Thyroid Gland and Hormones Flashcards
Thyroid Gland is shaped like?
BUTTERFLY
Thyroid gland consists of ____ lobes, namely: ___ and ____ ; Which are connected by narrow band?
2; TRACHEA and LARYNX; ISTHMUS
How many weeks of gestation does thyroid gland begin to produce measurable amounts of hormone?
11
T/F
Does thyroid hormone play an important role?
TRUE
These hormones influence metabolic activity in the body
T3 and T4
T/F
All thyroid hormones DO NOT NEED IODINE to be formed
FALSE; ALL THYROID HORMONES ARE FORMED BY THE PRESENCE OF IODINE
Steps in regulation of Thyroid Gland
- Iodide
- Thyroid (oxidized)
- combined with Tyrosine
- Forms MIT and DIT
- coupled with T3 and T4
These are precursors or pro-hormones for the production of hormones.
MIT and DIT
Fundamental structural unit of the thyroid
gland
FOLLICLES
Follicles appear as ____; They are also shaped as _____; They rest in the _____ and rich in _____
tiny buds/ sacs; RING; basement membrane; GLYCOPROTEIN
The apex of the follicular cells has
MICROVILLI
2 Types of cells:
- Follicular cells
- Parafollicular cells
Type of cell that secretes T3 and T4 hormones
Follicular cells
T/F
Follicular cells produce some ACTIVE rT3 and rT4
FALSE; INACTIVE rT3 and rT4
Follicular cells have precursors namely?
MIT and DIT
Parafollicular cells is also known as
C cells
Type of cell that produces calcitonin
Parafollicular cells/ C cells
Physiologic Effects of Thyroid Hormones (6)
- Growth maturation and Sexual development
- Heat Production and Energy expenditure
- Influence carbohydrate, protein, and lipid metabolism
- Increase oxygen consumption.
- Increase heart rate.
- Increase blood volume.
This acts as preformed matrix containing tyrosyl groups.
THYROGLOBULIN
Thyroglobulin is stored in ____
It weighs about ____
follicular colloid of thyroid gland; 15-25 g
Steps in stimulating Thyroid hormone
- Hypothalamus
- secretes TRH
- stimulate anterior Pituitary
- secretes TSH
- stimulate Thyroid hormone
T/F
Is there a Positive feedback on hypothalamus and pituitary gland
FALSE; NEGATIVE FEEDBACK
It is the GRADUAL or SLOW decreasing release of hormones; narrow or maintain limits
NEGATIVE FEEDBACK
Percentage of T4 and T3 that is thyroid origin
100% T4 and 20% T3
Where is the 20% of T3 originates?
Enzymatically non-thyroidal tissues
What is Monodeionization?
T4 becoming T3
Classifications of Thyroid Glands
- Hyperthyroidism
- Hypothyroidism
- Euthyroidism
Hyperthyroidism is the ____ of thyroid hormones
EXCESS/ INCREASED
2 types of Hyperthyroidism
- Primary
- Secondary
Primary Hyperthyroidism PROFILE and gland that is abnormal
Increased T3, T4 and Decreased TSH; THYROID
Secondary Hyperthyroidism PROFILE and gland that is abnormal
Increased TSH, Pre-T4; PITUITARY
It is due to pituitary destruction of pituitary adenoma
Secondary Hyperthyroidism
Hyperthyroidism is caused by: (7)
- Graves’ disease – antibody present against TSH (antibody attacks TSH)
- Toxic adenoma – exposure to agents causing abnormalities.
- Toxic multinodular adenoma
- Exogenous iodine and Iodine-containing drugs.
- Ectopic thyroid tissue pituitary tumor
- TSH secreting pituitary tumor
- Thyroid cancer
Symptoms of Hyperthyroidism (6)
- Heat intolerance
- Tachycardia
- Weight loss
- Weakness
- Emotional inability
- Tremor
Conditions of Hyperthyroidism
- Thyrotoxicosis
- Thyroid Storm
A condition that is applied to a GROUP OF SYNDROMES caused by HIGH LEVELS OF FREE THYROID HORMONES in the circulation
THYROTOXICOSIS
Thyrotoxicosis PROFILE and is also known as:
TSH is low; FT₄ is normal but increased FT₃; Plummer’s disease
A condition that is rare and is destructive or severe when ignored
THYROID STORM
Hypothyroidism is the ____ of thyroid hormones
DECREASED
Hypothyroidism is treated with
thyroid hormone replacement therapy or levothyroxine
Hypothyroidism is caused by: (7) PAPACAR
- Pituitary/ hypothalamus
- Atrophic hypothyroidism
- Post-surgery
- Autoimmune hypothyroidism/ Hashimoto’s
- Congenital hypothyroidism
- Anti-thyroid drug therapy
- Radioactive therapy
3 types of Hypothyroidism
- Primary
- Secondary
- Tertiary
Primary Hypothyroidism PROFILE and gland that is abnormal
decreased T3 and T4; Increased TSH; THYROID
Primary Hypothyroidism is caused by
destruction or ablation of thyroid gland
Other causes of Primary Hypothyroidism
Surgical removal of the gland
Radiation exposure
Drugs like LITHIUM
Secondary Hypothyroidism PROFILE and gland that is abnormal
decreased T3, T4, TSH; PITUITARY
Tertiary Hypothyroidism PROFILE and gland that is abnormal
decreased T3, T4, TSH and TRH; HYPOTHALAMUS
Due to hypothalamic disease
Tertiary Hypothyroidism
Euthyroidism is a problem in ____ which makes it ____
rT3; INCREASED
Euthyroidism is caused by: (3)
- Presence of goiter
- Thyroid adenoma
- Thyroid carcinoma
Major component of thyroid hormone
IODINE
Major source of IODINE
DIET
Additional source of IODINE
DEIONIZATION
Conversion of thyroid hormones:
LIVER, KIDNEYS; T4 – T3
Hormones which THYROID DO NOT ENTER CELLS and is Biologically inert
Protein bound thyroid hormones
T/F
Protein-bound thyroid hormones acts as RESERVOIR for circulating thyroid hormones
TRUE
Hormones that are a Physiologically active form of thyroid hormones and it readily enter cells; exert biological effects
Free thyroid hormones
REGULATES production and secretion of thyroid hormone
Hypothalamic-Pituitary-Thyroid axis or HPTA
MAIN THYROID HORMONE released from thyroid gland.
THYROXINE or Total T4
Reference range for THYROXINE or Total T4 is
5-12.5 ug/dL (adults)
Distribution of THYROXINE or Total T4
- 70% of T4: bound to thyroid binding globulin (TBG)
- 20% of T4: bound to Transthyretin/Prealbumin.
- 10% of T4: bound to albumin
Thyroid disorders and their relation to Total T4
- Primary hypothyroidism
- Hyperthyroidism
- T4 thyrotoxicosis
- Low T3 and low T4 syndrome
Primary hypothyroidism PROFILE in Total T4
decreased T4; increased TSH
Hyperthyroidism PROFILE in Total T4
increased T3 and T4; decreased TSH
T4 thyrotoxicosis PROFILE in Total T4
increased T4; normal serum T3
Low T3 and low T4 syndrome PROFILE in Total T4
decreased T3 and T4
Analytical method for THYROXINE or Total T4
IMMUNOASSAY (Ab reagent)
Reference Interval of Thyroxine/ Total T4
5-12.5 ug/dL (71-161 mmol/L)
A CLASSICAL METHOD of adjusting a total T4 measurement for ALTERATIONS in binding protein
T3 uptake test
Biologically active fraction of T4 in circulating blood
FREE THYROXINE/ Free T4
Thyroid disorders and their relation to FT4
- Hyperthyroidism: increased or high FT4
- Hypothyroidism: decreased or low FT4
Reference method of measurement for Free thyroxine/ Free T4 is
Equilibrium dialysis
Other methods of measurement for Free thyroxine/ Free T4
- ULTRAFILTRATION
- SYMMETRICAL dialysis
- MASS SPECTROMETRY
- IMMUNOASSAYS
- FT4 INDEX
A free T4 method that uses PRESSURE to push the plasma sample through a dialysis membrane
ULTRAFILTRATION
A free T4 method that plasma is DIALYZED against itself, using a radioactive tracer added on one side to measure the rate of diffusion of FT4 which is proportional to its concentration.
SYMMETRICAL dialysis
A free T4 method that simultaneously measures FT4 and FT3.
MASS SPECTROMETRY
A free T4 method that is from total T4 and unbound T4 sites serum proteins
FT4 INDEX
MAJOR THYROID HORMONES
- T3
- rT3
- T4
Also known as: 3,5,3’ triiodothyronine
T3 or TRIIODOTHYRONINE
Most active thyroid hormone
T3 or TRIIODOTHYRONINE
T/F
T3 or triiodothyronine is MORE tightly bound to serum proteins than T4
FALSE; LESS
Greater proportion of T3 exists in 3 forms namely:
- Free form
- Diffusible state
- Protein-bound
Production of T3 or TRIIODOTHYRONINE
80% – produced outside the thyroid (tissue) through the deionization process.
20% - formed within thyroid gland
The principal application of T3 or TRIIODOTHYRONINE
Diagnosis of T3 thyrotoxicosis
T/F
FT4 is better indicator of recovery from
hyperthyroidism
FALSE; T3 or TRIIODOTHYRONINE
T/F
T3 or TRIIODOTHYRONINE can be used for Reoccurrence of thyroidism
TRUE
T/F
FT4 is helpful in confirming diagnosis of
hyperthyroidism
FALSE; T3 or TRIIODOTHYRONINE
An increase in the plasma level is the first abnormality seen in cases of
HYPERTHYROIDISM
Thyroid disorders and their relation to T3
- T3 thyrotoxicosis
- Hyperthyroidism
- Hypothyroidism
Analytical Method for T3 or TRIIODOTHYRONINE
IMMUNOASSAYS
Reference Values for T3 or TRIIODOTHYRONINE
- 80-200 ng/dL or 1.2 – 3.1 nmol/L (adult)
- 105 – 245 ng/dL or 1.8 – 3.8 nmol/L (children 1-14 yrs old)
- 60-160 ng/dL or 0.92-2.46 nmol/L (neonates)
It is the MAJOR METABOLITE of THYRONINE and produced by deiodination of T4
rT3 or REVERSE TRIIODOTHYRONINE
It is the removal of 1 Iodine from the inner ring of T4 and the end-product of FT4 metabolism
rT3 or REVERSE TRIIODOTHYRONINE
T/F
rT4 is used to assess borderline or conflicting laboratory results of thyroid hormones
FALSE; rT3 or REVERSE TRIIODOTHYRONINE
T/F
rT3 identifies patients with Euthyroid sick syndrome (increased rT3)
TRUE
T/F
rT3 is used to represent the product of T4 metabolism
TRUE
Also known as 3,5,3’5’ tetraiodothyronine
T4 or TETRAIODOTHYRONINE
Principal secretory product of thyroid
T4 or TETRAIODOTHYRONINE
T/F
Does T4 level represents the organic iodine level present in circulation
TRUE
The amount of ____ is a good indicator of the thyroid secretory production rate
serum T4
Elevated thyroxine causes inhibition of _____ and vice versa.
BH secretion
Reference values for T4 or TETRAIODOTHYRONINE
- 5.5 -12.5 ug/dL or 71-161 nmol/L (adult)
- 11.8 – 22.6 ug/dL or 152-292 nmol/L (newborn/ neonate)
Other Hormones in Thyroid Gland
- Thyrotropin – releasing hormone (TRH)
- Thyroid – stimulating hormone (TSH)
- Thyroglobulin
Regulate their own production by feedback inhibition to synthesis of TRH and TSH in the hypothalamus and pituitary
TRH or Thyrotropin – releasing Hormone
TRH is a _____ derived from a large prepro-TRH molecule.
Modified tripeptide
TRH acts also on the production of other pituitary hormones, especially _____
PROLACTIN
This plays a significant role in the regulation of the TRH gene
LEPTIN
Synthesized in the anterior pituitary gland that controls the biosynthesis and release of thyroid hormones from thyroglobulin
TSH or Thyroid – stimulating hormone
Less bound to serum protein compared to T4
TSH
TSH is a ____ with ____ and ___ subunits
GLYCOPROTEIN; A and B
Subunit that has the same amino acid sequences as LH, FSH and hCG
A subunit
Subunit that carries the specific information to the binding receptors for expression of hormonal activities.
B subunit
It is regulated by the hypothalamus through TRH as well as negative feedback from the thyroid hormones
TSH
Most important test in determining thyroid dysfunction
TSH
Measured commonly by 3RD GENERATION ASSAY that can measure down to 0.005 mU/L
TSH
Thyroid Disorders and their relation to TSH
- Hypothyroidism
- Nonthyroidal Illness
- Subclinical hyperthyroidism
Hypothyroidism disorder in TSH has 3 types:
- Primary hypothyroidism
- Secondary hypothyroidism
- Subclinical hypothyroidism
Primary hypothyroidism PROFILE in TSH
TSH levels are markedly elevated
Secondary hypothyroidism PROFILE in TSH
TSH secretion is decreased
Subclinical hypothyroidism PROFILE in TSH
elevated TSH levels but with T4 and FT4 levels are within the reference interval/ normal
Nonthyroidal Illness PROFILE in TSH
TSH levels may be increased or decreased
Subclinical hyperthyroidism PROFILE in TSH
TSH levels are decreased with T4 and T3 levels within reference interval
Reference Interval for TSH
0.5-5 uIU/mL
TSH and free T3 for hyperthyroidism classes
- T3 Thyrotoxicosis
- T4 Thyrotoxicosis
Overproduction of T3 with normal to low-normal T4
T3 Thyrotoxicosis
Overproduction of T4 with normal to low-normal T3
T4 Thyrotoxicosis
Synthesized and secreted by the follicles.
THYROGLOBULIN
It reflects thyroid mass, thyroid injury, and TSH receptor stimulation.
THYROGLOBULIN
T/F
Is THYROGLOBULIN useful in monitoring the course of thyroid disease or response to treatment
TRUE
T/F
Is THYROGLOBULIN recommended in pre-operative identification of thyroid malignancy?
FALSE; NOT RECOMMENDED
Conditions of THYROGLOBULIN (3)
- Grave’s disease
- Thyroiditis
- Nodular goiter
THYROID HORMONE BINDING PROTEINS
- Thyroxine – binding globulin (TBG)
- Thyroxine – binding prealbumin (Transthyretin)
- Thyroxine – binding albumin (TBA)
Main serum carrier for T3 and T4
Thyroxine – binding globulin (TBG)
This thyroid hormone binding protein’s measurement is helpful if serum T3 and T4 levels do not agree with other laboratory parameters of thyroid function or not compatible with clinical findings
Thyroxine – binding globulin (TBG)
Thyroxine – binding globulin (TBG) transports:
T4:
T3:
70-75%
80%
Thyroxine – binding prealbumin (Transthyretin) transports:
T4:
T3:
15-20%; NONE
Thyroxine – binding albumin (TBA) transports:
T4:
T3:
10%; 20%
An autoimmune thyroid disease causes cellular damage and alters thyroid gland function
THYROID AUTOANTIBODIES
3 thyroid autoantigens
- TPO (thyroperoxidase)
- Tg (thyroglobulin)
- TSH receptor (TR)
A thyroid autoantigen that antibodies responsible in hypothyroidism in Hashimoto’s and atrophic thyroiditis
TPO (thyroperoxidase)
Also known as TRAbs or thyroid stimulating Ig or long-acting thyroid stimulators (LATS)
TSH receptor (TR)
TSH receptor (TR) in Grave’s Disease
Ig induced goiter and hyperthyroidism
Drugs that INCREASE in Thyroid Autoantibodies (COH-5)
Clofibrate estrogens
Oral contraceptives
Heroin Methadone
5-fluororacil
Drugs that DECREASE in Thyroid Autoantibodies
Androgens
Glucocorticoids
Genetic condition that INCREASE in Thyroid Autoantibodies
Acute or Chronic active hepatitis
Pregnancy
Idiopathic
Genetic condition that DECREASE in Thyroid Autoantibodies
Complete deficiency partial liver failure
Malnutrition
Nephrotic syndrome
Screening for thyroid disorders is recommended when a person reaches _____ and ____
35 YEARS OLD and every 5 YEARS thereafter
The MOST COMMON CAUSE of Thyrotoxicosis which is an autoimmune disease.
Graves’ Disease (Diffuse Toxic Goiter)
Graves’ Disease (Diffuse Toxic Goiter) occurs 6x more commonly in ____
WOMEN
Caused by CIRCULATING ANTIBODIES to the TSH receptor – STIMULATING and BLOCKING antibodies
Graves’ Disease (Diffuse Toxic Goiter)
Distinct features of Graves’ Disease
Exophthalmia (bulging eyes)
Pretibial myxedema
Diagnostic test for Grave’s Disease
TSH receptor antibody test or TR antibody test
The thyroid turns into a woody or stony-hard mass.
Riedel ‘s Thyroiditis
It shows no clinical symptoms but TSH levels are low, and FT₃ and FT₄ normal.
Subclinical Hyperthyroidism
Associated with neck pain, low-grade fever, and swings in thyroid function tests
Subacute Granulomatous/Sub acute Non-supprative Thyroiditis/De Quervain’s Thyroiditis (Painful Thyroiditis)
In Subacute Granulomatous/Sub acute Non-supprative Thyroiditis/De Quervain’s Thyroiditis (Painful Thyroiditis) when Thyroidal Peroxidase (TPO) antibodies are absent:
ESR and thyroglobulin levels are elevated.
The most common cause of primary hypothyroidism
Hashimoto’s Disease (Chronic Auto-Immune Thyroiditis)
Methods for testing Hashimoto’s Disease (Chronic Auto-Immune Thyroiditis) and its result
TPO antibody = (+) result
TSH = increased
Describes the peculiar nonpitting swelling of the skin
Myxedema
In Myxedema the skin becomes infiltrated by
mucopolysaccharides
Myxedema that is a severe form of primary hyperthyroidism
Myxedema coma
Clinical features of Myxedema (WESDAP)
- “Puffy Face”
- Weight gain
- Slow speech
- Eyebrows thinned
- Dry and yellow skin
- Anemia
Defects in the development or function of the gland.
Congenital Hypothyroidism/Cretinism
Congenital Hypothyroidism/Cretinism screening test and result
T₄ (decreased)
Congenital Hypothyroidism/Cretinism confirmatory test and result
TSH (decreased)
The most SPECIFIC and SENSITIVE TEST for diagnosing thyroid disease
TRH Stimulation Test (Thyrotropin Releasing Hormone)
TRH Stimulation Test (Thyrotropin Releasing Hormone) measures relationship between ____ and ____ secretions
TRH and TSH secretions
TRH Stimulation Test is used to differentiate ___ and ____ patients who both had undetectable TSH levels.
euthyroid and hyperthyroid
TRH Stimulation Test may also be helpful in the detection of _____
thyroid hormone resistance syndromes
Dose needed in TRH Stimulation Test
500 µg TRH by IV
TRH Stimulation Test is INCREASED in ____ and DECREASED in ____
Primary hyperthyroidism; Hyperthyroidism
The MOST IMPORTANT thyroid function test; BEST screening test
TSH Test
The MOST CLINICALLY SENSITIVE ASSAY for the detection of primary thyroid disorders
TSH Test
TSH Test helps in early detection of
hypothyroidism
TSH Test differentiate _____ from _____
primary hypothyroidism; secondary hypothyroidism
TSH Test is used to MONITOR and ADJUST ____
thyroid hormone replacement therapy
It is used to measure the ability of the thyroid gland to trap iodine
Radioactive Iodine Uptake (RAIU)
It is helpful in establishing the CAUSE of hyperthyroidism
Radioactive Iodine Uptake (RAIU)
- It is normally used as a POSTOPERATIVE MARKER of thyroid cancer.
- It is used in MONITORING the course of METASTATIC or RECURRENCE of thyroid cancer.
Thyroglobulin (Tg) Assay
Thyroglobulin (Tg) Assay INCREASES levels in
- Untreated and metastatic differentiated thyroid cancer
- Hyperthyroidism
Thyroglobulin (Tg) Assay DECREASES levels in
- Infants with goitorous hypothyroidism
- Thyrotoxicosis factitia
Thyroglobulin (Tg) Assay reference values
- 3-42 ng/mL or µg/mL (Adult)
- 38-48 ng/mL or µg/mL (Infant)
Thyroglobulin (Tg) Assay methods for testing
- double-antibody RIA,
- ELISA,
- IRMA
- Immunochemiluminescent assay (ICMA)
- It is used to assess BORDERLINE or CONFLICTING laboratory results.
- It identifies patients with EUTHYROID sick syndrome
Reverse T₃ (rT₃)
Reverse T₃ (rT₃) reference Value
38-44 ng/dL
It indirectly assesses the level of free T₄ in blood
Free Thyroxine Index (FT₄1 or T₇)
Free Thyroxine Index (FT₄1 or T₇) is based on the ____ of bound T₄ and FT₄.
equilibrium relationship
It is IMPORTANT in CORRECTING Euthyroid individuals
Free Thyroxine Index (FT₄1 or T₇)
Free Thyroxine Index (FT₄1 or T₇) is elevated and decreased in
hyperthyroidism; hypothyroidism
Reference method of Free Thyroxine Index (FT₄1 or T₇)
Equilibrium dialysis
Free Thyroxine Index (FT₄1 or T₇) reference value
4-12 %
Test used to DIFFERENTIATE drug-induced TSH elevation and hypothyroidism
FT4
The value of ___ is in confirming hyperthyroidism.
TT₃ or FT₃
Measures the NUMBER of AVAILABLE binding sites of the thyroxine-binding proteins, most notably TBG
T₃ Uptake Test
T/F
T₃ uptake Test does measure the level of thyroid hormones in serum
FALSE; DOEST NOT
In T₃ uptake Test, ____ increases TBG while ___ depresses TBG
Estrogen; Androgen
T₃ Uptake Test INCREASED levels in (HEC)
- Hyperthyroidism
- Euthyroid patients
- Chronic liver disease
T₃ Uptake Test DECREASED levels in (4)
- Hypothyroidism
- Oral contraceptives
- Pregnancy
- Acute hepatitis
T₃ Uptake Test reference value
25-35%
It is used to CONFIRM RESULTS of FT₃ or FT₄ or abnormalities in the relationship of the total thyroxine
Thyroxine Binding Globulin Test (TBG)
It is useful to distinguish between hyperthyroidism causing thyroxine levels and euthyrodism with increased binding by TBG and increased thyroxine
Thyroxine Binding Globulin Test (TBG)
___ and __ are dependent on the amount of TBG
Total serum T₃ and T₄
Thyroxine Binding Globulin Test (TBG) INCREASED levels in (3)
- Hypothyroidism
- Pregnancy
- Estrogen
Thyroxine Binding Globulin Test (TBG) DECREASED levels in (2)
- Anabolic steroids
- Nephrosis
MOST ACCURATE TOOL in the evaluation of thyroid nodules
Fine-Needle Aspiration
Used to test patients with thyroid cancers for the PRESENCE of RESIDUAL or RECURRENT disease
Recombinant Human TSH
Method and Test in Recombinant Human TSH
- Tanned Erythrocyte Hemagglutination Method
- Serum Calcitonin Test
Recombinant Human TSH that is method for antithyroglobulin antibodies
Tanned Erythrocyte Hemagglutination Method
Recombinant Human TSH that is test for tumor marker for DETECTING RESIDUAL THYROID METASTATIC in medullary thyroid carcinoma (MTC)
Serum Calcitonin Test
Most common cause of hypothyroidism
Atrophic hypothyroidism
Decreased size or shrinkage of hypothalamus
Atrophic hypothyroidism