THE THYROID GLAND

Anatomical Structure
 Gross Anatomy
• Located in neck
– lobes
– isthmus
• Relations
– Larynx
– Trachea
– Recurrent laryngeal
nerves
– Parathyroid glands
– Carotid sheath
• Blood supply
– Sup. thyroidal a.
– Inf. thyroidal a.
 Embryology
• Thyroglossal duct
• Foramen caecum
• Thyroid cysts
 Histology
• Thyroid follicles
– Simple cuboidal-
columnar
• Colloid
– Thyroglobulin
• Rich vascularization
• Parafollicular cells
 Thyroid Hormone

• Tyrosine
• 3-Monoiodotyrosine
(MIT)
• 3,5-Diiodotyrosine (DIT)
• 3,5,3’,5’-Tetraiodothyronine
(T4)
• 3,5,3’-Triiodothyronine
(T3)
• 3,3’,5’-Triiodothyronine
(Reverse T3, rT3)
 Thyroid Hormone
Synthesis RC
C=O

OH- CH3CH
C=O
RC

• Tyrosine in Thyroglobulin
 Thyroid Hormone
Synthesis RC
I C=O

OH- CH3CH
C=O
RC

• Thyroperoxidase attaches Iodine to 3

position---MIT
 Thyroid Hormone
Synthesis RC
I C=O

OH- CH3CH
C=O
I RC

• Thyroperoxidase attaches Iodine to 5

position---DIT
 Thyroid Hormone
Synthesis RC
I C=O
I
N
OH- O CH3CH
C=O
I I RC

• Thyroperoxidase attaches ring from one

DIT to adjacent DIT = Thyroxine (T4)
 Thyroid Hormone
Synthesis RC
I C=O
I
N
OH- O CH3CH
C=O
I RC

• Thyroperoxidase attaches ring from one

MIT to adjacent DIT = Triiodothyronine (T3)
 Thyroid Hormone
Synthesis RC
I C=O
I
N
OH- O CH3CH
C=O
I RC

• Thyroperoxidase attaches ring from one

DIT to adjacent MIT = Reverse T3
 Thyroid Hormone
Biosynthesis
• Iodine pump/trap
• Thyroglobulin
• Iodination
• Thyronine
• Thyroglobulin
pinocytosis
• Hormone release
 Thyroid hormone
transport
• Thyroid binding globulin (TBG)
– Highest affinity
• Thyroid binding prealbumin
– Intermediate affinity
• Albumin
– Low affinity, High capacity
 Thyroid Hormone
• T3 is 3-8X more active than T4
• Thyroid Gland produces 10X T4 to T3
• 5’-deiodinase
– Converts T4 to T3 in Target Tissues
– Primarily responsible for circulating
levels of T3
• T4 probably a pro-hormone
• Thyroid hormone receptor
– Nuclear
 Physiological effects
of thyroid hormone
• Increases oxygen consumption and
heat production
• Positive chronotropic and inotropic
effects on heart
• Increase sensitivity to adrenergic
effectors
– Up-regulates -adrenergic receptors
• Increase gut motility
• Increase bone turnover
 Physiological effects
of thyroid hormone
• Increases reflex response
• Increase hepatic glycogenolysis and
gluconeogenesis
• Stimulates lipolysis
• Developmental effects
– Growth
– Brain development
 REGULATION
HIGHER BRAIN OF THE
CENTERS
BODY
SHORT-LOOP
THYROID GLAND
TEMP.
FEEDBACK LONG-LOOP
STARVATION
HYPOTHALAMUS FEEDBACK

EXPOSURE TRH
GOITROGENS
TO COLD TSH ANTERIOR
PITUITARY
TSH- T4
TSH
RECEPTOR
ANTIBODIES THYROID HIGH
GLAND SERUM
THYROID AUTO IODIDE
REGULATION T3 & T4
Endocrinopathies
 Hyperthyroidism
• Level of the defect
(1, 2, 3)
• Thyrotoxicosis
• Graves’ disease
• Toxic Adenoma
• Toxic Multinodular
Goiter
• Chronic Thyroiditis
 Hyperthyroidism Symptoms
• Tachycardia/arrhythmia
• Muscle tremors
• Hyperreflexia
• Increased core & skin
temp./ Heat Intolerant
• Exophthalmos
• Muscle wasting
• Loose stool
• Osteoporosis
• Hair loss
• Oligo-/amenorrhea
• Irritability, Restlessness
 Hypothyroidism
• 1, 2, 3
• Newborn
– Cretinism
– Lack of myelination
• Children
– Retarded Growth
– Disproportionate
 Hypothyroidism
• Adult
– Muscle weakness
– Mental slowness
– Tired/fatigued
– Cold
– Slowed intestinal
peristalsis
– Impaired renal
function
– Anemia
– Myxedema
Myxedema
 Causes of
Hypothyroidism
• Iodine deficiency
• Hashimoto’s Disease
– Initially hyperthyroid
• Post-ablative
• 5’-Deiodinase Deficiency
 Thyroid hormone
resistance
• Mutation of the receptor.
• Characterized by high blood levels of
both TSH and Thyroid hormones
 Non-toxic goiter

• Iodine deficiency
 Thyroiditis
• Subacute thyroiditis
• Chronic thyroiditis (Hashimoto’s
Disease)
– Autoimmune
 Euthyroid Syndrome
• Patient presents and complains of
hypothyroid type symptoms
• Levels of Thyroid hormones (free &
total), & TSH in low normal range.
• May be due to a 5’-deiodinase
deficiency
 Allopathic treatments
for thyroid disorders
• Hyperthyroidism
– Goitrogens
– Partial thyroidectomy
– Radiothyroidectomy
• Hypothyroidism
– Hormone Replacement