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The most common cause of hyperthyroidism is Graves' disease. TRH and TSH are hormonal factors that modulate and control thyroid function in Graves' disease. In the immunological aspect, Graves' disease is played by the role of T-reg, IL-4, and anti-TPO. Graves' disease treatment goal is to inhibit thyroid hormone secretion by administering thionamide. The evaluation of this treatment is its hormonal and immunological aspects. To describe the effect of thionamide on serum TRH, TSH, IL-4, T-reg, and anti-TPO levels in Graves' disease. This study is a clinical trial study in 25 study participants. All study participants were given thionamide, namely PTU 300mg for three months and blood samples were taken for laboratory tests. Serum TRH, TSH, IL-4, T-reg FOXP3, and anti-TPO levels were examined by ELISA. The mean levels at the beginning and after three months of therapy are: serum TRH 92.589pg/mL and 115.944pg/mL; serum TSH 0.041mU/L and 0.223mU/L; serum IL-4 19.759pg/mL and 23.040pg/mL; T-reg FOXP3 gene polymorphism 0.621ng/mL and 0.518 ng/mL; serum anti-TPO 2697.539pg/mL and 2604.710pg/mL. Increased levels of serum TRH and TSH levels were statistically significant. The change in serum IL-4, T-reg FOXP3 gene polymorphism, and anti-TPO levels were not statistically significant. The administration of thionamide in Graves' disease for three months will significantly decrease Wayne index and serum FT4 levels, increase serum TRH and TSH levels.

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AbstrakHigh-altitude illness (HAI) merupakan sekumpulan gejala paru dan otak yang terjadi pada orang yang baru pertama kali mendaki ke ketinggian. HAI terdiri dari acute mountain sickness (AMS), high-altitude cerebral edema (HACE) dan high-altitude pulmonary edema (HAPE). Tujuan tinjauan pustaka ini adalah agar dokter dan wisatawan memahami risiko, tanda, gejala, dan pengobatan high-altitude illness. Perhatian banyak diberikan terhadap penyakit ini seiring dengan meningkatnya popularitas olahraga ekstrim (mendaki gunung tinggi, ski dan snowboarding) dan adanya kemudahan serta ketersediaan perjalanan sehingga jutaan orang dapat terpapar bahaya HAI. Di Pherice, Nepal (ketinggian 4343 m), 43% pendaki mengalami gejala AMS. Pada studi yang dilakukan pada tempat wisata di resort ski Colorado, Honigman menggambarkan kejadian AMS 22% pada ketinggian 1850 m sampai 2750 m, sementara Dean menunjukkan 42% memiliki gejala pada ketinggian 3000 m. Aklimatisasi merupakan salah satu tindakan pencegahan yang dapat dilakukan sebelum pendakian, selain beberapa pengobatan seperti asetazolamid, dexamethasone, phosopodiestrase inhibitor, dan ginko biloba.Kata kunci: high-altitude illness, acute mountain sickness, edema cerebral, pulmonary edema AbstractHigh-altitude illness (HAI) is symptoms of lung and brain that occurs in people who first climb to altitude. HAI includes acute mountain sickness (AMS), high-altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE). The objective of this review was to understand the risks, signs, symptoms, and treatment of high-altitude illness. The attention was given to this disease due to the rising popularity of extreme sports (high mountain climbing, skiing and snowboarding) and the ease and availability of the current travelling, almost each year, millions of people could be exposed to the danger of HAI. In Pherice, Nepal (altitude 4343 m), 43% of climbers have symptoms of AMS. Furthermore, in a study conducted at sites in Colorado ski resort, Honigman describe AMS incidence of 22% at an altitude of 1850 m to 2750 m, while Dean showed that 42% had symptoms at an altitude of 3000 m. Acclimatization is one of the prevention that can be done before the climbing, in the addition of several treatment such as acetazolamide, dexamethasone, phospodiestrase inhibitor and gingko biloba.Keywords: high-altitude illness, acute mountain sickness, edema cerebral, pulmonary edema

Objective: This study was conducted to the profile of hormonal and immunological aspects, which is thyrotropin-releasing hormone (TRH), T-regulator (T-reg) Forkhead box P3 (FOXP3) gene polymorphism, and interleukin-4 (IL-4) of untreated Graves’ disease with hyperthyroid in M Djamil General Hospital Padang, Indonesia. Methods: A cross-sectional study was conducted to observe Graves’ disease with hyperthyroid in the Internal Medicine Department in Dr. M. Djamil Hospital, Padang, West Sumatera, Indonesia. Graves’ disease was confirmed by measuring free thyroxine (FT4), thyroid-stimulating hormone (TSH), and antithyroid peroxidase (anti-TPO). TRH, T-reg FOXP3 gene polymorphism, and IL-4 were examined with an enzyme-linked immunosorbent assay method. Results: Twenty-five subjects with Graves’ disease included in this study with an average of age is 27.48 (5.6) years. Mean Wayne index is 23.44 (1.4), mean serum FT4 level is 55.55 (17.98) pmol/l, median serum TSH level is 0.041 (0.004–0.053) mU/l, and mean anti-TPO level is 2697.539 (479.72) pg/ml. Median serum TRH level is 92.589 (24.843–253.186) pg/ml, mean T-reg FOXP3 gene polymorphism is 0.621 (0.23) ng/ml, and mean serum IL-4 level is 19.759 (7.03) pg/ml). Conclusion: Graves’ disease with hyperthyroid has median serum TRH level 92.589 (24.843-253.186) pg/ml and high levels of T-reg FOXP3 gene polymorphism and IL-4.