12.04.17 Thyroid hormones Flashcards

1
Q

The thyroid hormones control (3):

A

– the body’s basal metabolic rate
– the overall metabolism of protein, fat, and carbohydrates
– the sensitivity to catecholamines

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2
Q

Triiodothyronine (T3) and thyroxine (T4) are synthesized from ______

A

Triiodothyronine (T3) and thyroxine (T4) are synthesized from thyroglobulin

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3
Q

The major form of thyroid hormone in the blood is ___:

  • ratio of T4:T3 = _____
  • which has longer half-life?
  • potency?
  • ___% of T4 is converted to T3 in peripheral tissues
A

The major form of thyroid hormone in the blood is T4:

  • ratio of T4:T3 = 20:1
  • which has longer half-life? T4
  • potency? T3 5-10x more potent than T4
  • 25% of T4 is converted to T3 in peripheral tissues
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4
Q

Decarboxylation and deiodination of T3 and T4 produce _____ (T0a) and _____ (T1a).

A

Decarboxylation and deiodination of T3 and T4 produce thyronamine (T0a) and iodothyronamine (T1a).

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5
Q

Iodine enters the thyroid follicular cell via a _____ channel. It leaves the cell through pendrin and is oxidized by ____, which enables it to iodize _____ which undergoes conjugation, endocytosis, ____ (thyroxine and triiodothyronine) and eventual release into bloodstream.

A

Iodine enters the thyroid follicular cell via a Na/I symporter channel. It leaves the cell through pendrin and is oxidized by thyroid peroxidase (TPO), which enables it to iodize thyroglobluin which undergoes conjugation, endocytosis, proteolysis (thyroxine and triiodothyronine) and eventual release into bloodstream.

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6
Q

Thyroid stimulating hormone acts directly on ____ cells, increasing (6):

A
– iodide transport into follicular cells
– production of thyroglobulin
– iodination of thyroglobulin
– endocytosis of iodinated thyroglobulin from the colloid into
follicular cells
– Proteolysis of iodinated thryoglobulin
– exocytosis into the capillaries
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7
Q

The rate of iodine uptake and incorporation into thyroglobulin is influenced by the amount of dietary iodide available

  • low iodide levels ____ iodine transport
  • high iodide levels ____ iodine transport
A

The rate of iodine uptake and incorporation into thyroglobulin is influenced by the amount of dietary iodide available

  • low iodide levels increase iodine transport
  • high iodide levels decrease iodine transport
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8
Q

Major sources of dietary iodine include (4):

A

– iodized salt (developed to control iodine intake)
– iodated bread (potassium iodate used in flour
preservation and dough leavening process)
– dairy products
– shellfish

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9
Q

Minimum requirement of iodine is ____/day, the US intake is ____/day

A

Minimum requirement of iodine is 75 micrograms/day, the US intake is 200-500 micrograms/day

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10
Q

Physiological roles of the thyroid hormone include (8):

A
  • Cardiovascular system
  • Respiratory system
  • Oxygen-carrying capacity
  • Oxygen-consumption
  • Renal system
  • Reproductive system
  • Growth and tissue development
  • Nervous system
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11
Q

Thyroid receptors belong in the _____ family of receptors. It is constitutively bound to DNA.

  • No ligand: ____ gene expression
  • With ligand: ____ of gene expression
A

Thyroid receptors belong in the Retinoid X receptor (RXR) family of receptors. It is constitutively bound to DNA.

  • No ligand: No gene expression
  • With ligand: Activationof gene expression
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12
Q

Tα1 and Tα2 are splice variants of the ____ gene. Tβ1 and Tβ2 are splice variants of the ____ gene

A

Tα1 and Tα2 are splice variants of the THRA gene. Tβ1 and Tβ2 are splice variants of the THRB gene.

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13
Q

___, ___, and ___ generally activate transcription when T3 binds. Except in the pituitary, ___ is an activator unbound, but with T3 binding becomes an inhibitor.

A

Tα1, Tβ1, and Tβ2 generally activate transcription when T3 binds. Except in the pituitary, Tβ2 is an activator unbound, but with T3 binding becomes an inhibitor.

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14
Q

___ does not bind T3/T4 and therefore inhibits

A

Tα2 does not bind T3/T4 and therefore inhibits

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15
Q

• Tα1: widely expressed, high levels in ____ and ____
muscles
• Tα2: widely expressed, but unable to bind hormone
• Tβ1: predominantly expressed in ___, ___, and ___
• Tβ2: expression primarily in the ___ and ___. Mutations (splicing, receptor) can result in Thyroid resistance disease (Refetoff syndrome)

A

• Tα1: widely expressed, high levels in skeletal and cardiac
muscles
• Tα2: widely expressed, but unable to bind hormone
• Tβ1: predominantly expressed in brain, kidney, and liver
• Tβ2: expression primarily in the hypothalamus and pituitary
Thyroid resistance disease (Refetoff syndrome)

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16
Q
  • ~99.98% of __ is bound to 3 serum proteins (TBG, TBPA, albumin)
  • ~0.02% of __ in serum is __
  • ~0.4% of total __ in serum is __
A

• ~99.98% of T4 is bound to 3 serum proteins
– 75% thyroid-binding globulin (TBG)
– 15 - 20% thyroid-binding prealbumin (TBPA or
transthyretin)
– 5 - 10% albumin
• ~0.02% of T4 in serum is free
• ~0.4% of total T3 in serum is free

17
Q

Thyroxine (T4)

  • activation to 3,5,3’ Tri-iodothyronine (T3) (2):
  • deactivation to 3,3’,5’ Tri-iodothyronine (Reverse T3) (2):
A

Thyroxine (T4)

  • activation to 3,5,3’ Tri-iodothyronine (T3) (2): β adrenergic, dehalogenases (D1, D2)
  • deactivation to 3,3’,5’ Tri-iodothyronine (Reverse T3: inhibits T3 production) (2): glucocorticoids, dehalogenase (D3)
18
Q

Thyroid hormone dehalogenases:

  • D1: located in ___, ___. Can deiodinate ___ rings
  • D2: located in heart, skeletal muscle, CNS, fat, thyroid, pituitary. Can only deiodinate ___ ring of ___, is the major ___ enzyme.
  • D3: located in fetal tissue, placenta, brain (except pituitary). Can only deiodinate ___ ring of ___, major ____ enzyme.
A

Thyroid hormone dehalogenases:

  • D1: located in liver, kidney. Can deiodinate both rings
  • D2: located in heart, skeletal muscle, CNS, fat, thyroid, pituitary. Can only deiodinate outer ring of T4, is the major activating enzyme.
  • D3: located in fetal tissue, placenta, brain (except pituitary). Can only deiodinate inner ring of T4 and T3, major inactivating enzyme.
19
Q

Subcategories of primary hypothyroidism are (5):

A

– Cretinism: hypothyroidism during childhood (retarded growth, sluggish movements, mental deficiencies)
– Myxedema: hypothyroidism during adulthood (5% of the adults)
– Simple Goiter: Iodine deficiency (high TSH causes thyroid hypertrophy)
– Hashimoto’s syndrome: autoimmune
– Iatrogenic: often following treatment of hyperthyroidism

20
Q

Secondary hypothyroidism can be due to (2):

A

Pituitary disease, hypothalamic disease (tumors)

21
Q

Hyperthyroidism can be categorized into (4):

A
  • Graves Disease: autoimmune, usually 3rd decade, 8:1 women:men, s/sx: thyroid enlargement, opthalmopathy, etc.
  • Excess endogenous thyroid hormone: after hypothyroidism tx
  • Thyroid cancers: produce excess thyroid hormone
  • Acute hyperthyroidism: cause unknown, s/sx: muscle fatigue, weight loss, heat intolerance
22
Q

Radioactive iodine uptake test is used to determine the type of hyperthyroidism:

  • low uptake: _____
  • normal uptake: 15-25%
  • high uptake: _____
  • uneven uptake: indicates nodule
  • food/diet can influence
A

Radioactive iodine uptake test is used to determine the type of hyperthyroidism:

  • low uptake: acute thyroiditis
  • normal uptake: 15-25%
  • high uptake: Graves disease
  • uneven uptake: indicates nodule
  • food/diet can influence
23
Q

Radioactive iodine uptake test is different from radiation therapy in that ___ is used instead of ___. Lower doses are used, with shorter half lives (12hrs vs 8 days)

Contraindicated in ____ and ____

A

Radioactive iodine uptake test is different from radiation therapy in that 123 I is used instead of 131 I. Lower doses are used, with shorter half lives (12hrs vs 8 days)

Contraindicated in pregnant and breastfeeding

24
Q

Hypothyroidism is treated with (2):

A
  • Iodine supplemention
  • Synthetic T4 (Synthroid, levothyroxine): less susceptible than T3 for feedback regulation, less toxic. Always check for angina and perform ECG.
25
Q

Propylthiouracil (PTU), methimazole (MMI), carbimazole

Class: ____
Disadvantage: short half life, can inhibit dehalogenase, slow acting
SE: agranulocytosis, aplastic anemia, liver damage

A

Propylthiouracil (PTU), methimazole (MMI), carbimazole

Class: Thioamides (TPO inhibitor)
Disadvantage: short half life, can inhibit dehalogenase, slow acting
SE: agranulocytosis, aplastic anemia, liver damage

26
Q

__ I

Advantages: safe and effective, rapid excretion
Disadvantages: can’t be used long-term, delayed hypothyroidism (most develop), contraindicated in pregnancy

A

131 I

Advantages: safe and effective, rapid excretion
Disadvantages: can’t be used long-term, delayed hypothyroidism, contraindicated in pregnancy

27
Q

Surgery reserved for patients allergic to thioamides or resistant to 131 I treatment. P

  • partial thyroidectomy:____
  • complete:____
A

Surgery reserved for patients allergic to thioamides or resistant to 131 I treatment. P

  • partial thyroidectomy (adenoma)
  • complete (Grave’s disease)