THYROID FUNCTION

CLINICAL CHEMISTRY III

presented by: Jannica Dominique Claros, RMT

FACULTY- LPU-ST. CABRINI SCHOOL OF HEALTH
SCIENCES
THYROID GLAND
- PRODUCES TWO MAIN HORMONES: thyroid
hormone and calcitonin
- calcitonin: calcium homeostasis
thyroid hormone: body metabolism, neurologic
development

GLAND ANATOMY AND DEVELOPMENT

-placed at lower anterior of the neck and is shaped
like a butterfly
- possess two lobes parted by a bridge (isthmus)
- produces thyroid hormone at 11th week of gestation
- Iodine is an essential component of thyroid hormone
(deficiency leads to hypothyroidism)
-hypothyroidism leads to mental retardation and cretinism

HORMONE SYNTHESIS
- thyroid hormone is primarily made up of iodine
- iodine is mainly found in seafood, dairy products, iodine-
enriched breads, and vitamins
- amiodarone, an iodine-containing medication used to
treat certain heart conditions
-minimum daily intake of iodine is 150 g
ANATOMY:

Follicle- major unit of thyroid gland

Colloid - group of follicles surrounded by a viscous
fluid
thyroglobulin- a glycoprotein manufactured
exclusively by thyroid follicular cells, major
component of colloid

thyroid peroxidase - enzyme that oxidizes

concentrated iodide and forms bonds with
thyroglobulin
 FORMS OF THYROID HORMONE
• monoiodothyronine (MIT)
• diiodothyronine (DIT)
• triiodothyronine (T3) (one MIT residue AND one DIT residue)
• thyroxine (T4) (two DIT residues)

Thyroid stimulating hormone (TSH) signals the follicular cell to

ingest a microscopic droplet of colloid by endocytosis

Protein Binding of Thyroid Hormone

three major binding proteins:

• thyroxine-binding globulin (TBG),

• thyroxine-binding prealbumin (TBPA)
• albumin
 CONTROL OF THYROID FUNCTION:

• TRH is synthesized in the nuclei of the hypothalamus

and stored in the median eminence
• upon secretion: stimulates cells in the anterior pituitary
gland to manufacture and release TSH
• increased production and release of thyroid hormone
• Regulation by negative feedback mechanism
** This feedback loop requires a normally functioning
hypothalamus, pituitary, and thyroid gland **
**there should be no any interfering agents oragents that
mimic TSH action
Actions of Thyroid Hormone

• Thyroid hormones combine with its nuclear

receptor on thyroid hormone-responsive genes
• production of messenger RNA
• production of proteins that influence metabolism
and development
• Effects: tissue growth, brain maturation,
increased heat production, increased oxygen
consumption, and an increased number of
adrenergic receptors
 TESTS FOR THYROID EVALUATION
Blood Tests
TSH
• The most useful test for assessing thyroid function
• three generations of assays have been developed
• monitors replacement therapy as well as screen for both
hyperthyroidism and hypothyroidism

Serum T3 and T4

Thyroglobulin
• This prohormone inthe circulation is proof of the presence of thyroid
tissue, either benign or malignant.
• an ideal tumor marker for thyroid cancer patients
• well-differentiated thyroid cancer who have been treated
successfully with surgery and radioactive iodine should have
undetectable thyroglobulin levels
TSH receptor antibodies
- for auto immune thyroid disorders

DISORDERS OF THE THYROID

Hypothyroidism
- defined as a low free T4 level with a normal or high TSH
—is one of the most common disorders of the thyroid gland
- cold intolerance, fatigue, dry skin, constipation,
hoarseness, dyspnea on exertion, cognitive dysfunction,
hair loss, and weight gain
Signs
• Delayed relaxation phase of deep tendon
• reflex testing
• Bradycardia
• Diastolic hypertension
• Coarsened skin, yellowing of skin (carotenemia)
• Periorbital edema
• Thinning of eyebrows/loss of lateral aspect
• of brows
• Slowed movements/speech
• Pleural/pericardial effusion
• Ascites
• Symptoms
• Cold intolerance
• Depression
• Mental retardation (infants), slowed cognition
• Menorrhagia
• Growth failure (children)
• Pubertal delay
• Dry skin
• Edema
• Constipation
• Hoarseness
• Dyspnea on exertion
 TYPES OF HYPOTHYROIDISM

Primary: Thyroid gland dysfunction

Secondary: Pituitary dysfunction
Tertiary: Hypothalamic dysfunction

Guidelines for Hypothyroidism Screening

Measurement of TSH
■ At age 35
■ Every 5 years after the age of 35
■ More frequently with risk factors or symptoms: goiter,
family history, lithium use, amiodarone use
Hypothyroidism is treated with thyroid
hormone replacement therapy
(T4) : treatmentof choice
* goal of therapy is to achieve a normal TSH
level.
THYROTOXICOSIS: excessive thyroid hormone
ingestion, leakage of stored thyroid hormone from storage in the
thyroid follicles, or excessive thyroid gland production of
thyroid hormone

SIGNS AND SYMPTOMS

OF THYROTOXICOSIS

• Tachycardia
• Tremor
• Warm, moist, flushed, smooth skin
• Lid lag, widened palpebral fissures
• Ophthalmopathy (Graves’ disease)
• Goiter
• Brisk deep tendon reflexes
• Muscle wasting and weakness
• Dermopathy/pretibial myexedema (Graves’ disease)
• Osteopenia, osteoporosis
• Graves’ disease is the most common cause of
thyrotoxicosis
• an autoimmune disease in which antibodies are
produced that activate the TSH receptor
• thyrotoxicosis, goiter, ophthalmopathy and dermopathy
(skin changes in the lower extremities that have an
orange peel texture)
• treated with medication, radioactive iodine, or surgery.
Toxic Adenoma and Multinodular Goiter
• tworelatively common causes of hyperthyroidism
• conditions are caused by autonomously functioning
thyroid tissue
• neither TSH no TSH receptor–stimulating
immunoglobulin is required to stimulate thyroid hormone
production

DRUG-INDUCED THYROID DYSFUNCTION

• Amiodarone-Induced Thyroid Disease
• drug used to treat cardiac arrhythmias, interferes with
normal thyroid function.
Subacute Thyroiditis
• conditions are associated with inflammation of the
thyroid gland, leakage of stored thyroid hormone
• Postpartum thyroiditis is the most common form of
subacute thyroiditis
• Painful thyroiditis, also called subacute granulomatous,
subacute nonsuppurative thyroiditis, or de Quervain’s
thyroiditis, is characterized by neck pain, low-grade
fever, myalgia, a tender diffuse goiter, and swings in
thyroid function tests
NONTHYROIDAL ILLNESS
• Hospitalized patients often have
abnormalities in their thyroid function tests
• less T4 is converted to active T3.
decreased levels of T3 and higher levels
of reverse T3
THYROID NODULES
• Thyroid nodules are common. Clinically
apparent thyroid nodules are present in
6.4% of adult women and 1.5% of adult
men
• Thyroid ultrasound finds unsuspected
thyroid nodules in 20%–45% of women
and 17%–25% of men
END OF LECTURE. THANK YOU