Nama : Lk/Pr MR :Umur : Ruangan :

INDEX WAYNETanggal INTERPRETASISimptoms Indeks Wayne:Dyspneu d’effort 1 Eutiroid ≤

11Palpitasi 2 Equivocal =

11 -18Fatigue 2 Hipertiroid > 18Suka udara panas

-5

Suka udara dingin

5 Indeks New Castle :

Over sweating 3 Eutiroid : 11 -23

Gugup 2 Equivocal : 24 – 39

Appetite ↑ 3 Hipertiroid : 40 – 80

Appetite ↓ -3BB ↑ -3 T3 :

nmol/LBB ↓ -3 T4 :

ng/dlSign + - FT3 :Palpable tiroid 3 -3 Ft4 :Bruit 2 -2 TSH :Exophthalmus 2 0(Eye) lid lag 1 0 Up take :Hiperkinetic (gelisah)

4 -2 - 2 jam :

Fine finger tremor

1 0 - 24 jam :

Tangan hangat 2 -2 Tangan basah 1 -1 USG Tiroid :Atrium fibrilasi 4 0Nadi < 80 x/menit

0 3 Scanning Tiroid :

Nadi 80-90 x/menit

0 0

Nadi > 90 x/menit

3 0

JUMLAH

INDEX NEW CASTLE

Usia mulai :

Usia saat mulai 15 – 20 : 0 Psycological precipitate

-5 25 – 34 : 4

Frequent checking

-3 35 – 44 : 8

Severe anticip. Anxiety

-5 45 – 54 : 12

Appetite 5 > 55 : 16

Palpable Tiroid 3Bruit 18 Heart rateExophthalmus 19 < 90 : 1Lid retraction 9 80 – 90 : 8Hiperkinetic 4 < 80 : 0Fine finger tremor

4

Heart rateJUMLAH

EKG