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All Journal Medicina journal of internal medicine E-Jurnal Medika Udayana Journal of Medicine and Health Jurnal Kedokteran Anatomica (Anatomica Medical Journal) Indonesian Journal of Rheumatology ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Neurologico Spinale Medico Chirurgico Jurnal Ilmu Kesehatan Indonesia (JIKSI) GANESHA MEDICINA MEDICINUS Jurnal Kedokteran Meditek Journal of Medicine and Health Technology Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD) Journal of Medicine and Health
Wira Gotera
Department Of Endocrinology And Metabolism, Medical Faculty, Udayana University/ Sanglah General Hospital, Denpasar, Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Comparison of Anti Thyroid Drugs, Radioactive Iodine and Surgery for Graves’ Disease: A Systematic Review and Meta-Analysis Dian Daniella; Ida Bagus Aditya Nugraha; Wira Gotera
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

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Abstract

Selection of therapy for Graves’ Disease (GD) has always been a puzzling decision to be taken by both the patient and physician. This is due to the three modalities (Anti Thyroid Drug (ATD), Radioactive Iodine (RAI) and surgery) in with each one being just as established as the other two in being an effective treatment strategy. Therefore, this study was conducted in purpose to compare ATD, RAI and surgery for GD. The author searches from several databases such as PubMed, Directory of Open Access Journals (DOAJ), and Science Direct as well as registers, such as Cochrane Central Register of Controlled Trials (CENTRAL). The systematic review was incorporated to all of seven studies and six studies has been selected to be included in the analysis. ATD has higher risk of relapse compared to RAI (RR 2.77, 95% CI 0.99–7.75); p=0.05) and surgery (RR 6.60, 95% CI 3.76–11.58); p<0.00001). In comparison to surgery, RAI has higher risk of relapse (RR 2.52, 95% CI 0.66–9.67); p 0.18). ATD has lower success rate compared to RAI (RR 0.47, 95% CI 0.35–0.63); p<0.00001) and surgery (RR 0.44, 95% CI 0.34–0.58); p<0.00001). ATD has lower risk of hypothyroid compared to RAI (RR 0.08, 95% CI 0.02–0.27); p<0.0001) and surgery (RR 0.09, 95% CI 0.02–0.40); p=0.001). ATD has the highest risk of relapse compared to RAI and surgery. RAI and surgery did not differ significantly in risk of relapse and hypothyroid.
The Comparison of X-ray Finding in Pulmonary Tuberculosis with and without Diabetes Mellitus Ida Bagus Aditya Nugraha; Wira Gotera; Made Nian Anggara
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 1 No. 2 (2024): InaJEMD Vol. 1, No. 2
Publisher : PP PERKENI

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Abstract

Diabetes Mellitus patients are considered as a high-risk population for the development of Pulmonary Tuberculosis (PTB) by about three-fold. Diabetes Mellitus sufferers by glycated haemoglobin A1C (HbA1C) level. The relative risk (RR) of Tuberculosis (TB) was 3,1 (95% CI 1.6-5.9) for those with HbA1C ≥7%. There are several contradictory opinions regarding the radiological appearance of TBC sufferers with genuine effect of DM. Chest X-ray remains the primary investigation for the assessment of PTB. Pulmonary Tuberculosis is found predominantly in the lung apices. It is not clear whether DM can affect the presentation of TB. Thus, whether diabetic subjects present atypical radiological presentation of PTB is still controversial. There have been several studies with contradictory results regarding the differences in the radiological appearance of PTB patients with and without DM. Clinical studies have shown ambiguous results. Any other risk factors maybe associated with age, sex, smoking status, and nutrition status.
Case Report: A Patient with Suspicious of Thyrotoxic Periodic Paralysis Ni Made A Yudhawati; Ni Made D Adnyani; Ida Bagus A Nugraha; Wira Gotera
Journal of Medicine and Health Vol 4 No 1 (2022)
Publisher : Universitas Kristen Maranatha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.28932/jmh.v4i1.3590

Abstract

Thyrotoxic periodic paralysis (TPP) adalah suatu kelainan elektrolit yang reversibel, ditandai dengan kelemahan otot yang bersifat akut dan hipokalemia yang dihubungkan dengan kondisi hipertiroid. Kelainan ini lebih sering terjadi pada populasi Asia terutama pada laki-laki. Usia terjadinya serangan antara 20 sampai 40 tahun. Sebagian besar penderita tidak menunjukan gejala dan tanda hipertiroid yang jelas sehingga sering terjadi kesalahan diagnosis. Paralisis yang terjadi tidak bisa kita sampingkan dan berkaitan dengan kelainan tiroid. Tujuan penulisan ini adalah menyampaikan sebuah kasus TPP, gejala awal yang perlu diwaspadai dan tatalaksana pada keadaan emergency. Laki-laki berusia 20 tahun. didapatkan kondisi hipertiroid dengan indeks Wayne 27, kadar Free Thyroxine (FT4) meningkat, Thyroid Stimulating Hormone (TSH) yang rendah dan penurunan kalium serum. Pasien datang dengan keluhan lemah pada kedua kaki sehingga tidak bisa berjalan. Pemberian terapi terapi dengan drip KCl 50 meq, propranolol 3x10mg, dan PTU 3x100 mg kondisi memberikan outcome pasien yang membaik selama lebih kurang 7 hari dan akhirnya dipulangkan dengan kadar kalium serum normal (4,71 mmol/L). Penegakan diagnosis yang tepat dari anamnesis, pemeriksaan penunjang akan memberikan hasil yang baik. Pada kasus disimpulkan bahwa pemberian supplementasi kalium di tahap awal sangat penting untuk memulihkan kondisi paralisis dan mencegah komplikasi lebih lanjut. Kata kunci: Thyrotoxic periodic paralysis; elektrolit; reversible; hipokalemia
Hydatidiform Mole Pregnancy with Hyperthyroidism: A Case Report Dewi, Ni Made Ratih Purnama; Gotera, Wira; Lestari, Anak Agung Wiradewi; Herawati, Sianny; Wande, I Nyoman; Mulyantari, Ni Kadek; Sudana, I Nyoman Gde; Prabawa, I Putu Yuda
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 31 No. 3 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v31i3.2243

Abstract

Hyperthyroidism is a condition with excess biosynthesis and hormone secretion by the thyroid gland. One of the secondary causes of hyperthyroidism is hydatidiform mole pregnancy, which is included in Gestational Trophoblastic Disease (GTD). Hyperthyroidism in hydatidiform mole pregnancies occurs due to increased beta-Human Chorionic Gonadotropin (beta-hCG).  Increasing beta-hCG level affects stimulation of the thyroid gland, increasing thyroid hormone levels in the serum, which causes thyrotoxicosis. This case is such a rare case. A 22-years-old female, G1P0A0, came complaining of amenorrhea accompanied by vaginal bleeding with abdominal pain, nausea, vomiting and palpitations.accompanied by vaginal bleeding with abdominal pain, nausea, vomiting and palpitations. Physical examination showed tachycardia with a pulse rate of 120 beats per minute. Ultrasound examination of the abdomen showed an anteflexed uterus with a honeycomb appearance. Based on a series of tests, the patient has a hydatidiform mole pregnancy with a risk of impending thyroid storm, indicated by TSH suppression with increased fT4. Beta-hCG can cause hyperthyroidism through cross-reaction with TSH receptors. In patients with hyperthyroidism due to GTD, it is not characterized by the characteristic features often found in Graves' disease. Evacuation with curettage and medication was performed to reduce thyroid hormone and serum beta-hCG levels. Hyperthyroidism is an abnormality that can be found in hydatidiform mole pregnancies. It is important to carry out early detection by examining thyroid function in GTD, proper management, and regular monitoring of thyroid function and beta-hCG in pregnant female to provide comprehensive management and prevent complications that can be caused by hyperthyroidism.      
Problems of Diagnosis and Management of a Patient with Suspected Scurvy: A Case Report Gunadi, Hendra; Gotera, Wira
Journal of Medicine and Health Technology Vol. 2 No. 1 (2025)
Publisher : Direktorat Riset dan Pengabdian Kepada Masyarakat, Institut Teknologi Sepuluh Nopember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.12962/j30466865.v2i1.2509

Abstract

Vitamin C is a substance needed by the human body to maintain metabolic function. Scurvy is a disease caused by vitamin C deficiency. This disease is often forgotten in the era of modern medicine. Vitamin C (ascorbic acid) plays a role in the formation of type IV collagen. Type IV collagen is an essential component of the walls of blood vessels, skin, and the basement membrane zone that separates the epidermis from the dermis. Three things must be met to diagnose scabies, namely a history of insufficient vitamin C intake, the presence of clinical manifestations typical of scabies, and biochemical indices, namely low levels of vitamin C in the blood (serum, white blood cells, and whole blood) and low urinary excretion levels. In patients with scabies who already have clinical manifestations, immediate vitamin C replacement is needed. A case of a male patient with suspected scabies with various clinical manifestations has been reported who improved with direct vitamin C replacement therapy. Early diagnosis and appropriate treatment can improve the prognosis in patients with scabies.
Koinsidens Insulinoma dan Sindrom Cushing: Laporan Kasus Aditya Nugraha, Ida Bagus; Gotera, Wira
Jurnal Ilmu Kesehatan Indonesia Vol. 6 No. 2 (2025): Juni 2025
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jikesi.v6i2.1505

Abstract

Latar belakang: Insulinoma adalah tumor neuroendokrin langka yang menyebabkan pelepasan insulin yang tidak tepat. Penggunaan kortikosteroid kronis adalah penyebab paling umum dari Sindrom Cushing. Tujuan: mempelajari tentang kasus khusus dan langka Deskripsi Kasus: Seorang wanita obesitas berusia 39 tahun dengan riwayat gejala hipoglikemik berulang dirujuk ke rumah sakit kami dengan keluhan utama moon face, striae, dan beberapa plak annular berwarna merah muda di dada dan perut. Dia sebelumnya diobati dengan kortikosteroid dosis tinggi dan jangka panjang selama 8 tahun tanpa mengetahui etiologi dari kondisi hipoglikemia yang terus-menerus. Tes darah menunjukkan kadar insulin puasa dan c-peptida yang tinggi meskipun kadar glukosa plasma rendah. Meskipun pemindaian tomografi terkomputerisasi tidak menunjukkan adanya kelainan, pemeriksaan pencitraan resonansi magnetik menunjukkan adanya massa seperti insulinoma di pankreas. Dosis steroid dan krim antijamur topikal diberikan untuk terapi medis. Ia kemudian dijadwalkan untuk menjalani operasi enukleasi tumor. Setelah operasi, glukosa darahnya kembali ke kisaran normal. Kesimpulan: Dokter harus lebih waspada dalam mendiagnosis pasien dengan hipoglikemia berulang. Penggunaan steroid harus dipertimbangkan dengan bijak, bahkan di daerah dengan sumber daya yang terbatas.
Pengaturan Dan Fungsi Autophagy Penyakit Metabolik Nugraha, Ida Bagus; Widya Utama, I Putu Sista; Gotera, Wira
ANATOMICA MEDICAL JOURNAL | AMJ Vol 8, No 3 (2025)
Publisher : Universitas Muhammadiyah Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30596/amj.v8i3.25164

Abstract

Autophagy atau yang dikenal dengan istilah self eating adalah suatu proses katabolik yang melibatkan proses degradasi konstituen sel oleh lisosom (termasuk mitokondria, peroksisom, dan retikulum endoplasma), protein intraseluler, dan patogen intraseluler. Beberapa studi asosiasi telah menemukan hubungan antara autophagy dan penyakit kardiovaskuler dan publikasi yang melaporkan walaupun autophagy mempunyai peran penting dalam menjaga keseimbangan intraseluler dan menjaga kelangsungan hidup sel namun ada hubungan yang kuat antara autophagy dan faktor resiko penyakit kardiometabolik seperti obesitas, dislipidemia, inflamasi, arterosklerosis, resistensi insulin, diabetes melitus dan non alcoholic steatohepatitis. Mengurangi autophagy pada pada jaringan adiposa mungkin menjadi pendekatan untuk mengendalikan obesitas, sedangkan peningkatan autophagy dalam sel β pankreas dan lesi  artherosclerosis dapat memberikan proteksi terhadap hiperlipidemia, diabetes melitus, dan aterosklerosis.Kata kunci: autophagy, katabolik, lisosom, jaringan adiposa 
Co-Authors A Santoso AAG Budhiarta Anak Agung Gede Budhiarta Anak Agung Wiradewi Lestari Anwar Santoso Budhiarta, Anak Agung Gde Dewa Gde Agung Budiyasa Dewi, Ni Made Ratih Purnama Dian Daniella Dwijo Anargha Sindhughosa Elizabet Haryant Gede Kambayana Gunadi, Hendra H Taniguchi I Ketut Mariadi I Ketut Suastika I Made Pande Dwipayana I Made Siswadi Semadi I Nyoman Wande I. K. Suastika Ida Bagus A Nugraha Ida Bagus Aditya Nugraha Ida Bagus Putu Putrawan IGN Gunadi IMR Saraswati Irianto, Petrus K Badjra Nadha K Rina Komang Agus Wira Nugraha LP Dea Sasmita P Luh Gede Sri Yenny Made Nian Anggara MADE RATNA SARASWATI . Mia Felina Prasetya Muhammad Ridwan N Kajiwara Ni Kadek Mulyantari Ni Made A Yudhawati Ni Made D Adnyani Nugraha, Ida Bagus Pande Ketut Kurniari Parastan, Rovie Hikari Prabawa, I Putu Yuda R. A.T. Kuswardhani RIONALDO ANTHONIUS S., Hantono Sianny Herawati Siorcani, Putu Tasha Sudana, I Nyoman Gde Sutanegara - W Wita Wan Muhamad Syafiq Wardana, Rr. Cattleya Allayka Wayan Evie Frida Yustin Widya Utama, I Putu Sista Yenny Kandarini