Kehamilan berhubungan dengan perubahan spesifisitas pada reseptor antibodi thyroid stimulating hormone (TSH). Pada kehamilan, reseptor antibodi TSH yang semula distimulasi berubah menjadi penghambatan. Perubahan aktivitas reseptor ini menyebabkan terjadinya peningkatan hormon tiroid selama kehamilan. Kondisi hipertiroid dalam kehamilan yang tidak terkontrol dapat meningkatkan risiko terjadinya preeklamsia berat pada maternal. Kondisi ini dapat lebih diperburuk dengan adanya riwayat hipertensi. Laporan kasus ini melaporkan seorang pasien perempuan usia 24 tahun yang didiagnosis dengan kasus suspek pneumonia COVID-19, hipertensi kronik superimposed preeklamsia, serta hipertiroid jangka panjang yang sudah mendapatkan pengobatan. Pemeriksaan fisik menunjukkan tekanan darah 128/65 mmHg, nadi 129 kali/menit, dan SpO2 96% menggunakan non rebreathing mask (NRBM) 10 liter per menit. Tidak ditemukan tanda maupun gejala yang mengarah kepada penyakit Grave ataupun thyroid storm namun evaluasi dengan skala Burch and Wartofsky’s didapatkan total skor 25 yang mengindikasikan bahwa pasien dalam keadaan impending thyroid storm. Pemeriksaan laboratorium menunjukkan hasil T3 0,86; FT4 1,73; dan TSH < 0,01. Pasien mendapatkan terapi tyrozol, lugol, propanolol, hidrokortison, serta magnesium sulfat. Persalinan dilakukan dengan prosedur seksio sesarea dimana teknik anestesi yang digunakan adalah combine spinal epidural menggunakan bupivakain 0,5% 15 mg. Manajemen anestesi yang tepat dalam kehamilan dengan hipertensi kronik superimposed preeklamsia dan hipertiroid menjadi penting karena ditujukan untuk mencegah terjadinya eklamsia dan thyroid storm yang dapat meningkatkan risiko perburukan kondisi pada pasien
Pain is one of the most common complain encountered in outpatient clinic. Inadequate pain management has been widely reported. As an anesthesiologist and pain physician, we perform a social service of pain management for patients unresponsive to conservative treatment. The social service was held from April - June 2022. We enrolled thirty-two patients from other physician reference and Primary Health Care in several districts around Malang city to come to Brawijaya University Hospital with the age range of 30-80 years old. The pain interventions given to the participants mainly include prolotherapy, pulsed radiofrequency (PRF), and others. The pain measurement of the patients were assessed with Numerical Rating Scale (NRS), pre and post-intervention. The social service is performed on 32 patients (male 34,37%, female 65.62%), majority aged 60 years od and older (34.37%) with low back pain become the major complaint (43.75%). The majority of patients receive prolotherapy (68%). The mean NRS decrease from 6.19 ± 0.18 (before treatment) to 2.69 ± 0.10 (after treatment). After this social service, most patients (96.875%) have obtained better pain control after given pain interventions.
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