THYROID GLAND

Pinzon, Anne Katlyn G.

What is Thyroid Gland?
1.ANATOMY (microscopic and gross)
2. PHYSIOLOGY (function of thyroid)
3. Abnormalities
4.Clinical manifestation of abnormalities
5. Management and treatment
•Thyroid gland is controlled
by the hypothalamus and
pituitary (anterior pituitary).
•Thyroid gland gets its name
from the Greek word for
"shield", after the shape of
the related thyroid cartilage.
Most common problems of
the thyroid gland consist of
an over-active thyroid
gland, referred to as
hyperthyroidism and an
under-active thyroid gland,
referred to as
‘hypothyroidism'.
•one of the largest endocrine glands in the body
• Brownish-red in color and is highly vascularized
• Location: Anterior lower neck extending from
the level of 5th cervical vertebrae down to the 1st
thoracic by 2 elongated lateral lobes connected
by median isthmus (12-15mm) overlying 2 nd-4th
tracheal rings
• each lobe has 50-60mm long with the superior
poles diverging laterally at the level of oblique
lines
• lower pole diverge laterally at the level of 5 th
tracheal cartilage
• the average weight of thyroid is 2-3 grams in
neonates and 18-60 grams in adults but
heavier in women.
• the gland enlarges during menstruation and
pregnancy.
 •Right lobe is also known as lobus dexter while left lobe is lobus sinister
•Thyroid gland is covered by a fibrous sheath called capsula glandulae thyroidea
•The gland is covered anteriorly with infrahyoid muscles and laterally with the
sternocleidomastoid muscles
• between the 2 layers of capsule and on posterior side of lobes, there are on
each side 2 parathyroid glands

•thyroid isthmus is variable in presence and size, and can encompass a

cranially extending pyramid lobe (lobus pyramidalis or processus pyramidalis),
remnant of the thyroglossal duct
•The thyroid is supplied with
arterial blood from the
superior thyroid artery, and
inferior thyroid artery.

•Sometimes by the
thyroid ima artery
•The venous blood is drained via
superior thyroid veins, draining in
the internal jugular vein, and via
inferior thyroid veins, draining via
the plexus thyroideus impar in the
left brachiocephalic vein.

•Lymphatic drainage passes

frequently the
lateral deep cervical lymph nodes
and the
pre- and parathracheal lymph node
s
.

•The gland is supplied by

parasympathetic nerve input from
the superior laryngeal nerve and
the recurrent laryngeal nerve.
HISTOLOGY
FOLLICLES- absorb iodine from the blood for production of thyroid
hormones and also for
Storage of iodine in thyroglubin.
•25% of all body’s iodide ions are in thyroid gland
•Inside there follicles, Colloid serve as a reservoir of materials for
thyroid hormones
Production

THYROID EPITHELIAL CELL (follicular cell)- secretes T3 and T4.

• When gland is not secreting, the epithelial cells range from low
columnar to cuboidal.
•When gland is active, epithelial cells become tall columnar cell

PARAFOLLICULAR (C-CELL)- scattered among follicular cell and

secretes CALCITONIN.
 Physiology
The production of thyroxine and
triiodothyronine is regulated by thyroid-
stimulating hormone (TSH), released by
the anterior pituitary. The thyroid and
thyrotpes form a negative feedback loop:
TSH production is suppressed when the T4
levels are high. The TSH production itself
is modulated by
thyrotropin-releasing hormone (TRH),
which is produced by the hypothalamus
and secreted at an increased rate in
situations such as cold (in which an
accelerated metabolism would generate
more heat). TSH production is blunted by
somatostatin (SRIH) or growth hormone-
inhibiting hormone (GHIH) , rising levels of
glucocorticoids and sex hormones
(estrogen and testosterone), and
excessively high blood iodide
concentration.
•primary function of the thyroid gland is production of the
hormones triidothyronine (T3), thyroxine (T4),
and calcitonin.
•80% of the T4 is converted to T3 by peripheral organs
such as the liver, kidney and spleen.
• T3 is several times more powerful than T4, which is
largely a prohormone, perhaps four or even ten times
more active
•Iodine is captured with the "iodine trap" by the hydrogen
peroxide generated by the enzyme thyroid
peroxidase(TPO)
•Thyroid hormones play a particularly crucial role in brain
maturation during fetal development.
Hyperthyroidism
•or overactive thyroid, is the overproduction of the
thyroid hormones T3 and T4, and is most commonly
caused by the development of Graves' disease
•an autoimmune disease in which antibodies are
produced which stimulate the thyroid to secrete
excessive quantities of thyroid hormones.
•The disease can result in the formation of a toxic goiter
as a result of thyroid growth in response to a lack of
negative feedback mechanisms. It presents with
symptoms such as a thyroid goitre, protruding eyes (
exophthalmoses), palpitations, excess sweating,
diarrhea, weight loss, muscle weakness and unusual
sensitivity to heat.
Hypothyroidism is the
underproduction of the thyroid
hormones T3 and T4. Hypothyroid
disorders may occur as a result of
congenital thyroid abnormalities,
autoimmune disorders such as
Hashimoto's thyroiditis, iodine
insufficiency. The removal of the
thyroid following surgery to treat
severe hyperthyroidism. Typical
symptoms are abnormal weight
gain, tiredness, baldness,
temperature intolerance (both heat
and cold), and palpitation
 Initial hyperthyroidism followed by hypothyroidism
•Hashimoto's thyroiditis is an autoimmune disorder whereby the body's own
immune system reacts with the thyroid tissues. At the beginning, the gland
is overactive, and then becomes underactive as the gland is destroyed
resulting in too little thyroid hormone production or hypothyroidism.
Hashimoto's is most common in middle-age females and tend to run in
families. Also more common in individuals with hashimoto's thyroiditis are
type 1 diabetes and celiac disease.

•Postpartum thyroiditis occurs in some females following delivery. The

gland gets inflamed and the condition initially presents with over activity of
the gland followed by under activity. In some cases, the gland does recover
with time and resume its functions.
Cancers occur in the thyroid gland and are more
common in females. The thyroid cancer presents
as a painless mass in the neck. It is very unusual
for the thyroid cancers to present with symptoms,
unless it has been neglected. One may be able
to feel a hard nodule in the neck. Diagnosis is
made using a needle biopsy and various
radiological studies.

Non-cancerous nodules
may find the presence of small masses (nodules)
in the neck. The majority of these thyroid nodules
are benign (non cancerous). The presence of a
thyroid nodule does not mean one has thyroid
disease. Most thyroid nodules do not cause any
symptoms, and most are discovered on an
incidental exam. Doctors usually perform a
needle aspiration biopsy of the thyroid to
determine the status of the nodules. If the nodule
is found to be non-cancerous, no other treatment
is required. If the nodule is suspicious then
surgery is recommended.
Antithyroid medicines
•work best if you have mild hyperthyroidism
•first time you are being treated for Graves' disease
•younger than 50
•Thyroid gland is only swollen a little bit (small goiter).

Radioactive iodine
•Grave disease
• older than 50
•Thyroid nodules(toxic multinodular goiter) that are releasing too
much thyroid hormone.

Radioactive iodine is not used if:

•pregnant or you want to become pregnant within 6 months of
treatment.
•breast-feeding.
•Thyroiditis
If you have symptoms
• fast heartbeat
•Tremors
•Sweating
•Nervousness
•dry eyes
you may take some additional medicines to treat those symptoms.

Surgery is not usually part of initial treatment. You may need surgery
if your thyroid gland is so big that you have a hard time swallowing or
breathing. Or you may need surgery if a single large thyroid nodule is
releasing too much thyroid hormone.

During and after treatment for hyperthyroidism, you will have regular
blood tests to check your levels of thyroid-stimulating hormone (TSH).
You will also have regular thyroid hormone tests to check your levels
of hormones called T4 and T3. These tests are a good way to know
how well your treatment is working.
The purpose of treatment is to replace the thyroid hormone that is
lacking. Levothyroxine is the most commonly used medication.
Doctors will prescribe the lowest dose that effectively relieves
symptoms and brings the TSH level to a normal range. If you have
heart disease or you are older, your doctor may start with a very small
dose.

Myxedema coma is a medical emergency that occurs when the body's level of
thyroid hormones becomes extremely low. It is treated with intravenous thyroid
hormone replacement and steroid medications. Some patients may need
supportive therapy (oxygen, breathing assistance, fluid replacement) and
intensive-care nursing.
 Important things to remember when you are taking thyroid
hormone
•Do NOT stop taking the medication when you feel better
•Continue taking the medication exactly as directed by your
doctor.
•Some dietary changes can change the way your body absorbs
the thyroid medicine.
•Talk with your doctor if you are eating a lot of soy products or a
high-fiber diet.
•Thyroid medicine works best on an empty stomach and when
taken 1 hour before any other medications.
•Do NOT take thyroid hormone with calcium, iron, multivitamins,
albumin hydroxide antacids, colestipol or other medicines that
bind bile acids, or fiber supplements.