Dr.

Farrukh Majeed
Department of Physiology
doctorfarrukhmajeed@gmail.com
 Endocrinology Lecture- 7

Thyroid gland & Thyroid hormones # 2

 Learning objectives
At the end of this lecture student should be able
to:
• Describe actions of Thyroid hormones
• Predict diseases produced by
increase/decrease Thyroid hormone release
 TH- Decreased Body Weight
• TH Decreased Body Weight,
• also increases the appetite,  this may
counterbalance the change in the metabolic
rate.
• Greatly increased TH decreases the body
weight,
• decreased TH increases the body weight
 Sympathomimetic effect of TH
“Any action similar to one produced by the
sympathetic nervous system is known as a
sympathomimetic effect “
(sympathomimetic means “sympathetic mimicking).
– Thyroid hormone increases target-cell responsiveness
to catecholamines (epinephrine and norepinephrine),
– hormonal reinforcements from the adrenal medulla.
• TH causing a proliferation of catecholamine
target-cell receptors.
 TH: Cardiovascular System
Increased Blood flow
• Increased metabolism  rapid utilization of oxygen and Increased
metabolic end products from the tissues  These effects cause
vasodilation in most body tissues  increasing blood flow.
• The rate of blood flow in the skin increases increased need for heat
elimination from the body.
Increased Cardiac output
• As a consequence of the increased blood flow, cardiac output also
increases, sometimes rising to 60 per cent or more above normal when
excessive thyroid hormone is present and falling to only 50 per cent of
normal in very severe hypothyroidism.
Increased Heart Rate.
• TH  have a direct effect on the excitability of the heart increases the
heart rate.
Increased Heart Strength.
• TH The increased enzymatic activity  increases the
strength of the heart
• TH is increased markedly heart muscle strength becomes
depressed  because of long-term excessive protein
catabolism.
Normal Arterial Pressure.
• The mean arterial pressure usually remains normal
• pulse pressure is often increased,
• In hyperthyroidism  systolic pressure elevated and the
diastolic pressure reduced a corresponding amount.
 TH: Respiration and GIT
Increased Respiration.
• The increased rate of metabolism increases the utilization of
oxygen and formation of carbon dioxide increase the rate
and depth of respiration.

Increased Gastrointestinal activity

• increased appetite and food intake,
• increases rates of secretion of the digestive juices
• increases motility of the gastrointestinal tract
– Hyperthyroidism often results in diarrhea.
– Lack of thyroid hormone can cause constipation.
 TH: Central Nervous System
Excitatory Effects on the Central Nervous System.
• thyroid hormone increases the rapidity of
cerebration (thinking process) but also often
dissociates this.
• Decrease TH: decreases this function
• Increase TH:
– extreme nervousness
– psychoneurotic tendencies, such as anxiety
complexes, extreme worry, and paranoia.
 TH: Growth

Thyroid hormone has both general and specific effects on growth.

• Mainly in growing children.
• Decrease TH, the rate of growth is greatly retarded.
• Increase TH excessive skeletal growth often occurs, causing the child to become
considerably taller at an earlier age.
• The bones also mature more rapidly and the epiphyses close at an early age, so
that the duration of growth and the eventual height of the adult may actually be
shortened.
Growth and development of the brain during fetal life /first few years of postnatal
life.
• If the fetus does not secrete sufficient quantities of thyroid hormone, growth and
maturation of the brain both before birth and afterward are greatly retarded, brain
remains smaller than normal.
• The child without a thyroid gland will remain mentally deficient throughout life.
 TH: Function of the Muscles
• Increase TH makes the muscles react with vigor,
• but when the quantity of hormone becomes excessive
muscles become weakened excess protein catabolism.
• lack of thyroid hormone muscles to become sluggish/
relax slowly after a contraction.

Muscle Tremor
• hyperthyroidism fine muscle tremor caused by
increased reactivity of the neuronal synapses in the
areas of the spinal cord that control muscle tone.
 TH: Sleep
• TH Exhausting effect on the musculature
and on the central nervous system,
• Increase TH
– feeling of constant tiredness,
– but excitable effects of thyroid hormone on the
synapses, it is difficult to sleep.
• Decrease TH
– extreme somnolence
 TH: Other Endocrine Glands
• Increased TH  increases the rates of secretion of most
other endocrine glands, but it also increases the need of
the tissues for the hormones.
• TH increases many metabolic activities related to bone
formation  a consequence, increases the need for
parathyroid hormone.
• TH increases the rate at which adrenal glucocorticoids are
inactivated by the liver  leads to feedback increase in
adrenocorticotropic hormone production by the anterior
pituitary increased rate of glucocorticoid secretion by
the adrenal glands.
 TH: Sexual Function
For normal sexual function, thyroid secretion needs to be approximately normal.
In men
• lack of TH  loss of libido
• Excesses of the TH impotence
In women,
• lack of TH  menorrhagia and polymenorrhea— that is, respectively,
• excessive and frequent menstrual bleeding.
• Or irregular periods and occasionally amenorrhea.
• decreased libido.
• Excesses of the TH oligomenorrhea (reduced bleeding) or amenorrhea
• TH  metabolic effects on the gonads as well as excitatory and inhibitory
feedback effects operating through the anterior pituitary hormones that
control the sexual functions.
Diseases of the Thyroid
 Abnormalities of thyroid function

• Abnormalities of thyroid function are among

the most common endocrine disorders.
• They fall into two major categories
– Hyperthyroidism excess TH secretion,
– Hypothyroidism  deficient TH secretion
 Hyperthyroidism and thyrotoxicosis
Hyperthyroidism and thyrotoxicosis are used interchangeably,
however each refers to slightly different conditions.
• Hyperthyroidism: over activity of the thyroid gland excessive
secretion of TH  accelerated metabolism in the periphery.
– Pituitary disease
– High dietary iodine intake or very low dietary intake.
– Genetic factor.
• Thyrotoxicosis: refers to the clinical effects of an unbound
thyroid hormone, regardless of whether or not the thyroid is the
primary source.
• Grave’s disease 95%
• Multi-nodular disease
• Thyroid adenoma
Pathophysiology:
Hyperthyroidisms characterized by loss of normal regulatory
control of thyroid hormone secretion.
Increase TH:
hyper metabolism
Increase sympathetic nervous system activity
stimulate the cardiac system Tachycardia and increase
cardiac –output, stroke volume and peripheral blood flow.
Negative nitrogenous balance, lipid depletion and the
resultant state of nutritional deficiency.
TSI
Investigation
– History and physical examination
– Ophthalmic examination
– ECG- atrial tachycardia
– Thyroid function test: T3 and T4
– Thyroid releasing hormone stimulation test
– Radioactive iodine uptake (RAIU)
– Thyroid scan
Causes Hormone status Goitre
:GOITER
 Treatment
1. Radioactive iodine :Taken by mouth, radioactive iodine is
absorbed by your thyroid gland, where it causes the gland
to shrink and symptoms to subside, usually within three to
six months.
2. Anti-thyroid medications • These medications gradually
reduce symptoms of hyperthyroidism by preventing your
thyroid gland from producing excess amounts of hormones.
They include propylthiouracil and methimazole (Tapazole). •
3. Beta blockers • These drugs are commonly used to treat
high blood pressure.
4. Surgical management
 Hypothyroidism
• Abnormally low activity of the thyroid gland, resulting in retardation
of growth and mental development in children and adults.
• Causes :
– Dietary Iodine deficiency
– Hashimoto’s thyroiditisAutoimmune Thyroid Disease: most common
cause of Hypothyroidism
– Medication: Lithium,
– Genetic dysfunction:
– Previous thyroid surgery
– Treatment for Hyperthyroidism
– Radiation therapy
– Damage to the Pituitary Gland/hypothalamus
Investigations
 Myxedema and Cretinism
• The puffy appearance, of the face, hands, and
feet, is known as myxedema edematous
condition caused by infiltration of the skin with
complex, water-retaining carbohydrate
molecules (glycosaminoglycans),  that were
normally suppressed by thyroid hormone.
• If a person has hypothyroidism from birth, a
condition is cretinism  TH are essential for
normal growth and CNS development, 
dwarfism and mental retardation, in addition
– to general symptoms of thyroid deficiency.
– The mental retardation is preventable if
replacement therapy is started promptly,
but it is not reversible once it has
developed for a few months after birth.
 Treatment
• Hypothyroidism is treated by taking
replacement thyroid hormone pills,
• hypothyroidism caused by iodine deficiency, in
which case the remedy is adequate dietary
iodine.
 Reading material
• Guyton 11th edition, page no: 931- 942.
• Sherwood human physiology page no: 666-
671