VALIDASI TOTAL GOITRE RATE (TGR) BERDASAR PALPASI TERHADAP ULTRASONOGRAFI (USG) TIROID SERTA KANDUNGAN YODIUM GARAM DAN AIR DI KECAMATAN SIRAMPOG KABUPATEN BREBES (Studi pada anak sekolah dasar Tahun 2006) TGR VALIDATION BASED ON PALPATION TO TYROID USG AND IODINE CONTENT SALT AND WATER IN SIRAMPOG DISTRICT, BREBES REGENCY (A Study on Schoolchildren In 2006)

Abstract

Latar Belakang : Prevalensi GAKY (Gangguan Akibat Kekurangan Yodium) di Kabupaten Brebes dengan parameter TGR (Total Goiter Rate) berdasarkan palpasi pada pemetaan Tahun 2004 oleh Dinkes Kabupaten dan Propinsi adalah 15,9 % dan 8,49 %. Perbedaan angka yang cukup tinggi memunculkan perlu dilakukanya validasi TGR hasil palpasi terhadap hasil USG tiroid. Tujuan : melakukan penilaian sensitivitas dan spesifisitas hasil palpasi terhadap hasil USG tiroid serta menganalisis kandungan yodium garam dan air yang dikonsumsi masyarakat di daerah endemik berat. Metode : Dilakukan suatu studi cross sectional dengan metode survei pada anak SD Kelas 4 - 6 di Kecamatan Sirampog Kabupaten Brebes (TGR Tahun 2004 = 40,71 %) dengan sampel 100 anak dari dua desa yang terpilih diambil secara Proportional random sampling. Untuk penghitungan sensitivitas dan spesifisitas dilakukan USG tiroid pada 50 % sub sampel. Besar ukuran kelenjar gondok dinilai dengan palpasi dan USG dilakukan oleh petugas dan dokter yang terlatih. Yodium urin diperiksa dengan metode acid digestion sedangkan yodium air dan garam dengan metode titrasi. Hasil : TGR berdasar palpasi sebesar 29,0 %, sedangkan berdasar USG 32,7 % anak di atas nilai upper limit WHO 1997. Pada USG didapatkan banyak pembesaran tiroid yang kearah belakang hingga tak terdeteksi saat palpasi. Sensitivitas dan spesifisitas yang dihasilkan sebesar 76 % dan 66 %. Rata-rata dan median kandungan yodium urin adalah 166,6 µg/L dan 176,5 µg/L. Berdasarkan kandungan yodium urin ada 2,0 % dan 11 % anak dengan kategori defisiensi yodium sedang dan ringan. Ada hubungan kandungan yodium garam dengan UIE (r = 0,237 dan p = 0,009) namun tidak ada hubungan kandungan yodium air dengan UIE (r = -0,161 dan p = 0,055) Simpulan : Hasil palpasi tiroid memberikan nilai false positive dan false negative yang cukup tinggi (24 % dan 34 %). Berdasarkan kandungan yodium urin daerah penelitian tidak lagi termasuk daerah GAKY berat. Background: There was a big difference in TGR (Total Goitre Rate) prevalence in 2004 IDD mapping by district (15.9%) and province authority (8.49%). Therefore palpation method needs to be validated to thyroid volume enlargement measured by ultrasound. Sirampog Subdistrict with the highest TGR in Brebes District (40.7%), was chosen for this study. Objective: To assess the sensitivity and specificity of palpation method in comparison to ultrasound measurement and to assess the iodine content of salt and water which were consumed by the community. Methods: A cross sectional survey was conducted on 100 schoolchildren of grade 4 to 6 from 2 rural villages in Sirampog Subdistrict, Brebes District. For the sensitivity and specificity analysis, 50% of the subjects were chosen randomly for thyroid measurements. Thyroid enlargements were assessed by trained health workers using palpation method, and by trained physicians using ultrasound. Urinary Iodine Excretions (UIE) were measured used acid digestion method, while iodine content of salt and water used titration method. Results: TGR in Sirampog by palpation method was 29.0%. Based on ultrasound, 32.7% of the schoolchildren had larger thyroid volume than the upper limit by WHO 1997. There were some thyroid enlargements toward the back, which were not detected by palpation. Sensitivity and specificity of palpation method were 76.0 and 66.0%, respectively. The mean of UIE was 166.6 µg/L and the median was 176.5µg/L. Two percents of the schoolchildren had mild and 11% had moderate Iodine deficiency based on their UIE. There was a correlation between iodine content of the salt consumed and UIE (r=0.237, p=0.009), but there was no correlation between iodine content of the water and UIE (r=-0.161, p=0.055). Conclusion: Palpation method showed a relatively high false positive (24%) and false negative (34%). Based on UIE results, Sirampog was not a severe endemic goitre area anymore.