[M6] Part 2: Thyroid & Parathyroid gland Flashcards
Butterfly-shaped glands found in the lower anterior neck
THYROID GLAND
THYROID GLAND is a Butterfly-shaped glands found in the ____
lower anterior neck
T/F: Thyroid gland is Bilobed
T
thyroid tissue that connects the two lobes
Isthmus
Thyroid gland functions:
- Controls ____ and release of ____ from ____
- Regulates ___ , ____ and ____
- Acts on ___
- Stimulates the ____
- Physical ___ and ____
- ___ body temperature
- ____ consumption
-biosynthesis ; thyroid hormones ; thyroglobulin
-carbohydrates ; proteins ; lipid metabolism
-CNS
-heart
-growth ; development
-Basal
-Oxygen
Thyroid gland acts on CNS by ____ and ____ of the ____
By maturation and development of the brain
Thyroid gland Function:
Basal body temperature:
_____ TH = ____ body temperature
↑ TH = ↑ body temperature
Thyroid gland Function:
Oxygen consumption
___ TH = ____ O2 demand
↑ TH = ↑ O2 demand
The thyroid gland is composed of hollow spheres called ____
colloid follicles
Colloid fills the ____
follicle cavities
Follicle cells produce ___
thyroglobulin
HISTOLOGY OF THYROID GLAND:
composed of Cuboidal cells called ___ or ____
Follicular cells ;
thyroid follicular cells
Where T3 and T4 are produced/synthesized
follicular cells or thyroid follicular cells
Arranged in spheres
follicular cells or thyroid follicular cells
a gel-like matrix retained within the spherical structures of the follicular cells
Colloid
found within the colloids
Thyroglobulin
Major component of the colloid itself
Thyroglobulin
Thyroglobulin has 2 ____
Has 2 tyrosine backbone
Has 2 tyrosine backbone
Thyroglobulin
Each tyrosine backbone has_____, therefore, each thyroglobulin has _____
1 iodine-binding site ;
2 iodine-binding sites
Important substance in the synthesis of thyroid hormones
Thyroglobulin
Produces calcitonin
Parafollicular C cells
important element in the synthesis of thyroid hormones
Iodine
Iodine deficiency =____
thyroid hormone deficient
_____ = thyroid hormone deficient
Iodine deficiency
What are the 2 biologically active thyroid hormones:
T3, T4
What is T3
triiodothyronine
What is T4
tetraiodothyronine
More active thyroid hormones
T3 (triiodothyronine)
Not that biologically active thyroid hormones
T4 (tetraiodothyronine)
What are the 5 steps in Thyroid Hormone Synthesis
- Iodide uptake
- Iodide → iodine
- Iodine uptake
- Iodination of tyrosine (thyroglobulin)
- Coupling of iodinated tyrosine
____ from ___ will enter the ____
Iodide
diet
follicular cells
Inside the ___, it will be ____ to form ____
follicular cells;
oxidized ;
iodine
Iodine in the ___ will attach to the ____ of the ____
colloid ;
tyrosine backbone;
thyroglobulin
For each ____, pwedeng ____ ang mag attach pero ____ all the time
thyroglobulin;
2 iodine;
not
1 iodine attached
Monoiodothyronine (MIT)
2 iodine attached
Diiodothyronine (DIT)
Coupling reaction:
DIT + MIT = ____
triiodothyronine
____ + ___ = triiodothyronine
DIT
MIT
Coupling reaction:
DIT + DIT = ____
tetraiodothyronine
____+ ____= tetraiodothyronine
DIT
DIT
For T4 to be biologically active, ____ should be
____ (para maging T3)
1 iodine;
removed
removal of iodine by the enzyme_____
Deiodination
monodeiodinase
more specific term since 1 iodine lang ang tinatanggal
Monodeiodination
Pag nagtanggal ng iodine, dapat yung nasa ____ ang tatanggalin
outer ring
Pag yung nasa ___ ang natanggal, the T4 will become ___ or ____ which is ____
inner ring;
rT3;
reverse T3;
biologically inactive
The REGULATION OF THYROID GLAND follows the ___
hypothalamic-pituitary-thyroidal axis
hypothalamic-pituitary-thyroidal axis:
- The hypothalamus secretes the ____
thyrotropin releasing hormone (TRH)
hypothalamic-pituitary-thyroidal axis:
- TRH stimulates the___ to secrete ____
pituitary gland;
thyroid-stimulating hormones (TSH)
hypothalamic-pituitary-thyroidal axis:
- TSH stimulates the ___ to produce ____ (___ , ____)
thyroid gland;
thyroid hormones;
T3, T4
hypothalamic-pituitary-thyroidal axis:
- TSH stimulates the ___ to produce ____ (___ , ____)
thyroid gland;
thyroid hormones;
T3, T4
hypothalamic-pituitary-thyroidal axis:
- ___ and ___ will then act on its ____ which contain the ____ specific to them
T3 ;
T4 ;
peripheral tissues;
receptors
hypothalamic-pituitary-thyroidal axis:
- If enough ___ and ____ are produced, the ____ will send signals to the ____ to stop production of ____, hence, the ____ will no longer produce ____, hence, no hormone will stimulate the____ to secrete ___ and ___
T3;
T4 ;
thyroid gland;
hypothalamus ;
TRH;
pituitary gland;
TSH;
thyroid gland;
T3;
T4
hypothalamic-pituitary-thyroidal axis:
- On the other hand, when T3 and T4 levels are ___, the thyroid gland will send signals to the ___ to secrete ___
low;
hypothalamus;
TRH
3 classifications of thyroid hormone disorders
Primary ;
Secondary;
Tertiary
the affected gland is the thyroid gland
Primary
Primary Hypothyroidism
↓ T3, T4
Primary Hyperthyroidism
↑ T3, T4
the problem is the pituitary gland
Secondary
Secondary Hypothyroidism
↓ TSH, T3, T4
Secondary Hyperthyroidism
↑ TSH, T3, T4
the problem is the hypothalamus
Tertiary
Tertiary Hypothyroidism
↓ TRH, TSH, T3, T4
Tertiary Hyperthyroidism
↑ TRH, TSH, T3, T4
What are the 2 Major Thyroid Hormones
Triiodothyronine (T3)
Tetraiodothyronine (T4)
Triiodothyronine (T3) is Chemically known as ___
3, 5, 3’-triiodothyronine
With Most active hormonal activity
Triiodothyronine (T3)
More biologically active than T4
Triiodothyronine (T3)
Metabolic rate of every cell of the body
Triiodothyronine (T3)
Encourages cellular differentiation
Triiodothyronine (T3)
Tissue growth and development
Triiodothyronine (T3)
Triiodothyronine (T3) ____ oxygen consumption
Increased
Increased oxygen consumption
Triiodothyronine (T3)
Calorie and Vitamin/Mineral metabolism
Triiodothyronine (T3)
Triiodothyronine (T3) is an indicator of ___
hyperthyroidism recovery
Involved in brain maturation
Triiodothyronine (T3)
It can cause increase in heat production
Triiodothyronine (T3)
Accounts for 20% of the total thyroid hormone synthesized
Triiodothyronine (T3)
Triiodothyronine (T3) Accounts for ____ of the ____ synthesized
20%;
total thyroid hormone
Triiodothyronine (T3)
Reference Ranges:
ADULT: ___
60 – 160 μg/dL
Triiodothyronine (T3)
Reference Ranges:
Children (1-14 y.o): ___
105 – 245 ng/dL
Mas mataas ang reference range ng T3 sa mga bata kasi involved sila sa ____ and ___
tissue growth and development
Tetraiodothyronine (T4) is Chemically known as ___
3, 5, 3’, 5’-tetraiodothyronine
Also known as thyroxine
Tetraiodothyronine (T4)
Tetraiodothyronine (T4) is AKA
thyroxine
Pre-hormone for T3
Tetraiodothyronine (T4)
_____ level of Tetraiodothyronine (T4)
will inhibit ____, ___ level will stimulate ____
Increased ; TSH production
decreased ; TSH production
Tetraiodothyronine (T4)
Accounts for ____ of the ____ synthesized
80% ;
total thyroid hormone
Accounts for 80% of the total thyroid hormone synthesized
Tetraiodothyronine (T4)
Tetraiodothyronine (T4)
Reference Ranges:
Adult:_____
5.5 – 12.5 μg/dL
Tetraiodothyronine (T4)
Reference Ranges:
Neonates:_____
11.8 – 22.6 ng/dL
T/F: Thyroid hormones may be bound or free
T
Thyroid hormones may be ____ or ____
bound ;
free
How many % of thyroid hormones are protein bound
99.9%
How many % of T4 is unbound/free (FT4)
0.04%
How many % of T3 is unbound/free (FT3)
0.4%
WHAT ARE THE 3 THYROID BINDING PROTEINS
Thyroxine Binding Globulin (TBG)
Thyroxine Binding Prealbumin
Albumin
Major transporter for T3
Thyroxine Binding Globulin
Also binds 70% to 75% of T4
Thyroxine Binding Globulin
Thyroxine Binding Globulin Also binds ___ to ____ of ____
70%
75%
T4
Binds 15% to 20% of T4
Thyroxine Binding Prealbumin
Thyroxine Binding Prealbumin
Binds ___ to ____ of ____
15%
20%
T4
Transport protein for T3
Albumin
Binds 10% of T4
Albumin
Albumin Binds ___ of ____
10%
T4
T/F: Only free thyroid hormones are biologically active
T
Only ___ thyroid hormones are biologically active
free
Binding of thyroid hormones to binding proteins is affected by _____
Example: ____ estrogen = ____ thyroid-binding proteins = ____concentration of bound thyroid hormones
several factors;
↑ estrogen = ↑ thyroid-binding proteins = ↑ concentration of bound thyroid hormones
Kapag ang pinapatest ng patient is T3 and T4, it refers to the ____ of T3 and T4
total population
T/F: There is a separate test for FT3 and FT4 which measures free T3 and T4
T
There is a separate test for FT3 and FT4 which measures _____
free T3 and T4
What are the 11 Laboratory Analysis in Thyroid Gland
- Thyroid Stimulating Hormone (TSH)
- Serum T3 And T4
- Thyrotropin-Releasing Hormone (TRH)
- Thyroglobulin
- T3 Resin Uptake
- Free Thyroxine Index (FT4I)
- Thyroid Antibody Screen
- TRH Stimulation Test
- Radioactive Iodine Uptake (RAIU)
- Thyroid Ultrasound
- Thyroid Needle Biopsy
Also known as thyrotropin
Thyroid Stimulating Hormone (TSH)
Thyroid Stimulating Hormone (TSH) is AKA
thyrotropin
Most useful test for assessing thyroid function
Thyroid Stimulating Hormone (TSH)
Used to differentiate primary hypothyroidism from secondary hypothyroidism
Thyroid Stimulating Hormone (TSH)
Thyroid Stimulating Hormone (TSH) is used to differentiate ____ from ____
primary hypothyroidism
secondary hypothyroidism
Primary hypothyroidism
TSH LEVEL ___
N – ↑
Primary hypothyroidism
T3 and T4 LEVEL ___
↓
Secondary hypothyroidism
TSH LEVEL ___
↓
Secondary hypothyroidism
T3 and T4 LEVELS ___
↓
Used to monitor and adjust thyroid hormone replacement therapy
Thyroid Stimulating Hormone (TSH)
3 Generation Test in Thyroid Stimulating Hormone (TSH)
Second Generation
Third Generation
Fourth generation
0.1 mU/L detection limit
Second Generation
Second Generation: ____
0.1 mU/L detection limit
0.01 mU/L detection limit
Third Generation:
Third Generation: _____
0.01 mU/L detection limit
More sensitive generation test
Third Generation:
Generation test that Monitor and adjust thyroid hormone therapy
Third Generation
for research purposes only, not used for diagnosis
Fourth generation
Serum T3 And T4 measures:
________
_________
Total T3 and T4
Free T3 and T4 (FT3, FT4)
Serum T3 And T4 methods: (3)
Radioimmunoassay
Chemiluminometric assay
Immunometric technique
Measures relationship between TSH and TRH secretions
Thyrotropin-Releasing Hormone (TRH)
Thyrotropin-Releasing Hormone (TRH) Measures relationship between ____ and ____ secretions
TSH
TRH
Used to confirm euthyroid Grave’s disease
Thyrotropin-Releasing Hormone (TRH)
Thyrotropin-Releasing Hormone (TRH) is used t o confirm ____
euthyroid Grave’s disease
euthyroid Grave’s disease is a type of __ (hypothyroidism/hyperthyroidism)
hyperthyroidism
Thyrotropin-Releasing Hormone (TRH) is INCREASED in ___
primary hypothyroidism
Thyrotropin-Releasing Hormone (TRH) is DECREASED in ___
hyperthyroidism
Glycoprotein synthesized and secreted only by the thyroid follicular cells
Thyroglobulin
Proof of presence of thyroid tissues
Thyroglobulin
Ideal tumor marker for thyroid cancer patients
Thyroglobulin
Post-operative marker of thyroid cancer
Thyroglobulin
Thyroglobulin Method: ____
Immunoassays
Analyzes the capacity of TBG to bind thyroid hormones
T3 Resin Uptake
Indirect measurement of the number of free binding sites on the TBG molecules
T3 Resin Uptake
Measures the remaining binding sites
T3 Resin Uptake
T3 Resin Uptake:
↑ thyroid-binding sites = ____ thyroid hormones
↓
T3 Resin Uptake:
↓ thyroid-binding sites = ____ thyroid hormones
↑
Indirectly assesses the concentration of circulating FT4
Free Thyroxine Index (FT4I)
FT4I = ____ x ___
total T4;
T3 resin uptake
Thyroid Antibody Screen
T/F: There are thyroid disorders that are autoimmune
T
Thyroid Antibody Screen
There are thyroid disorders that are _____
autoimmune
the immune system attacks the body because of the presence of autoantibodies
Autoimmune
Thyroid Antibody Screen:
Naturally or physiologically, antibodies must only attack ____, _____ should not be attacked
foreign substances;
self-antigens
antibodies directed against self-antigens are produced
Autoimmunity
- TSH receptor antibody
- Antithyroglobulin
- Thyroid peroxidase antibody
are all under what lab analysis?
THYROID ANTIBODY SCREEN
TSH receptor antibody OR __
anti-TSH receptor
TSH receptor antibody is Associated with ____
Grave’s disease
Associated with Grave’s disease
TSH receptor antibody
Associated with some, if not all, autoimmune hypothyroidism
Antithyroglobulin
Antithyroglobulin is Associated with some, if not all, ____
autoimmune hypothyroidism
Thyroid peroxidase antibody OR __
anti-TPO
Associated with Hashimoto’s thyroiditis
Thyroid peroxidase antibody
Thyroid peroxidase antibody is associated with ___
Hashimoto’s thyroiditis
Measures pituitary TSH stores
TRH Stimulation Test
Considered conclusive for hyperthyroidism
TRH Stimulation Test
TRH Stimulation Test Considered conclusive for hyperthyroidism
where:
Inject ____ TRH ____
After administration, ____ is collected (___is measured)
500 μg ; intravenously
blood sample ; TSH
TRH Stimulation Test:
NORMAL: ___
↑ TSH
In TRH Stimulation Test, ↑ TSH is ___
NORMAL
TRH Stimulation Test:
no rise in TSH before and after administration of TRH indicates ___
Hyperthyroidism
Measures the ability of thyroid gland to trap iodine
Radioactive Iodine Uptake (RAIU)
RAIU
Radioactive Iodine Uptake
Radioactive Iodine Uptake (RAIU):
High uptake: _____
metabolically active gland
↑ RAIU + undetectable TSH =________
autonomous thyroid gland activity
Radioactive Iodine Uptake (RAIU):
Low uptake: _____
metabolically inactive gland
Radioactive Iodine Uptake (RAIU):
Hot nodules: _____
high RAIU;
Radioactive Iodine Uptake (RAIU):
Cold/Indeterminate: _____
low to no RAIU
Less likely to be cancerous nodules
Hot nodules:
Tends to be cancerous nodules
Cold/Indeterminate:
Assessment of thyroid anatomy
Thyroid Ultrasound
Characterization of palpable abnormalities
Thyroid Ultrasound
Normally, a healthy individual may have a thyroid nodule as small as ____
<1 cm
Through fine needle aspiration biopsy (FNAB)
Thyroid Needle Biopsy
Most accurate tool in thyroid nodule evaluation
Thyroid Needle Biopsy
Identification and treatment of thyroid malignancy
Thyroid Needle Biopsy
1st test to be performed for evaluating thyroid abnormalities
Thyroid Needle Biopsy
Pwedeng through palpation of nodule or assisted by ultrasound
Thyroid Needle Biopsy
What are the two types of thyroid disorders
Hypothyroidism
Hyperthyroidism
Thyroid hormone deficiency
HYPOTHYROIDISM
Hypothyroidism is categorized as ____
Categorized as primary, secondary or tertiary
HYPOTHYROIDISM
Usually referring to __
primary hypothyroidism
Inability to provide thyroid hormones for the metabolic needs of the cells
HYPOTHYROIDISM
HYPOTHYROIDISM
Inability to provide ______ for the metabolic needs of the cells
thyroid hormones
HYPOTHYROIDISM
Symptoms
o Thyroid gland enlargement
o Fatigue
o Impairment of mental process
o Loss of appetite
o Myxedema
o Cold intolerance
o Weight gain
HYPOTHYROIDISM (SYMPTOMS)
Thyroid gland enlargement is a.k.a
goiter
HYPOTHYROIDISM (SYMPTOMS)
TSH stimulates cell growth
Thyroid gland enlargement (goiter)
HYPOTHYROIDISM (SYMPTOMS)
Thyroid gland enlargement (goiter) example
primary hypothyroidism
HYPOTHYROIDISM (SYMPTOMS)
Thyroid gland enlargement (goiter)
When __ and __ levels are (high/low), the thyroid gland will send signals to the _______ to produce ____ which will stimulate the _______ to produce TSH
T3 and T4
low
hypothalamus
TRH
pituitary gland
HYPOTHYROIDISM (SYMPTOMS)
Low cardiac output
Myxedema
HYPOTHYROIDISM
Inadequate secretion of thyroid hormones by thyroid gland
Primary Hypothyroidism
Primary Hypothyroidism
Causes
Lack of dietary iodine
Thyroid tissue destruction
Autoantibodies
Primary Hypothyroidism (Laboratory Results)
Decreased:
T3, T4, FT3, FT4, FT4I, T3 uptake
Primary Hypothyroidism (Laboratory Results)
Increased:
TSH, TRH
Diseases associated with Primary Hypothyroidism
Hashimoto’s Thyroiditis
Congenital Hypothyroidism
Myxedema
Also known as chronic lymphocytic thyroiditis
Hashimoto’s Thyroiditis
Hashimoto’s Thyroiditis a.k.a
Chronic lymphocytic thyroiditis
Involves massive infiltration of thyroid gland by lymphocytes
Chronic lymphocytic thyroiditis
Chronic lymphocytic thyroiditis
Involves massive infiltration of thyroid gland by ______
lymphocytes
Most common form of primary hypothyroidism
Hashimoto’s Thyroiditis
Autoantibodies bind to cell membrane causing cell lysis and inflammatory reactions
Hashimoto’s Thyroiditis
Hashimoto’s Thyroiditis
Autoantibodies bind to ____ causing _____ and ________
cell membrane
cell lysis
inflammatory reactions
Goiter
Hashimoto’s Thyroiditis
Hashimoto’s Thyroiditis (Laboratory Results)
Decreased
T3, T4, FT3, FT4, FT4I, T3 uptake
Hashimoto’s Thyroiditis (Laboratory Results)
Increased
TSH, TRH
Hashimoto’s Thyroiditis (Laboratory Results)
______ positive
Anti-TPO
Also known as cretinism
Congenital Hypothyroidism
a.k.a cretinism
Congenital Hypothyroidism
Defect in the development or function of the gland
Congenital Hypothyroidism
Occurs at birth
Congenital Hypothyroidism
If left untreated within 3 months, there will be irreversible neurologic and mental deficiency
Congenital Hypothyroidism
Congenital Hypothyroidism
If left untreated within ____, there will be irreversible ________ and _______ deficiency
3 months
Neurologic
Mental
Involved in the newborn screening in the US
Congenital Hypothyroidism
Congenital Hypothyroidism
Symptoms
Retarded physical and mental development
One of the features of patients with cretinism is ___
dwarfism
Congenital Hypothyroidism (Laboratory Results)
Decreased
T3, T4
Congenital Hypothyroidism (Laboratory Results)
increased
TSH
Peculiar non pitting swelling of the skin
Myxedema
severe form of Hypothyroidism
Myxedema coma
Myxedema
Clinical features
Puffy face
Weight gain
Slow speech
Eyebrows thinned
Dry and yellow skin
Anemia
involves decrease in production of TSH leading to low serum levels of thyroid hormones
Secondary Hypothyroidism
Secondary Hypothyroidism
involves decrease in production of ___ leading to low serum levels of ____
TSH
thyroid hormones
Secondary Hypothyroidism (Laboratory Results)
Decreased
T3, T4, FT3, FT4, FT4I, T3 uptake, TSH
Secondary Hypothyroidism (Laboratory Results)
Increased
TRH
Lack of TRH production caused by hypothalamic failure
Tertiary Hypothyroidism
Tertiary Hypothyroidism
Lack of TRH production caused by _____ failure
hypothalamic
Tertiary Hypothyroidism (Laboratory Results)
Decreased
ALL (T3, T4, FT3, FT4, FT4I, T3 uptake, TSH, TRH
)
Patients are asymptomatic
Subclinical Hypothyroidism
Subclinical Hypothyroidism
Normal
FT3, FT4
Subclinical Hypothyroidism
Slightly increased
TSH
Also known as thyrotoxicosis
HYPERTHYROIDISM
HYPERTHYROIDISM
a.k.a
thyrotoxicosis
T/F: Increase in thyroid hormone is not toxic to all cells
F; TOXIC to all cells
Caused by excessive thyroid hormone in the circulation
HYPERTHYROIDISM
Causes the cells to be overactive
HYPERTHYROIDISM
HYPERTHYROIDISM
Causes the cells to be ___
overactive
HYPERTHYROIDISM
Symptoms
o Weight loss
o Loss of muscle mass
o Hyperactivity yet quick fatigability
o Insomnia
o Increased sweating
o Nervousness
o Palpitations
o Goiter
o Exophthalmia
HYPERTHYROIDISM (Symptoms)
Due to increased O2 demand
Hyperactivity yet quick fatigability
HYPERTHYROIDISM (Symptoms)
Due ↑ body temperature
Increased sweating
HYPERTHYROIDISM (Symptoms)
Due ↑ cardiac output
Palpitations
HYPERTHYROIDISM (Symptoms)
Due to ↑ in thyroid hormones
Goiter
HYPERTHYROIDISM (Symptoms)
Bulging of the eyes
Exophthalmia
a condition wherein patients have very high thyroid hormone levels which could lead to stroke due to increased CNS output, body temperature, and cardiac output
Thyroid storm
Thyroid storm
a condition wherein patients have very (high/low) thyroid hormone levels which could lead to ____ due to increased ______, _____, and _____
high
stroke
CNS output
body temperature
cardiac output
Group of syndromes caused by high levels of free thyroid hormones in the circulation
Thyrotoxicosis
Thyrotoxicosis
Group of syndromes caused by high levels of (bound/free) thyroid hormones in the circulation
free
T3 Thyrotoxicosis a.k.a
Plummer’s disease
T3 Thyrotoxicosis
FT3:
FT4:
TSH:
FT3: ↑
FT4: N
TSH: ↓
T4 Thyrotoxicosis
FT3:
FT4:
TSH:
FT3: N to low
FT4: ↑
TSH: ↓
Diseases associated with Hyperthyroidism
Grave’s Disease
Reidel’s Thyroiditis
Subclinical Hyperthyroidism
De Quervain Thyroiditis
Grave’s dx
Clinical features
Exophthalmos
Pretibial myxedema
Grave’s dx (Laboratory Results)
Increased
T3, T4, FT4I, T3 uptake
Grave’s dx (Laboratory Results)
Normal or Decreased
TSH
Grave’s dx (Laboratory Results)
_______ positive
Anti-TSH receptor
HYPERTHYROIDISM
Autoimmune disorder
Grave’s Disease
Grave’s Disease
Occurs ____ more in women than in men
5% – 6%
Thyroid turns into woody or stony-hard mass
Reidel’s Thyroiditis
Reidel’s Thyroiditis
Thyroid turns into ___ or ___ mass
woody
stony-hard
Calcification of the thyroid gland
Reidel’s Thyroiditis
HYPERTHYROIDISM
No clinical symptoms
Subclinical Hyperthyroidism
Subclinical Hyperthyroidism (Laboratory Results)
Normal
FT3, FT4
Subclinical Hyperthyroidism (Laboratory Results)
Decreased
TSH
De Quervain Thyroiditis
a.k.a
Subacute granulomatous thyroiditis
Subacute nonsuppurative thyroiditis
Painful inflammation of the thyroid gland associated with Increased ESR and Thyroglobulin
De Quervain Thyroiditis
De Quervain Thyroiditis
Painful inflammation of the thyroid gland associated with Increased ___ and _____
ESR
Thyroglobulin
De Quervain Thyroiditis
____ negative
Anti-TPO
Produced by the parafollicular C cells
CALCITONIN
CALCITONIN
Produced by the _______
parafollicular C cells
Participated in calcium homeostasis by responding to hypercalcemia
CALCITONIN
CALCITONIN
Participated in _______ by responding to _______
calcium homeostasis
hypercalcemia
Hypocalcemic agent:
CALCITONIN
Calcitonin is a hypocalcemic agent because:
it stimulates _______ of Calcium
renal excretion
Calcitonin is a hypocalcemic agent because:
Depresses release of Calcium from the bone (________)
bone resorption
Calcitonin is a hypocalcemic agent because:
Inhibits bone-dissolving activity of ______
osteoclasts
Osteoclasts are ______
bone macrophage
Calcitonin is a hypocalcemic agent because:
Indirectly regulates _______ by stimulating ________
phosphorus
renal reabsorption
The renal reabsorption of phosphorus leads to (inc/dec) in phosphorus
↑ phosphorous
CALCITONIN (Laboratory Analyses)
Methods
Serum Calcitonin
Pentagastrin Stimulation Test
CALCITONIN (Laboratory Analyses)
Marker for medullary thyroid carcinoma (MTC)
Serum Calcitonin
CALCITONIN (Laboratory Analyses)
Serum Calcitonin is a marker for ________
medullary thyroid carcinoma (MTC)
CALCITONIN (Laboratory Analyses)
Measured before and 6 months after thyroid surgery
Serum Calcitonin
CALCITONIN (Laboratory Analyses)
Serum Calcitonin is measure before and ______ after thyroid surgery
6 months
CALCITONIN (Laboratory Analyses)
Used for the diagnosis of medullary thyroid carcinoma
Pentagastrin Stimulation Test
CALCITONIN (Laboratory Analyses)
Pentagastrin Stimulation Test is used fore the diagnosis of ______
medullary thyroid carcinoma (MTC)
Located bilaterally in the posterior side of the thyroid gland
PARATHYROID GLAND
PARATHYROID GLAND
Located ____ in the _____ side of the thyroid gland
bilaterally
posterior
PARATHYROID GLAND
Most individuals have ___ parathyroid glands
4
PARATHYROID GLAND
Most individuals have 4 parathyroid glands, some may only have ___, some have ___
2
8
Because of its location, it is the smallest endocrine gland
PARATHYROID GLAND
What is the only hormone Parathyroid gland secrete?
Parathyroid hormone (PTH)
Regulates Blood Calcium
PARATHYROID HORMONE
PARATHYROID HORMONE
Regulates ___
Blood Calcium
Involved in the metabolism of both calcium and phosphorus by the kidney and bone
PARATHYROID HORMONE
PARATHYROID HORMONE
Involved in the metabolism of both ___ and ____ by the kidney and bone
calcium
phosphorus
PARATHYROID HORMONE
Involved in the metabolism of both calcium and phosphorus by the ___ and ____
kidney
bone
Stimulates conversion of Vitamin D to activated Vitamin D3
PARATHYROID HORMONE
PARATHYROID HORMONE
Stimulates conversion of ____to _____
Vitamin D
activated Vitamin D3
PARATHYROID HORMONE
Increases bone resorption of calcium into plasma by stimulating osteoclast
In bone
PARATHYROID HORMONE (In Bone)
Increases ____ of calcium into plasma by stimulating _______
bone resorption
osteoclast
PARATHYROID HORMONE
Increases renal reabsorption of calcium
In the Kidney
Hypercalcemic, hypophosphatemic agent
PARATHYROID HORMONE
Can regulate calcium and phosphorus within the normal range
PARATHYROID HORMONE
____ will be produced kapag may konting change sa _____ and _______ concentrations
PTH
calcium
phosphorus concentrations
PARATHYROID HORMONE
Regulation
free-standing varied input modulation
PARATHYROID HORMONE
T/F: Regulation is influenced by the concentration
T
Laboratory Analyses of PTH
Enumerate
PTH C-Terminal Analysis
PTH N-Terminal Analysis
Laboratory Analyses of PTH
Examines intact PTH molecule
PTH C-Terminal Analysis
PTH C-Terminal Analysis
Examines __________ molecule
intact PTH molecule
Laboratory Analyses of PTH
Specific for detecting hyperparathyroidism
PTH C-Terminal Analysis
PTH C-Terminal Analysis
Specific for detecting ______
hyperparathyroidism
Laboratory Analyses of PTH
Measured both the whole PTH molecule and the amino-terminal fragments in the serum
PTH N-Terminal Analysis
PTH N-Terminal Analysis
Measured both the _____ molecule and the ___________ in the serum
whole PTH
amino-terminal fragments
Inability to maintain Calcium in blood without calcium supplementation
HYPOPARATHYROIDISM
Decreased PTH secretion
HYPOPARATHYROIDISM
Usually, it is due to post-surgical cases
HYPOPARATHYROIDISM
HYPOPARATHYROIDISM
Usually, it is due to _____
post-surgical cases
↑ PTH = ↓ TH = ↓ calcium
HYPOPARATHYROIDISM
HYPOPARATHYROIDISM
↑ PTH = ↓ TH = (inc/dec) calcium
↓ calcium
Feature of HYPOPARATHYROIDISM
Tetany
HYPOPARATHYROIDISM
Tetany signs
Chvostek’s sign
Trousseau’s sign
HYPOPARATHYROIDISM (Tetany signs)
facial cramps/contraction
Chvostek’s sign
HYPOPARATHYROIDISM (Tetany signs)
carpal spasm
Trousseau’s sign
HYPOPARATHYROIDISM
Causes
Accidental injury to the parathyroid gland
Autoimmune parathyroid destruction
3 classifications of HYPOPARATHYROIDISM
- Primary Hypoparathyroidism
- Idiopathic Hypoparathyroidism
- Pseudohypoparathyroidism
HYPOPARATHYROIDISM
Problem with the parathyroid gland
Primary Hypoparathyroidism
HYPOPARATHYROIDISM
↓ PTH
Primary Hypoparathyroidism
Pseudohypoparathyroidism
HYPOPARATHYROIDISM
Unknown cause
Idiopathic Hypoparathyroidism
HYPOPARATHYROIDISM
Unknown cause
Idiopathic Hypoparathyroidism
HYPOPARATHYROIDISM
↓ serum calcium, ↑ phosphorous
Idiopathic Hypoparathyroidism
HYPOPARATHYROIDISM
lack of responsiveness of the parathyroid hormone by the renal system
Pseudohypoparathyroidism
HYPOPARATHYROIDISM
The kidneys do not respond to the parathyroid hormones
Pseudohypoparathyroidism
Classifications of Hyperparathyroidism
- Primary Hyperparathyroidism
- Secondary Hyperparathyroidism
- Tertiary Hyperparathyroidism
HYPERPARATHYROIDISM
Most common cause of hypercalcemia
Primary Hyperparathyroidism
HYPERPARATHYROIDISM
Due to parathyroid adenoma
Primary Hyperparathyroidism
Primary Hyperparathyroidism
Due to ____
parathyroid adenoma
Primary Hyperparathyroidism (Laboratory Results)
Increased
PTH, ionized calcium
HYPERPARATHYROIDISM
Develops in response to hypocalcemia
Secondary Hyperparathyroidism
Secondary Hyperparathyroidism
Causes
Vitamin D deficiency,
Chronic renal failure
Secondary Hyperparathyroidism
Increased
PTH
Secondary Hyperparathyroidism
Decreased
Ionized calcium
HYPERPARATHYROIDISM
Occurs with secondary hyperthyroidism
Tertiary Hyperparathyroidism
Tertiary Hyperparathyroidism
Occurs with ______
secondary hyperthyroidism
HYPERPARATHYROIDISM
Phosphates level are normal to high
Tertiary Hyperparathyroidism
HYPERPARATHYROIDISM
Calcium phosphates precipitate in soft tissues.
Tertiary Hyperparathyroidism
Tertiary Hyperparathyroidism
Calcium phosphates precipitate in ____
soft tissues.
HYPERPARATHYROIDISM
Primary, secondary, and tertiary hyperparathyroidism is accompanied by _______
phosphaturia
presence of phosphates in the urine
Phosphaturia
