THYROID FUNCTION

BIOSYNTHESIS, SECRETION, AND

TRANSPORT OF THYROID HORMONES
Iodine is the most important element in the biosynthesis of thyroid
hormones.
Thyroglobulin acts as a performed matrix containing tyrosyl
groups to which the reactive iodine attaches to form the hydroxyl
residues of monoiodotyrosine (MIT) and diiodotyrosine (DIT).
The coupling of two DIT molecules forms T 4 .
The coupling of one DIT molecules and one MIT molecule results in
the formation of T3 or reverse T3 (rT3)
Almost all circulating T4 and T3 hormones are bound to serum
proteins ( thyroid hormone-binding proteins )

 Only 0.03 % of T4 and 0.3 % of T3 are not bound to

proteins. These fractions, called free T4 (FT4) and free
T3 (FT3), are the physiologically active portions of the
thyroid hormones .
T3 is the most biologically active thyroid hormone and is
three to four times more potent than T4. T3 is more
active because it is not as tightly bound to the serum
proteins as is T4, and has a greater affinity to target
tissue receptors

ACTIONS OF THYROID HORMONE

Regulation of carbohydrate, lipid, and
protein metabolism .
Central nervous system activity and brain
development
Cardiovascular stimulation
Bone and tissue growth and development
Gastrointestinal regulation
Sexual maturation

THYROID FUNCTION TESTS

Specimen collection :
Specimens are routinely collected in a clot tube, although anticoagulants can be
used .
Specimens free of lipemia or hemolysis are preferred .

The tests used to investigate thyroid function can be

grouped into:
Tests that establish whether there is thyroid dysfunction ( TSH,T4 and T3
measurements)
Tests to know the cause of thyroid dysfunction
(thyroid auto-antibody and serum thyroglobulin measurements, thyroid enzyme
activities, biopsy of the thyroid, ultrasound and isotopic thyroid scanning )

THYROID FUNCTION TESTS

TSH :
- The single most sensitive, specific and reliable test of thyroid status .
- In primary hypothyroidism, [TSH] is increased.
- In primary hyperthyroidism, [TSH] is decrease or undetectable.

Total T4 and Total T3 :

- More than 99% of T4 and T3 circulate in plasma bound to protein
- Both [total T4] and [total T3] change if [TBG] alters, e.g. in pregnancy

Free T4 and Free T3

Free thyroid hormone concentrations are independent of changes in the
concentration of thyroid-hormone binding proteins more reliable for diagnosis
of thyroid dysfunction

Test
Serum
thyrotropin/thyroidstimulating hormone
Freethyroxine
Free thyroxine index
Serumtriiodothyronine
Serum thyroxine
Radioactiveiodine123uptake
Radioiodine scan (gamma
camera)
Free thyroxine fraction
Thyroid hormone binding
ratio
Free triiodothyronine l
Free T3 Index
Thyroxine-binding globulin
TRH stimulation test
Serumthyroglobulinl

Abbreviation

Normal ranges

TSH

0.56.0U/ml

FT4

718ng/l = 0.71.8ng/dl
411
0.81.8g/l = 80180ng/dl
46120g/l = 4.6
12.0g/dl

FT4I
T3
T4
RAIU

1030%

FT4F

N/A - thyroid contrasted

images
0.030.005%

THBR

0.91.1

N/A

FT3
FT3I
TBG
Peak TSH
Tg

230619pg/d
80180
1220ug/dl T4 +1.8g
930IU/ml at 2030min.
0-30ng/m

INTERPRETING
RESULTS OF THYROID
FUNCTION TESTS

PRIMARY HYPERTHYROIDISM
- Plasma [TSH] : due to feedback inhibition on
the
pituitary
- Plasma free and total T4 and T3 concentrations :

In a very small percentage of hyperthyroid

patients,
plasma [total T4] and [freeT4] are
both normal,
whereas both plasma [total
T3] and [freeT3] are
increased ; this
condition is known as T3 hyperthyroidism or T3
thyrotoxicosis .

PRIMARY HYPOTHYROIDISM
Plasma [TSH] :

Plasma [free T4] and [total T4] :

Plasma free T3 and total T3 measurements are

of no value here, since normal concentrations
are often observed .

SUB CLINICAL PRIMARY THYROID

DISEASE
Plasma [TSH] : abnormal
Thyroid hormone levels : normal
[TSH] : low sub clinical hyperthyroidism
[TSH] : elevated sub clinical hypothyroidism
Before the diagnosis of sub clinical thyroid disease can
be made, causes of an abnormal plasma [TSH] other
than thyroid disease must be excluded
eg :

- pregnancy
- drug treatment

SECONDARY THYROID
DISORDERS
Central (pituitary) hypothyroidism :
[TSH] & thyroid hormone levels low
Hyperthyroidism due to a TSH-secreting tumor
very rarely
Plasma TSH is widely used to screen for
congenital hypothyroidism in the neonate
( the incidence about one in 4000 live births)

THANK
YOU