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All Journal Medicina journal of internal medicine E-Jurnal Medika Udayana Berkala Kedokteran 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) PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico Jurnal Kesehatan Saintika Meditory 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 Nursing 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 
Relationship between Interleukin 6 and Estradiol Levels in Obese and Adult Men Dwipayana, I Made Pande; Semadi, I Made Siswadi; Nugraha, Ida Bagus Aditya; Gotera, Wira; Saraswati, Made Ratna; Suastika, Ketut; Saraswati, Putu Ayu Indah
Berkala Kedokteran Vol 21, No 2 (2025)
Publisher : Fakultas Kedokteran Universitas Lambung Mangkurat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20527/jbk.v21i2.24498

Abstract

Obesity is a chronic disease characterized by a pathophysiological process that causes an increase in adipose tissue mass, leading to an increased risk of morbidity and mortality. Currently, there are many conditions that allow the interaction between environmental factors and genes that lead to various metabolic disease complications, such as diabetes mellitus and heart attack. Health workers are at the forefront of managing obesity and its associated complications. The study was conducted at Ngoerah Hospital from March to October 2024. The target population in this study were adult male medical personnel with and without obesity, working at Ngurah Hospital. The inclusion criteria in this study: male health workers in the environment at Ngoerah Hospital aged 18-45 years and willing to participate in the study by signing informed consent. Exclusion criteria in this study were all male health workers with infectious or inflammatory diseases, and or suffering from malignancies or a history of chemotherapy, and or with the use of hormonal therapy. The sample size of the study was 64 subjects. Data analysis included descriptive statistics, a normality test using the Kolmogorov-Smirnov test, a comparison test using the Mann-Whitney U test, and a correlation test using the Spearman rank correlation. This study was approved by the Research Ethics Commission, approval number 1697/UN14.2.2.VII.14/LT/2024. The results of this study found that IL-6 and estradiol levels in the obese group were higher than the non-obese group, however, the differences were not statistically significant. This may be attributed to the relatively young age of the subjects and the absence of significant inflammation in the early stages of obesity. There was no significant correlation between IL-6 and estradiol in all subjects, obese and non-obese groups.
Karakteristik Pasien Nodul Tiroid di RS Ngoerah Denpasar Novia, Juvita; Gotera, Wira; Nugraha, Ida Bagus Aditya
Jurnal Kesehatan Saintika Meditory Vol 8, No 2 (2025): November 2025
Publisher : STIKES Syedza Saintika Padang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30633/jsm.v8i2.30627

Abstract

Thyroid nodules are the most common endocrine neoplasia seen in the clinic. The prevalence of thyroid nodules increases with age, sex, history of radiation exposure, family history, and other factors. The purpose of this study was to determine the prevalence and characteristics of patient with thyroid nodule at Ngoerah Hospital based on laboratory, ultrasonography and histopathology. This descriptive observational study involved 40 subjects. Data were obtained from the medical records of outpatient thyroid nodules who visited the Diabetes Polyclinic and inpatients at Ngoerah Hospital. The data collection was carried out within 3 months, from 1 December 2022 until 28 February 2023. The subjects consisted of 6 males (15%) and 34 females (85%), average age was 48 years and average nodule size was 3.9 cm. Thyroid hormone function was found most in 30 subjects (75%) euthyroid. Ultrasound using Ti-RADS score classification, 14 subjects were moderately suspicious (35%) and the same percentage for not suspicious group. FNAB using Bethesda classification, majority 23 subjects (57.5%) were benign. Histopathological showed 21 subjects (52.5%) were adenomatous struma. The highest proportion according to hormone function was euthyroid, moderately suspicious and not suspicious based on ultrasonography, nodule was benign based on FNAB, and adenomatous struma based on histopathology.
TATALAKSANA NUTRISI PASIEN DIABETES MELLITUS TIPE 2 DENGAN OBESITAS PADA KEHAMILAN Saraswati, Kadek Sinta Dwi; Gotera, Wira
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 10 No. 1 (2026): APRIL 2026
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v10i1.54845

Abstract

Diabetes mellitus merupakan masalah kesehatan global yang signifikan. Di antara gangguan metabolik, diabetes mellitus tipe 2 merupakan yang paling sering terjadi. Patogenesis diabetes mellitus tipe 2 melibatkan berbagai faktor. Obesitas berkontribusi terhadap perkembangan diabetes mellitus tipe 2 melalui mekanisme yang melibatkan resistensi insulin. Kontrol glikemik yang baik pada pasien diabetes dapat mengurangi risiko komplikasi diabetes. Terapi nutrisi medis merupakan komponen fundamental dalam penatalaksanaan diabetes mellitus. Komposisi, proporsi, dan kebutuhan kalori pasien diabetes disesuaikan dengan tingkat aktivitas, berat badan, serta kondisi stres atau pascaoperasi. Kondisi khusus lain pada pasien diabetes dengan obesitas, seperti kehamilan, juga memerlukan penatalaksanaan khusus terkait kenaikan berat badan ibu yang ideal pada masa kehamilan. Oleh sebab itu, penting untuk mengetahui pendekatan terapi nutrisi pada wanita hamil dengan diabetes mellitus tipe 2 dan obesitas.
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 Novia, Juvita Nugraha, Ida Bagus Pande Ketut Kurniari Parastan, Rovie Hikari Prabawa, I Putu Yuda R. A.T. Kuswardhani RIONALDO ANTHONIUS S., Hantono Saraswati, Kadek Sinta Dwi Saraswati, Putu Ayu Indah 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