Efikasi Pemberian Kortikosteroid Intravena Terhadap Perubahan Kadar Thyroid Stimulating Hormone Antibody (TRAb) Pada Pasien Orbitopati Graves Aktif Derajat Sedang Berat

DIMAS NUGROHO K, Prof. Dr. dr. Agus Supartoto, Sp.M(K).; dr. Tri Wahyu Widayanti,M.Kes, Sp.M(K) KVR.; dr. M. Robikhul Ikhsan, M.Kes, Sp.PD, KEMD

2022 | Tesis-Spesialis | ILMU KESEHATAN MATA

Latar Belakang: Orbitopati Graves (OG) manifestasi tersering ekstratiroid pada Penyakit Graves . Thyroid stimulating hormone receptor antibody (TRAb) biomarker spesifik dan berperan dalam patogenesis OG. Injeksi Kortikosteroid merupakan tata laksana utama GO aktif derajat sedang berat. Tujuan Penelitian: Mengetahui efek pemberian kortikosteroid terhadap kadar TRAb pasien OG aktif derajat sedang berat dan hubungannya dengan kondisi klinis pasien. Metode Penelitian: Penelitian retrospektif dengan menggunakan data sekunder pasien RSUP Dr. Sardjito Yogyakarta. Subyek pasien OG aktif derajat sedang berat dan mendapatkan injeksi steroid Methylprednisolone (MP) IV dosis kumulatif 3 gram selama 6 minggu. Pemeriksaan serum TRAb dengan metode electrochemiluminescence immunoassay (ECLIA). Data klinis eksofthalmos, fisura palpebra, diplopia dinilai. Uji analisis dengan t tes berpasangan dan dilanjutkan uji multivariat dengan regresi linier dan regresi logistic. Hasil Penelitian: 23 subyek dengan usia rerata 36.56 tahun, dominan wanita (60.9%). Kadar TRAb rerata turun signifikan setelah pemberian MP IV selama 6 minggu (p=0.02). Perbaikan eksoftalmos dan fisura palpebra yang secara statisktik bermakna (p=0.01; p=0.02). Tidak didapatkan adanya hubungan penurunan TRAb dengan parameter klinis yang dinilai (p>0.05). Kesimpulan: Pemberian MP IV dosis.kumulatif 3 gram selama 6 minggu terbukti secara statistik menurunkan rerata TRAb dan parameter klinis (eksoftalmos, fisura palpebra), nmun tidak ditemukankorelasi antara penurunan TRAb dengan perbaikan klinis tersebut.

Background: Graves orbitopathy (GO) is the most common extra thyroid manifestation in Graves disease. Thyroid stimulating hormone receptor antibody (TRAb) is a specific biomarker and plays a role in the pathogenesis of OG. Corticosteroid injection is the main treatment for moderate to severe active GO. Objective: To determine the effect of corticosteroid administration on TRAb levels in active moderately severe OG patients and its relationship to the clinical condition of the patient. Research Methods: This is a retrospective study using secondary data from patients at RSUP Dr. Sardjito Yogyakarta. Subjects were active moderate-to-severe OG patients and received injections of Methylprednisolone (MP) IV steroids at a cumulative dose of 3 grams for 6 weeks. TRAb serum examination by electrochemiluminescence immunoassay (ECLIA) method. Clinical data of exophthalmos, palpebral fissure, diplopia was assessed. Test analysis with paired t test and continued with multivariate test linear regression and logistic regression. Research Results: 23 subjects with a mean age of 36.56 years, female dominant (60.9%). The mean TRAb level decreased significantly after giving MP IV for 6 weeks (p=0.02). Exophthalmos and palpebral fissure improvement were statistically significant (p=0.01; p=0.02). The relationship between TRAb reduction and clinical parameters was not significant (p>0.05). Conclusion: Administration of MP IV at a cumulative dose of 3 grams for 6 weeks was statistically proven to reduce the mean TRAb and clinical parameters (exophthalmos, palpebral fissure), but no association was found between the decrease in TRAb and the clinical improvement.

Kata Kunci : Thyroid stimulating hormone receptor antibody (TRAb), Orbitopati Graves , Eksofthalmos, Methylprednisolone IV