil penelitian ini menganjurkan untuk tetap dilakukan pemeriksaan panel tiroid dalam penatalaksanaan molahidatidosa.
DAFTAR PUSTAKA
1. Report on The Achievement of The Millenium Development Goals Indonesia 2010, published by: Ministry of National Development Planning, 2010
2. Meister LHF, Hauck PR, Graf H, Carvalho GA. Hyperthyroidism due to secretion of Human Chorionic Gonadothropin in a patient with metastatic choriocarcinoma. Arq Bras Endocrinol Metab 2005, 49(2): 319-322
3. Gestational Trophoblastic Disease in : Williams Gynecology, Sec.4, Chapt.37, The McGraw-Hill Companies, Inc, New York, 2008
4. Gestational Trophoblastic Disease in : Berek & Novak's Gynecology 14th ed. Chapt 37, Lippincott Williams & Wilkins, 2007 5. Wiknjosastro H, Saifuddin AB, Rachimhadhi T. Gangguan
Bersangkutan Dengan Konsepsi. Dalam : Ilmu Kandungan. Edisi II, Cetakan VI. PT.Bina Pustaka Sarwono Prawirohardjo. Jakarta: 2008: Hal 247-266
6. Berkowitz RS, Goldstein DP. Presentation and Management of Molar Pregnancy. Chapter 9: 249-276.Access at February 28th 2014
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7. Almeida CED, Curi EF, Almeida CRD, Vieira DF. Thyrotoxic Crisis Associated with Gestational Trophoblatic Disease. Rev Bras Anatesiol 2011; 61(5): 604-609.
8. Hershman JM. Hyperthyroidism Due To Hcg Occurs In 2% Of Cases Of Gestational Trophoblastic Disease. Clinical Thyroidology August 2011; 23(8): 5-6
9. Salavatian F, Omrani GH, Andish MHK. The Correlation Between b-hCG and Thyroid Function Test in Molar Pregnancy. Shiraz University of Medical Sciences. May 1994.
10. Nandini D, Sarita F, Uday A, Hemalata I. Hydatidiform mole with hyperthyroidism – perioperative challenges. J Obstet Gynecol India. Case Report. 2009, 59(4): 356-357
11. Mansjoer, A. dkk. Mola Hidatidosa. Kapita Selekta Kedokteran. Fakultas Kedokteran Universitas Indonesia. Jilid I. Media Aesculapius. Jakarta. 2001. Hal 265-267.
12. Cuninngham. F.G. dkk. Penyakit Trofoblas Gestasional. Dalam: Obstetri Williams. Edisi 23 vol 1. Penerbit Buku Kedokteran EGC. Jakarta: 2010; hal 271-78.
13. Martaadisoebrata. D, & Sumapraja, S. Penyakit Serta Kelainan Plasenta dan selaput Janin. Ilmu Kebidanan. Yayasan Bina Pustaka Sarwono Prawirohardjo. Jakarta. 2002 Hal 341-348.
14. Mochtar. R. Penyakit Trofoblast. Sinopsis Obstetri. Jilid I. Edisi 2. Penerbit Buku Kedokteran. EGC. Jakarta. 1998. Hal 238-243.
15. Martaadisoebrata D, Wirakusumah FF. Kelainan Telur, Plasenta, Air ketuban, Cacat, dan Gangguan Janin. Dalam: Ilmu Kandungan : Obstetri Patologi. Fakultas Kedokteran Universitas Padjadjaran. Edisi 2. Penerbit Buku Kedokteran. EGC Jakarta: 2005; Hal 28-33 16. Hydatidiform Mole (molar pregnancy) artcle published by : The
Miscarriage Association, England, 2009
17. Tidy J, Sheffield and BW Hancock, Sheffield.The Management of Gestational Trophoblastic Disease.Royal College of Obstetricians and Gynaecologists.2010;1-11
18. Shah D, Sekharan. The Management of Gestational Trophoblastic Disease. ICOG FOGSI Recommendations for Good Clinical Practice. Guideline, India, 2009
19. Lazovic B, Milenkovic V. Treatment of Gestational Trophoblastic Disease- Review of Literature. Acta Medica Medianae 2010. Vol.49(1)
20. Feltmate M et al. Human Chorionic Gonadotropin Follow-up in Patients With Molar Pregnancy: A Time for Reevaluation, The
American College of Obstetricians and Gynecologists. 2003. Vol.101(4)
21. Berkowitz R, Goldstein D. Clinical Practice : molar pregnancy. New England Journal Medicine, 2009.
22. Cuninngham. F.G. dkk. Implantasi, Embriogenesis, dan Perkembangan Plasenta. Dalam: Obstetri Williams. Edisi 23 vol 1. Penerbit Buku Kedokteran EGC. Jakarta : 2010; Hal 64-66
23. Pittas AG, Lee SL. Evaluation of Thyroid Function. In: Hall JE, Nieman LK, eds. Handbook Of Diagnostic Endocrinology. Humana Press Inc. Totowa, New Jersey; 2003:107-29
24. Dayan CM. Interpretation of thyroid function tests, Review. Lancet 2001; 357: 619–24
25. Alaf SK, Omer DI. Prevalence and clinical observations of Gestational Trophoblastic Diseases in Maternity Teaching Hospital in Erbil City. WSEAS TRANSACTIONS on BIOLOGY and BIOMEDICINE. 2010;7(3): 190-199
26. Benjapibal M, Boriboonhirunsarn D, Suphanit I, et al. Molar Pregnancy: Clinical Analysis of 151 Patients. Thai Journal of Obstetrics and Gynaecology. 2000; 12: 35-41
27. Somashekhar SS. Clino Pathological Study of Gestational Trophoblastic Diseases – A Three Years Study : Dissertation. Department of Pathology M.R. Medical College Gulbarga. 2005 28. Bhat S, Maletkovic J. A Hydatidiform Mole Can Cause Severe
Gestational Hyperthyroidism. Clin Thyroidol. 2013;25:298–300 29. Mujawar SA, Patil VW, Daver RG. Human Chorionic Gonadotropin
and Thyroid Hormones Status during Normotensive Pregnancy. JPBMS. 2010: 2(01): 1-4
30. Lazarus JH, Soldin OP, Evans C. Assessing Thyroid Function in Pregnancy. In: Thyroid Function Testing, Brent GA. Springer, London. 2010: 208-228
31. Braunstein G. High Serum HCG Concentrations Cause TSH Suppression But Do Not Lead To Symptoms Of Hyperthyroidism. Clinical Thyroidology. Sept 2009: 5-6
32. Casey BM, Leveno KJ. Thyroid Disease in Pregnancy. Obstet Gynecol 2006;108:1283–92
Lampiran 1. Ethical Clearance
31. Braunstein G. High Serum HCG Concentrations Cause TSH Suppression But Do Not Lead To Symptoms Of Hyperthyroidism. Clinical Thyroidology. Sept 2009: 5-6
32. Casey BM, Leveno KJ. Thyroid Disease in Pregnancy. Obstet Gynecol 2006;108:1283–92
Lampiran 1. Ethical Clearance
Lampiran 3. Uji Statistik
Usia Usia kehamilan TDS TDD Tinggi Fundus β-hCG T3 T4 TSH hubungan TFU (tahun) G P A (minggu) (mmHg) (mmHg) Uteri (TFU) (mIU/mL) (ng/dL) (µg/mL)µIU/mL) dan usia kehamilan
1 Melda 85.37.83 32 SMA IRT 3 2 0 (12-14) p/v 130 80 2 jr b.pusat 707312 3.72 24 0.32 lebih besar 2 Ratna 81.33.14 32 SMA IRT 4 3 0 (14-16) p/v 120 60 stgh pst-simf 192028 0.93 6.8 0.57 sesuai 3 Darnaliani 81.01.97 34 SMA IRT 2 1 0 (14-16) p/v 160 100 sttg pusat 551220 2.38 19.27 0.28 lebih besar 4 Komariah 79.21.10 37 SMA IRT 1 0 0 (18-20) p/v 110 80 2 jr b.pusat 616580 5.28 23.82 0.24 sesuai 5 Sri Wahyuni 80.45.54 31 SMA IRT 3 2 0 (12-14) p/v 130 80 2 jr b.pusat 589210 1.26 16.16 0.12 lebih besar 6 yosmanidar 79.64.76 41 SMA IRT 5 3 1 (8-10) p/v 100 70 2 jr a.simf 60040 0.75 5.28 0.94 lebih besar 7 Sri Dewi 69.86.34 30 SMA IRT 2 1 0 (16-18) p/v 120 70 2 jr b.pusat 662035 1.56 12.7 0.17 sesuai 8 Ristiani 83.47.14 31 SMA IRT 2 1 0 (16-18) p/v 160 100 sttg pusat 225000 2.02 20.11 0.004 lebih besar 9 Anna R 81.00.71 43 SMA IRT 7 6 0 (10-12) p/v 130 80 sttg pusat 750000 3.94 24 0.64 lebih besar 10 Syaibah 80.07.39 23 SMA IRT 1 0 0 (18-20) p/v 140 80 2 jr b.pusat 88220 0.93 10.47 0.9 sesuai 11 Putri H 82.13.82 20 SMA IRT 3 0 2 (10-12) p/v 100 80 1 jr a.pusat 150000 4.44 24.86 0.05 lebih besar 12 Mita Ria L 75.37.68 23 SMA IRT 1 0 0 (12-14) p/v 110 80 3 jr b.pusat 99351 1.26 8.19 1.345 lebih besar 13 Suryani 79.62.67 24 SMA IRT 2 1 0 (14-16) p/v 130 80 sttg pusat 750000 6.01 17.41 0.26 lebih besar 14 Mariati 78.78.47 40 SMA IRT 3 2 0 (14-16) p/v 110 80 1 jr b.pusat 55622 1.67 12.77 0.14 lebih besar 15 Sisca W 80.39.42 25 SMA IRT 1 0 0 (16-18) p/v 140 80 2 jr b.pusat 164463 1.68 11.61 0.09 sesuai 16 Klara Roma 54.17.48 39 SMP Petani 5 4 0 (16-18) p/v 140 90 3 jr b.pusat 10000 0.68 8.07 0.005 sesuai 17 Irma H 48.83.01 33 SMA IRT 6 5 0 (8-10) p/v 120 70 sttg pusat 842635 6.09 24.86 0.005 lebih besar 18 Masyitah 41.24.27 50 SMP IRT 5 2 2 (10-12) p/v 170 110 3 jr b.pusat 825346 1.92 14.3 0.005 lebih besar 19 Misnawati 40.92.73 40 SMA IRT 5 4 0 (12-14) perut membesar 130 70 3 jr a.pusat 1000000 4.55 21.7 0.005 lebih besar 20 Indriani 40.15.36 30 SMA IRT 2 1 0 (10-12) p/v 120 80 1 jr b.pusat 1061198 1.33 17.63 0.06 lebih besar 21 Fitriani 49.87.13 21 SMP IRT 3 2 0 (14-16) p/v 120 80 3 jr a.simf 11900 0.6 4.62 0.25 sesuai 22 Sari Decta 52.48.82 17 SMA IRT 1 0 0 (14-16) nyeri perut 140 80 3 jr a.pusat 1000000 3.6 19.93 0.014 lebih besar 23 Uti 49.94.15 47 SD Petani 4 3 0 (8-10) perut membesar 130 70 1 jr a.pusat 24124 0.78 8.63 0.02 lebih besar 24 Samsiah 46.49.01 27 SMP IRT 4 2 1 (14-16) perut membesar 120 70 3 jr a.pusat 320409 0.88 11.44 0.01 lebih besar 25 Ersalina 49.00.04 26 SMA IRT 3 2 0 (14-16) nyeri perut 130 80 stgh pst-simf 93687 0.95 5.61 1.75 sesuai 26 Bibah 50.56.41 46 SMA IRT 9 7 1 (20-22) p/v 180 90 1 jr a.pusat 32781 2.05 15.99 1.01 sesuai 27 Risma 40.85.39 35 SMP IRT 5 4 0 (16-18) p/v 120 80 1 jr a.pusat 78380 0.77 6.31 0.008 lebih besar 28 Sudiarni 41.48.29 44 SMA IRT 5 4 0 (14-16) perut membesar 190 100 1 jr b.pusat 158150 4.9 24.9 0.005 lebih besar 29 Suaini 43.62.47 38 SMA IRT 3 2 0 (20-22) p/v 140 80 sttg pusat 77630 1.17 10.64 1.13 sesuai 30 M Sinaga 43.85.82 43 SMP IRT 6 4 1 (16-18) p/v 170 120 3 jr a.pusat 1000000 2.45 19.72 0.005 lebih besar 31 Sapiah 40.56.55 45 SMP IRT 9 7 1 (16-18) p/v 90 60 2 jr a.pusat 221615 0.6 5.58 0.07 lebih besar 32 Misriani 38.18.57 23 SMA IRT 2 1 0 (12-14) p/v 130 70 2 jr a.simf 38296 1.12 8.8 0.69 susuai 33 Siti Aisyah 53.01.32 28 SMP IRT 5 4 0 (8-10) perut membesar 110 70 1 jr b.pusat 10000 0.66 7.89 0.006 lebih besar 34 Nitip 39.09.48 49 SMA IRT 5 4 0 (6-8) p/v 120 70 4 jr a.simf 250866 0.4 5.3 0.005 lebih besar 35 Rani Junita 30.09.80 19 SMP IRT 1 0 0 (8-10) p/v 130 80 2 jr a.simf 112215 1.05 6.76 0.086 lebih besar 36 Rosminta 51.31.08 33 SMA IRT 5 4 0 (12-14) p/v 110 80 2 jr asimf 210348 3.15 18.87 0.005 sesuai 37 Aprah Meina 42.67.00 20 SMP IRT 1 0 0 (12-14) p/v 110 80 2 jr asimf 135476 0.87 6.51 2.98 sesuai 38 Sri R 39.44.50 26 SMA Petani 1 0 0 (16-18) p/v 130 70 sttg pusat 127720 1.09 8.86 1.34 lebih besar 39 Sri Ani S 41.21.49 41 SMP IRT 8 7 0 (14-16) p/v 140 80 stgh pst-simf 364992 2.23 16.4 0.008 sesuai 40 Mintasari 51.29.02 48 SMA IRT 1 0 0 (10-12) p/v 130 80 3 jr b.pusat 125097 1.18 10.46 1.158 lebih besar 41 Yeanne 40.01.96 21 SMA IRT 1 0 0 (12-14) p/v 130 80 2 jr b.pusat 596207 2.41 11.35 0.005 lebih besar 42 Supiyah 51.06.53 32 SMA IRT 2 1 0 (18-20) p/v 140 80 sttg pusat 44729 1.09 14.73 0.009 sesuai 43 Hariyani 43.49.59 20 SMP IRT 1 0 0 (18-20) p/v 120 70 sttg pusat 252031 1.46 11.8 0.188 sesuai 44 Cinta Ulina 48.82.66 44 SMP IRT 6 3 2 (12-14) p/v 130 80 2 jr b.pusat 315867 2.38 20.91 0.005 lebih besar 45 Nurhalima 51.96.60 22 SD IRT 3 2 0 (6-8) p/v 130 90 2 jr b.pusat 502468 2.39 13.07 0.031 lebih besar
keluhan Utama Paritas
No Nama No RM
Statistics TDSis TDDias N Valid 45 45 Missing 0 0 Mean 130,22 80,22 Std. Deviation 20,504 11,578 Statistics T3 T4 TSH β -hCG N Valid 45 45 45 45 Missing 0 0 0 0 Mean 2,0584 13,7576 ,376387 344561,07 Std. Deviation 1,53147 6,40589 ,6069688 327135,077
Hasil uji Korelasi.
Correlations β-hCG T3 T4 TSH β-hCG Pearson Correlation 1 ,574** ,606** -,321* Sig. (2-tailed) ,000 ,000 ,031 N 45 45 45 45 T3 Pearson Correlation ,574** 1 ,845** -,260 Sig. (2-tailed) ,000 ,000 ,084 N 45 45 45 45 T4 Pearson Correlation ,606** ,845** 1 -,361* Sig. (2-tailed) ,000 ,000 ,015 N 45 45 45 45 TSH Pearson Correlation -,321* -,260 -,361* 1 Sig. (2-tailed) ,031 ,084 ,015 N 45 45 45 45
**. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).
