THYROID GLAND

Thyroid gland
is part of the endocrine system of the body
butterfly-shaped gland
It is consist of two lobes (one on either side

of the trachea) located in the lower prt of

the neck, just below the voice box(larnyx).
2 types of Cell:
Follicular cells are secretory( T3 and T4)
Parafollicular o C cells( Calcitonin)

Functions of Thyroid hormones:

1. For tissue growth.
2. For development of the central nervous
system.
3. Elevated heat production
4. Control of oxygen consumption
5. It influence carbohydrate and protein
metabolism
6. For energy conservation

Major Thyroid Hormones

1. Triiodothyronine (T3)/ 3,5,3

triiodothyronine
- it has the most active thyroid hormonal
activity
- almost 75-80% is produced from the
tissue deiodination of T4
- the principal applicaton of this hormone
is in diagnosing t3 thyrotoxicosis
- better indicator of recovery from
hyperthyroidism as well as the
recognition of recurrence of
hyperthyroidism.

2. Tetraiodothyronine (T4)/ 3,5,35

tetraiodothyronine
-is the principal secretory product
- the major fraction od organic iodine in the
circulation
- a prohormone for T3 production
-all circulating T4 originates in the thyroid gland
-the amount of serum T4 is a good indicator of the
thyroid secretory rate.
- elevated thyroxine causes inhibition of TSH
secretion and vice versa
Ref. Values: 5.5-12.5 ug/dL or 71-161 nmol/L
(adult)
11.8-22.6 ug/dL or 152-292 nmol/L (neonate)

Clinical Disorders
1. Hyperthyroidism

- it refers to an excess of circulating

thyroid hormone
Signs and Symptoms:
. Tachycardia
. Tremors
. Weight loss
. Heat intolerance
. Emotional lability
. Menstrual changes

Primary hyperthyroidism
- elevated T3 and T4
- decreased TSH
Secondary hyperthyroidism
- increased TSH and FT4 ( due to primary
lesion in the pituitary gland)

A. Thyrotoxicosis
B. Graves disease ( diffuse toxic goiter)
C. Riedels thyroiditis
D. Subclinical hyperthyroidism
E. Subacute granulomatosus/ Subacute

nonsuppurative thyroiditis/ De Quervains

thyroiditis ( painful thyroiditis)

2. Hypothyroidism
- it develops whenever insufficient amounts of
thyroid hormone are available to tissues
- treated with thyroid hormones replacement
therapy (levothyroxine)
Signs and Symptoms:
Brachycardia
Weight gain
Coarsened skin
Cold intolerance
Mental dullness

A. Primary Hypothyroidism
- is primarily due to deficiency of elemental
iodine ( T3 and T4 TSh)
- it is also caused by destruction or ablation of
the thyroid gland
Hashimotos Disease ( chronic autoimmune
thyroiditis
Myxedema

B. Secondary hypothyroidism
- due to pituitary destruction or pituitary
adenoma
- T3 and t4 low levels, TSH is also decreased
C. Tertiary Hypothyroidism
- due to hypotalamic disease
- T3 and T4 low levels, TSH is also decreased

D. Congenital hypothyroidism/ cretinism

- defects in the development or function of the
gland
-physical and mental development of the child
are retarded
E. Subclinical hypothyroidism
- T3 and T4 normal , TSH is slightly increased

Thyroid Function Test

1.TRH Stimulation test ( Thyrotropin
Releasing Hormone)
- it measures the relationship between the
TRH and TSH secretions
- it may also be helpful in the detection of
thyroid hormone resistance syndromes
- dose needed: 500 ug TRH by IV
- increased levels: primary hypothyroidism
- decreased levels: hyperthyroidism

2. TSH test

- the most important thyroid function test; best

screening test.
- the most clinically sensitive assay for the
detection of primary thyroid disorders
- it helps in the early detection of hypothyroidism
-Ref. Values: 0.5-5 uU/mol
Increased TSH:
Primary hypothyroidism
Hashimotos thyroiditis
Decreased TSH:
Primary hyperthyroidism
Secondary and tertiary hypothyroidism

3. Radioactive Iodine Uptake (RAIU)

- it is used measure the ability of the thyroid
gland to trap iodine
- it is helpful in establishing the cause of
hyperthyroidism
- high uptake indicates metabolically active
gland( active hormone production)
- increased levels: hyperthyroidism, euthyroid
patients, chronic liver disease
- decreased levels: hypothyroidism, oral
contraceptives, pregnancy, acute hepatitis
- Ref. Values: 25-35%

4. Thyroxine binding globulin (TBG) test

- it is used to confirm results FT3 or FT4 or
abnormalities in the relationship of the total
thyroxine (TT4) and THBR test
- it is useful to distinguish between
hyperthyroidism causing high thyroxine levels
and euthyroidism with increased binding by
TBG and increased thyroxine
- increased levels: hypothyroidism,
pregnancy, estrogen
- decreased levels: anabolic steroids,
nephrosis