PBL 6 - Hypothyroidism Flashcards
Name the two hormones secreted by the cuboidal cells of the thyroid gland
follicles. No abbreviations
1) Triiodothyronine (T3)
2) Thyroxine (T4)
Name two consequences of hyperthyroidism on glucose metabolism.
Hyperthyroidism leads to Insulin resistance [1], mainly associated with increased
hepatic gluconeogenesis [1
Explain why the thyroid gland is enlarged in Hashimoto thyroiditis and why TSH
is elevated
Thyroid enlargement is induced by an inflammatory infiltrate of immunocytes that
replace the parenchyma and subsequent fibrosis [1]
Thyroid hormones have a negative feedback action on secretion of TSH by the
anterior pituitary Low plasma levels of T3 / T4 remove this ‘brake’ on TSH
production/release, resulting in high plasma levels of the hormone
What do coeliac disease and Hashimoto disease have in common?
They are both autoimmune disease [1].
Both involve CD4 T cells and B cells, producing auto-immune antibodies targeting
epithelial cells to undergo apoptosis/necrosis [1
) What treatment was Maria given and explain why it was probable the dose
would need adjusting. [
Hormone replacement therapy with thyroxine (tetraiodothyronine, T4), for life [1].
Normally patients started on low dose which is gradually increased [1], the aim
being to reverse S & S of hypothyroidism without causing predictable adverse
effects, especially cardiac [
What is TPO (thyroid peroxidase)
enzyme that oxidises iodide on tyrosine of thyroglobulin –> T3/T4 synthesis.
How are T3 and T4 stimulated
Hypothalamus secretes thyrotropin-releasing hormone –> AP secretes TSH –> Thyroid secreates triiodothyronine + thyroxine
= Negative feedback - too much T3 and T4 –> TRH inhibited
Effects of thyroid hormone
Increase BMR
Enhance fatty acid oxidation and mobilation
Thermogenesis
Insulin effects
How do thyroid hormones enhance FA oxidation and mobilisation
= Increases no LDL receptors
= Breaks down cholesterol
= Increases lipolysis –> removing triglycerides from chylomicrons and VLDL + depositing fat in tissue
How does thyroid hormone affect glucose metabolism
1) Synergistic with insulin - increases uptake of glucose via GLUT4 upregulation in muscles
2) Opposes insulin in the liver- gluconeogenesis/glycogenolysis in liver
How does TH increase thermogenesis
Increases uncoupling by increasing capacity to do more oxidative phosphorylation by increasing the no of mitochondria
TH effects on cardiac myocytes
Increase contractility by increasing no of beta adrenergic receptors
Symptoms of hypothyroidism
Skin, CV, GI, Nerves, renal, endocrine
= Myxoedema, brittle nails, hair falls out, wounds heal slowly
= reduced cutaneous circulation, sensitivity to cold, sinus bradyacrdia,LDL cholesterol up
= Reduced appetite, weight gain, constipation
= Hyponatraemia
= Decreased GLUT 4 stimulation, reduced libido
What is cretinism
Congenital hypothyroidism
What is hashimotos syndrome
Autoimmune disease where the thyroid gland is gradually destroyed