Goiter Sebagai Faktor Predisposisi Karsinoma Tiroid
Abstract
Goiter merupakan pembesaran kelenjar tiroid yang dapat berkaitan dengan gangguan primer pada organ tiroid ataupun akibat stimulasi hormonal atau faktor lain terhadap tiroid. Di Indonesia dan di Bali khususnya kasus karsinoma tiroid mengalami peningkatan sejalan dengan peningkatan kasus goiter endemik maupun non endemik. Goiter memiliki faktor risiko sebesar 2,5 kali lipat untuk menimbulkan karsinoma tiroid. Goiter dapat menimbulkan hiperplasia yang bersifat difusa maupun noduler (nodul tunggal dan multipel). Analisis klonal telah membuktikan bahwa hiperplasia merupakan proliferasi yang bersifat poliklonal. Pada tiroid, ditemukan perubahan pola monoklonal pada kelompok nodul yang sebelumnya merupakan nodul hiperplastik. Perubahan poliklonal menjadi monoklonal ini merupakan interaksi antara adanya lesi hiperplastik sebelumnya dengan predisposisi genetik yang selanjutnya menciptakan lingkungan mutagenik, ditandai oleh peningkatan proliferasi sel disertai pembentukan radikal bebas yang memicu adanya mutasi somatiktirosit. Pemberian suplementasi iodium pada kasus goiter endemik, dikatakan berkaitan dengan adanya kandungan iodine radioaktif nantinya justru menimbulkan kerusakan rantai DNA melalui tata ulang RET-TRK.
Kata Kunci: goiter, predisposisi, karsinoma tiroid.
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[Goitre as Predisposing Factor of Thyroid Carcinomas].
Goitre is an enlargement of thyroid gland which can be associated with primary thyroid disorders or stimulation of the gland by hormones and other factors. In Indonesia and especially in Bali, increase of Thyroid Carcinoma cases had been associated with either endemic or non endemic goiter. Goitre increases 2.5 fold risk of thyroid carcinoma. Goitre may cause diffuse and nodular hyperplasia (either single or multiple nodules). Clonal analysis has been discovered that hyperplasia is considered to be polyclonal proliferation. Monoclonal alterations had also been found in a subset of thyroid nodules that were previously considered hyperplastic. Alterations of polyclonal to monoclonal pattern was considered as interaction between past history of hyperplastic lesion and genetic predisposition which furthermore forming mutagenic environment such as increases of cell proliferation and also free radicals induce- somatic mutation. Iodine supplementation on endemic goiter related with radioactive iodine content which damaging DNA sequences in the form of RET-TRK rearrangement.
Keywords: goitre, predispose, thyroid carcinoma.
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