Hipotiroidisme pada Wanita Usia Subur (WUS) di Daerah Pertanian: Penelitian di Kecamatan Kersana Kabupaten Brebes

Abstract

Background: Hypothyroidism can cause infertility, spontaneous abortion, fetal growth-development disorders, placental abruption and prematurity. Exposure to pesticides, both of organochlorines and organophosphate, can cause hypothyroidism. The aim of the study was to examine the prevalence of hypothyroidism in WCA in agricultural areas.
Methods: A cross-sectional study was conducted in two hundred and eight women of WCA who were randomly selected from four villages and TSH levels were examined. The TSH cut-off point for the diagnosis of hypothyroidism was 4.5 μIU/mL. In a sub-sample, fT4 levels, UEI and thiocyanate in urine, were also examined.
Result: The mean level of TSH was 3.66 (±5.330) μIU/mL, the lowest value was 0.05, and the highest was 60 µIU/mL; the median was 2.38 μIU/mL; the mean FT 4 (n=89) was 16.207±3.0438 pmol/L; UEI median value (n=41) was 288.0 mcg/L; while the mean of urinary thiocyanate levels (n=41) was 1.468±1.25 mcg/mL. There were 47 WCA (22,6%) with hypothyroidism, 46 of which (97.9%) are sub-clinical hypothyroidism.
Conclusion: The prevalence of hypothyroidism in WCA was 22.6% and almost all women had sub-clinical hypothyroidism. Pesticide exposure is suspected as a risk factor for hypothyroidism in this population.

ABSTRAK
Latar belakang: Hipotiroidisme merupakan keadaan, di mana kelenjar tiroid tidak dapat memproduksi hormon cukup untuk memenuhi kebutuhan tubuh. Pada WUS, hipotiroidisme dapat menyebabkan infertilitas, abortus spontan, gangguan tumbuh-kembang janin, placental abruption dan bayi lahir sebelum waktunya. Pajanan pestisida, baik dari golongan organoklorin maupun organofosfat, dapat menyebabkan hipotiroidisme. Penelitian ini bertujuan mengkaji berapa besar prevalensi hipotiroidisme pada WUS yang bertempat tinggal di daerah pertanian.
Metode: Penelitian ini menggunakan desain cross-sectional. 208 WUS dipilih secara acak dari empat desa dan dilakukan pemeriksaan kadar TSH. Diagnosis hipotiroidisme ditegakkan berdasarkan kadar TSH 4,5 µIU/mL. Pada sebagian WUS (sub-sampel) dilakukan pemeriksaan kadar fT4, UEI dan kandungan tiosianat dalam urin.
Hasil: Rerata kadar TSH adalah 3,66 (±5,330) µIU/mL, nilai terendah 0,05, nilai tertinggi 60 µIU/mL sedangkan median TSH 2,38 µIU/mL; rerata fT 4 (n=89) adalah 16,207±3,0438 pmol/L; nilai median UEI (n=41) adalah 288,0 µg/L; rerata kadar tiosianat urin (n=41) adalah 1,25±1,468 µg/mL. Didapatkan 47 WUS (22,6%) dengan hipotiroidisme, 46 di antaranya (97,9%) adalah hipotiroidisme sub-klinik.
Simpulan: Prevalensi hipotiroidisme pada WUS sebesar 22,6%, hampir semuanya hipotiroidisme sub-klinik. Pajanan pestisida patut dicurigai sebagai faktor risiko pada WUS di daerah pertanian yang diteliti ini.