Thyroid Physiology Flashcards
what does the thryoid gland secrete
thyroxine -T4
tri-iodothyroxine -T3
calcitonin
what do the parathryoid glands secrete
parathyroid hormone
what is the isthmus of the thyroid
connects the two lobes across the trachea
where is the thyroid gland
between the 5th cervical and 1st thoracic vertebrae / 2-4th tracheal rings
how big and heavy is the normal thyroid gland
12-15mm
25-30 grams
is there always an isthmus
no- can just be 2 separate lobes
what can cause the thyroid to change in size without being pathological
increases in size during pregnancy/ menstruation
what innervates the thyroid gland
autonomic nerve supply- parasympathetic from vagus nerves
sympathetic fibres of superior, middle and inferior ganglia of the sympathic trunk
what is the blood supply to the thyroid (+ veins)
superior and inferior thyroid arteries (branch of external carotid) +/- thyroidea ima
3 pairs of veins- superior/ middle thyroid vein (goes into internal jugular)
inferior thyroid vein (goes into brachiocephalic veins)
what supports the thryoid gland
ligaments and strap muscles
posteromedial aspect of the gland is attached by the posterior suspensory ligament (berry ligament)
what is the relevance of the anatomy of the thyroid gland for any surgical proceudres
Isthmus encountered during routine tracheostomy (needs retracted)
Recurrent Laryngeal Nerve/ vascularity - surgery
what happens if the recurrent laryngeal nerve is bruised
causes temporary hoareness of voice
what are the componnents of the thryoid gland
follicle, follicular cells, colloid, parafollicular cells
what is a colloid thryoglobulin
tyrosine containing thyroglobulin filled spheres enclosed by follicular cells
what do parafollicular cells do
secrete calcitonin
what is the function of thyroid follicles
store the thyroid hormones produced by the follicular cells
why does it take 2-3 weeks to notice that a hormone has stopped being produced
as hormones stored in follicles and slowly released into blood stream
what mineral is need to make thyroid hormones
iodine
how is iodine taken into follicular cells
from blood stream via iodine transporters
what does iodine get trapped in to make thryoid hormones
pinocytes
what does iodine form when in follicular cells
attaches to tyrosine residues on thyroglobulin to form MIT (monoiodotyrosine unit) and DIT (di-iodotyrosine unit)
how do MIT and DIT form thyroid hormones
MIT and DIT couple to make triiodothyronine= T£
DIT and DIT couple to make thryoxine= T4
what drugs can stop the formation of thyroid hormones from iodine and how
what are they used to treat
carbimazole and propylthioracil
stops iodine binding to tyrosine residues on thryoglobulin
used to treat hyperthyroidism
what makes up the majority of thyroid hormones secreted
T4 thyroxine (90%) (T3 10%)
which thyroid hormone is more potent
T3 is 4x more potent than T4
what makes T4 more potent
is converted to T3 by any cell (take off the iodine)
what is the major biologically active thyroid hormone
T3- triiodothyronine
what causes the release of thyroid hormones
thyroid stimulating hormone (from pituitary gland)
how do T3 and T4 travel in the blood
are hyrdophobic/ lipophobic so bind to plasma proteins
what plasma proteins do T3 and T4 bind to
70% thyroxine binding globulin (TBG)
20% thryoxine binding prealbumin (TBPA)
5% albumin
what receptors do T3 and T4 work on
nuclear receptors
wha is the biologically active form of thyroid of thryoid hormone- bound or unbound to plasma proteins
why
unbound
as only the free hormone is available to the tissues
why is T3 the more active thyroid hormone
as is bound 10-20 times less by TBG and not significantly by the others so has a more rapid onset and offset of actions
metabolic state correlates more closely with the free than the total concentration in the plasma
what is the role of the bound plasma
acts a buffer to maintain free hormone concentration
what can increase total T4 but not free T4 by increasing TBG
pregnancy, newborn state, contraceptive pill/ other sources of oestrogen
hepatitis A and chronic active hepatitis, billiary cirrhosis
what can decrease total T4 but not free T4 by decreasing TBG
androgens
larges doses of glucocortcoids, cushings syndrome, active acromegaly
severe systemic illness, chronic liver disease, nephrotic syndrome
what are the effects of thyroxine
affects every tissue moist, sweaty skin increased HR, palpitations anxiety loose stools lessens/ loss of periods loss of muscle mass as you burn up stores
what do thryoid hormones do to the basal metabolic rate?
how?
increase it
increase:
- number and size of mitochondria
- oxygen use an rate of ATP hydrolysis
- synthesis of respiratory chain enzymes
how do thyroid hormones affect thermogenesis
increase it
how do thyroid hormones affect carbohydrate metabolism
increase blood glucose- stimulate glyconeogenesis and gluconeogenesis
increase insulin dependent glucose uptake to cells
how do thyroid hormones affect lipid metabolism
mobilise fats from adipose tissue
increase fatty acid oxidation in tissues
how do thyroid hormones affect protein metabolism
protein synthesis
how do thyroid hormones affect growth
growth hormone releasing hormone (GHRH) production and secretion requires thyroid hormones
glucocorticoid-insulin GHRH release also dependent on thyroid hormones
GH/ somatomedins require presence of thyroid hormone for activity
how do thyroid hormones influence development of foetal and neonatal brain
myelinogenesis and axonal growth require thyroid hormones
what are the effects of hypothyroidism on the CNS activity
slow intellectual functions
what are the effects of hyperthryoidism on the CNS activity
nervousness, hyperkinesis and emotional lability (quick changes in mood)
what is the permissive sympathetic action of thyroid hormones
thyroid hormones increase responsiveness to adrenaline and sympathetic NS neurotransmitter, noradrenaline- increases number of receptors
cardiovascular responsiveness also increased due to this effect - increased force of rate of contraction of the heart
what drug is used to treat symptoms of the permissive sympathomimetic action of thyroid hormones in hyperthyriodism
beta blockers (propanalol)
what stimulates the release of TSH
thyrotrophin releasing hormone from the hypothalamus
what releases TSH
anterior pituitary
what is the negative feedback loop of the thyroid hormone regulation
T3 and T4 exert negative feedback control of release of TRH and TSH
what effect does temperature have on thyroid hormone regulation
in babies and young children cold temperatures stimulate TRH release (stimulates TSH release- T3 and T4 release from thyroid)
what effect does stress have on thyroid hormone regulation
inhibits TRH and TSH release
what is the ‘rhythm’ of thyroid hormone release
circadian rhythm- highest late at night, lowest in the am
what are de-iodinase enzymes
3 enzymes (type 1,2,3), important in the activation (t4 - t3) and deactivation (t3- t4, t3- t2, t4-rt3) of thyroid hormone
add or remove iodine atom in the outer ring
where is de-iodinase type 1 found
in the liver and kidney (acts a reserve enzyme)
where is de-iodinase type2 found
heart, skeletal muscle, CNS, fat, thyroid and pituitary
where is de-iodinase type 3 found
fetal tissue and placenta and brain (except pituitary)
what is the most active de-iodinase ezyme
type 2
what can hypothyroidism be associated with
primary gland failure can be associated with enlarged thyroid gland (goitre)
secondary to TRH or TSH (no goitre)
lack of iodine in diet (goitre)
what are the symptoms of hypothyroidism
reduced BMR slow pulse rate fatigue lethargy slow response times mental sluggishness cold intolerance put on weight easily
what is myxoedema
sign of hypothyroidism in adults - puffy face, hands and feet
what is cretinism
sign of hypothyroidism in babies- dwarfism and limited mental function due to deficiency of thyroid hormones present at birth
what is the most common cause of hypothyroidism
autoimmune disease- destroys cells of the thyroid
what is graves disease
hyperthyroidism
what is hyperthyroidism associated with
autoimmune disease- thyroid stimulating immunoglobulin (acts like TSH but unchecked T3 and T4)
exophthalmos- bulging eyes due to water retaining carbohydrate build up behind eyes
goitres
what are the symptoms of hyperthyroidism
increases BMR very fast pulse rate increased nervousness and excessively emotional insomnia sweating and heat intolerance lose weight easily
does thyroxine affect affect cardiac muscle
yes- can affect every tissue in the body
can thyroxine cause infertility
yes can cause loss of periods
heat intolerance is in hyper/hypo thyroidism
hyperthyroidism
cold intolerance is in hyper/hypo thyroidism
hypothyroidism