Thyroid Hormone Synthesis and Function Quiz

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary role of the sodium-iodide symporter (NIS) in thyroid follicular cells?

  • To synthesize thyroid hormones from iodide
  • To transport iodide from the colloid into the bloodstream
  • To stimulate the production of hydrogen peroxide
  • To actively transport iodide from the bloodstream against its gradient (correct)

Which substance inhibits iodide uptake in the thyroid gland?

  • Hydrogen peroxide (H2O2)
  • Sodium-iodide symporter
  • Thyroid peroxidase
  • Perchlorate ion (ClO4-) (correct)

What is the product of the iodination process involving thyroglobulin?

  • Thyroid-stimulating hormone (TSH)
  • Monoiodinated and diiodinated tyrosines (correct)
  • Iodide
  • Triiodothyronine (T3)

Which enzyme is primarily responsible for the conversion of iodide to iodine during thyroid hormone synthesis?

<p>Thyroid peroxidase (TPO) (A)</p> Signup and view all the answers

Pendred syndrome is associated with which of the following?

<p>Congenital hypothyroidism due to failure of iodide transport (B)</p> Signup and view all the answers

What percentage of circulating T4 is found in a protein-free form?

<p>0.04% (B)</p> Signup and view all the answers

Which binding protein has the highest affinity for thyroid hormones?

<p>Thyroxine binding globulin (TBG) (C)</p> Signup and view all the answers

What is the approximate concentration of T4 in plasma?

<p>100 nmol/L (A)</p> Signup and view all the answers

Compared to T4, how much more biologically active is T3?

<p>2 to 10 times more (A)</p> Signup and view all the answers

Which of the following statements about the half-life of thyroid hormones is correct?

<p>rT3 has a half-life of 5 hours (A)</p> Signup and view all the answers

What is the structural unit of the thyroid gland?

<p>Thyroid follicle (A)</p> Signup and view all the answers

Which cells in the thyroid gland are responsible for producing calcitonin?

<p>C-Cells (C)</p> Signup and view all the answers

What artery is NOT involved in the arterial supply of the thyroid gland?

<p>Brachiocephalic artery (C)</p> Signup and view all the answers

What is the role of capillaries associated with the thyroid follicle?

<p>Transport of nutrients and hormones (A)</p> Signup and view all the answers

From which structure does the thyroid gland originate during embryonic development?

<p>Thyroglossal duct (B)</p> Signup and view all the answers

Which nerve, when damaged, may lead to vocal cord paralysis?

<p>Recurrent laryngeal nerve (D)</p> Signup and view all the answers

What anatomical feature connects the two lobes of the thyroid gland?

<p>Isthmus (B)</p> Signup and view all the answers

At what point in gestation does the thyroid gland begin to develop?

<p>Third week (A)</p> Signup and view all the answers

Which of the following roles is NOT associated with thyroid hormones?

<p>Increasing synthesis of red blood cells (A)</p> Signup and view all the answers

What is the recommended daily intake of iodine for lactating women?

<p>290 mcg (D)</p> Signup and view all the answers

Which micronutrient is essential for thyroid hormone synthesis?

<p>Iodine (B)</p> Signup and view all the answers

What condition can arise due to severe iodine deficiency during pregnancy?

<p>Cretinism (C)</p> Signup and view all the answers

What is the primary function of thyroglobulin in thyroid hormone synthesis?

<p>Facilitating the coupling of thyroid hormones (C)</p> Signup and view all the answers

Endemic goiter is often associated with which geographical condition?

<p>Deficient soil iodide (A)</p> Signup and view all the answers

What is the role of Na+-K+ ATPase in relation to thyroid hormones?

<p>Increasing metabolic rate and heat production (C)</p> Signup and view all the answers

Which step in the synthesis of thyroid hormones involves the transformation of iodide?

<p>Iodide trapping (A)</p> Signup and view all the answers

What happens to the thyroglossal duct if it does not atrophy?

<p>It forms a thyroglossal duct cyst. (C)</p> Signup and view all the answers

Which week of gestation marks the final descent of the thyroid gland to its position anterior to the trachea?

<p>By the 8th week (B)</p> Signup and view all the answers

What is the primary function of T3 and T4 thyroid hormones?

<p>They synthesize from iodide and tyrosine residues. (B)</p> Signup and view all the answers

What does the presence of reverse T3 (rT3) indicate?

<p>It is a biologically inactive form of thyroid hormone. (B)</p> Signup and view all the answers

In the case of ectopic thyroid tissue, what typically occurs?

<p>It develops along the path of the thyroglossal duct. (B)</p> Signup and view all the answers

Which of the following is a characteristic presentation of a thyroglossal duct cyst?

<p>50% presenting as midline cystic masses below the level of the hyoid bone. (A)</p> Signup and view all the answers

What is the significance of elevated Thyrotropin (TSH) levels in a patient?

<p>It can suggest hypothyroidism. (D)</p> Signup and view all the answers

What is the expected normal range for total Thyroxine (T4) levels?

<p>5-12 mcg/dl (A)</p> Signup and view all the answers

What is the role of the thyroid hormone in carbohydrate metabolism?

<p>Enhance glycolysis and gluconeogenesis (A)</p> Signup and view all the answers

What effect does thyroid hormone binding have at the cellular level?

<p>Induces transcription through its receptor (A)</p> Signup and view all the answers

Which of the following is NOT an effect of thyroid hormone on fat metabolism?

<p>Decreased mobilization of lipids from adipose tissue (A)</p> Signup and view all the answers

What is the impact of thyroid hormone on cardiovascular function?

<p>Increased heart strength and output (A)</p> Signup and view all the answers

Which process is stimulated by thyroid hormone as part of its metabolic effects?

<p>Increase in oxygen consumption (D)</p> Signup and view all the answers

Which metabolic function is NOT directly stimulated by thyroid hormone?

<p>Increased insulin resistance (A)</p> Signup and view all the answers

What effect does thyroid hormone NOT have on the cardiovascular system?

<p>Decreased heart rate (A)</p> Signup and view all the answers

Which of the following effects is associated with hypothyroidism?

<p>Increased plasma cholesterol (D)</p> Signup and view all the answers

How does thyroid hormone influence metabolic rate?

<p>By increasing basal metabolic rate (BMR) (C)</p> Signup and view all the answers

What mechanism mediates the transcriptional effect of thyroid hormone binding to its receptor?

<p>Addition of a coactivator and release of a co-repressor (B)</p> Signup and view all the answers

What role does increased gluconeogenesis play in the body when present in higher excess?

<p>Stimulates the breakdown of proteins (D)</p> Signup and view all the answers

Which of the following is NOT an effect of growth hormone on development?

<p>Promotes emotional dysregulation (A)</p> Signup and view all the answers

What are essential functions of the respiratory system's increased respiration?

<p>Stimulates learning and memory capacity (A), Increases basal metabolic rate (B)</p> Signup and view all the answers

How does growth hormone impact skeletal muscle contraction?

<p>Increases the speed and amplitude of contraction (D)</p> Signup and view all the answers

Which process is stimulated directly by growth hormone in the body?

<p>Synthesis of structural and enzymatic proteins (C)</p> Signup and view all the answers

Considering the binding affinities, which protein has the lowest affinity for thyroid hormones?

<p>Serum albumin (A)</p> Signup and view all the answers

Which thyroid hormone serves primarily as a prohormone for another hormone?

<p>Thyroxine (T4) (B)</p> Signup and view all the answers

What is the biological activity relationship between T3 and T4?

<p>T3 is significantly more biologically active than T4. (B)</p> Signup and view all the answers

What is the approximate half-life of Triiodothyronine (T3)?

<p>1-3 days (B)</p> Signup and view all the answers

What is the primary consequence of severe iodine deficiency during pregnancy?

<p>Significant cognitive delay and stunted growth (A)</p> Signup and view all the answers

Which characteristic is most associated with endemic goiter in iodine-deficient areas?

<p>Enlargement of the thyroid gland (C)</p> Signup and view all the answers

What percentage of the recommended daily intake of iodine is advised for adults?

<p>150 mcg (C)</p> Signup and view all the answers

Which of the following is a key building block required for the synthesis of thyroid hormones?

<p>Tyrosine (D)</p> Signup and view all the answers

What is the role of thyroglobulin in thyroid hormone synthesis?

<p>To act as a precursor for thyroid hormone production (D)</p> Signup and view all the answers

Which tissue type is least affected by thyroid hormones?

<p>Brain tissue (C)</p> Signup and view all the answers

What is the primary method of preventing iodine deficiency in populations?

<p>Use of iodized table salt (D)</p> Signup and view all the answers

Which of the following is true regarding the basal metabolic rate (BMR) and thyroid hormones?

<p>Thyroid hormones regulate BMR by increasing metabolic activity. (D)</p> Signup and view all the answers

What happens to the thyroglossal duct during normal embryonic development?

<p>It may persist as a remnant. (B)</p> Signup and view all the answers

Which of the following conditions can result from ectopic thyroid tissue?

<p>Thyroid hormone deficiency. (A)</p> Signup and view all the answers

During which week of gestation does the thyroid gland assume its mature shape?

<p>7-8 weeks. (C)</p> Signup and view all the answers

In what context is reverse T3 (rT3) significant?

<p>It is biologically inactive. (B)</p> Signup and view all the answers

What can be a clinical manifestation of a thyroglossal duct cyst?

<p>Cystic masses below the hyoid bone. (A)</p> Signup and view all the answers

What is the primary source of the building blocks for thyroid hormones?

<p>Iodide and tyrosine residues. (A)</p> Signup and view all the answers

Which age group is most likely to present with symptoms of ectopic thyroid tissue?

<p>Newborns. (A)</p> Signup and view all the answers

What is the expected outcome if a patient has a significantly elevated Thyrotropin (TSH) level with low T4?

<p>Hypothyroidism is indicated. (C)</p> Signup and view all the answers

Which change in the TSH level indicates hyperthyroidism?

<p>Decreased TSH level (A)</p> Signup and view all the answers

Which condition is characterized by high levels of both TSH and TRH?

<p>Primary hypothyroidism (D)</p> Signup and view all the answers

What is the normal range for Free Triiodothyronine (FT3) levels?

<p>2.3 - 4.2 pg/mL (A)</p> Signup and view all the answers

In cases of TSH deficiency secondary to hypothyroidism, which of the following hormone levels would be expected?

<p>N or ↓ TSH, ↓ T4, ↓ T3 (D)</p> Signup and view all the answers

Which of the following best describes the normal relationship between TSH and Free Thyroxine (FT4)?

<p>Inverse relationship (C)</p> Signup and view all the answers

What is the role of Thyroid Stimulating Hormone (TSH) in the hypothalamic-pituitary-thyroid axis?

<p>Stimulates T4 and T3 secretion from the thyroid (D)</p> Signup and view all the answers

In the laboratory diagnosis of a patient with suspected thyroid issues, which test is considered the optimal screening test?

<p>TSH assay (C)</p> Signup and view all the answers

Which of the following statements is true regarding the TSH normal range?

<p>Normal range is 0.5-4.5 mU/L (D)</p> Signup and view all the answers

Flashcards

Thyroid Follicle

The basic building block of the thyroid gland, responsible for hormone production.

Follicular Cells

Specialized cells lining the thyroid follicle, responsible for synthesizing and releasing thyroid hormones.

Colloid

The fluid inside the thyroid follicle, containing thyroid hormones in their inactive form.

Capillaries

Tiny blood vessels that supply the thyroid gland with nutrients and oxygen, and transport hormones to other parts of the body.

Signup and view all the flashcards

Sympathetic Innervation

Nerves that regulate hormone production and secretion, responding to stress and other stimuli.

Signup and view all the flashcards

Lymphatics

Structures that drain excess fluid from the thyroid gland.

Signup and view all the flashcards

C-Cells (Parafollicular Cells)

Specialized cells in the thyroid gland that secrete calcitonin, a hormone that regulates calcium levels in the blood.

Signup and view all the flashcards

Thyroid Gland Origin - Embryology

The process of the thyroid gland's development during fetal life.

Signup and view all the flashcards

Thyroglossal Duct Cyst

This is a remnant of the thyroglossal duct which may persist after the duct completely obliterates. This remnant can sometimes form into a cyst.

Signup and view all the flashcards

Thyroglossal Duct Cyst

A cyst formed from the remnants of the thyroglossal duct, usually located in the midline of the neck, just below the hyoid bone.

Signup and view all the flashcards

Ectopic Thyroid Tissue

A condition where thyroid tissue develops in an abnormal location along the path of the thyroglossal duct.

Signup and view all the flashcards

Lingual Thyroid

Thyroid tissue found in the tongue.

Signup and view all the flashcards

T3 (Triiodothyronine)

A thyroid hormone important for regulating metabolism in the body.

Signup and view all the flashcards

T4 (Thyroxine)

A thyroid hormone important for regulating metabolism in the body.

Signup and view all the flashcards

Reverse T3 (rT3)

A form of thyroid hormone that is biologically inactive.

Signup and view all the flashcards

Thyroid Hormone Synthesis

The process of creating thyroid hormone from iodide and tyrosine residues

Signup and view all the flashcards

Thyroid Hormone

A hormone produced by the thyroid gland that is crucial for many bodily functions, including brain development, metabolism, and growth.

Signup and view all the flashcards

How does Thyroid Hormone increase metabolic rate?

Thyroid hormone increases basal metabolic rate and oxygen consumption by stimulating the activity of the Na+-K+ ATPase pump.

Signup and view all the flashcards

Endemic Goiter

A condition where the thyroid gland enlarges (forms a goiter) in response to low iodine levels in the body, leading to inadequate thyroid hormone production.

Signup and view all the flashcards

Cretinism

A severe form of hypothyroidism caused by iodine deficiency during pregnancy and postnatally, characterized by developmental delays, mental retardation, and physical stunting.

Signup and view all the flashcards

Why is iodine important?

Iodine is a crucial micronutrient that plays a key role in the synthesis of thyroid hormone.

Signup and view all the flashcards

What is thyroglobulin?

Thyroglobulin is a large protein produced by the thyroid gland that serves as the foundation for thyroid hormone production.

Signup and view all the flashcards

What is the role of tyrosine in thyroid hormone synthesis?

Tyrosine is an amino acid that is essential for the synthesis of thyroid hormone.

Signup and view all the flashcards

What are the steps in thyroid hormone synthesis?

The process of thyroid hormone synthesis involves multiple steps, including iodine trapping, oxidation, coupling, endocytosis, proteolysis, and transport.

Signup and view all the flashcards

Thyroglobulin

A protein found in the colloid of the thyroid follicle, it is the precursor to thyroid hormones.

Signup and view all the flashcards

Sodium-Iodide Symporter (NIS)

A protein found in the thyroid follicular cell membrane, it actively pumps iodine from the bloodstream into follicular cells using energy from ATP. It transports iodide against its concentration gradient.

Signup and view all the flashcards

Thyroid Peroxidase (TPO)

An enzyme found in the thyroid follicular cell membrane, it converts iodide (I-) to iodine (I2). It also catalyzes the iodination of tyrosine residues on thyroglobulin, the precursor to thyroid hormones.

Signup and view all the flashcards

Organification

The process of incorporating iodine into tyrosine residues on thyroglobulin. This process is catalyzed by thyroid peroxidase (TPO) and leads to the formation of MIT and DIT, the building blocks of thyroid hormones.

Signup and view all the flashcards

Thyroid hormone transport

Thyroid hormones are fat-soluble and require carrier proteins to travel in the bloodstream. These proteins bind to thyroid hormones with varying degrees of strength.

Signup and view all the flashcards

T4 binding proteins

T4 is bound more tightly to all three significant serum binding proteins: thyroxine binding globulin (TBG), thyroxine-binding prealbumin (transthyretin) (TBPA), and serum albumin.

Signup and view all the flashcards

Free thyroid hormones

Only a very small fraction of circulating T4 and T3 are in protein-free form. This free fraction is the biologically active form of the hormone.

Signup and view all the flashcards

T4 as a prohormone

T4 is the main hormone secreted by the thyroid gland. It acts as a precursor for the more potent hormone, T3.

Signup and view all the flashcards

T3: Active thyroid hormone

T3 is the most active form of thyroid hormone in regulating metabolism.

Signup and view all the flashcards

What is the mechanism of action for thyroid hormone (T3)?

Thyroid hormone (T3) binds to the thyroid response element on DNA, triggering a cascade of events leading to gene expression and protein synthesis.

Signup and view all the flashcards

How does thyroid hormone affect carbohydrate metabolism?

Thyroid hormone stimulates carbohydrate metabolism by promoting glucose uptake, enhancing glycolysis and gluconeogenesis, and increasing insulin secretion.

Signup and view all the flashcards

How does thyroid hormone affect fat metabolism?

Thyroid hormone promotes fat metabolism by increasing lipolysis, mobilizing lipids from adipose tissue, and leading to increased β-oxidation. It also decreases plasma cholesterol, phospholipids, and triglycerides.

Signup and view all the flashcards

What are some of the other metabolic effects of thyroid hormone?

Thyroid hormone increases the number of mitochondria, Na+/K+ ATPase activity, oxygen consumption, protein synthesis, and basal metabolic rate. These effects contribute to overall energy expenditure and cellular function.

Signup and view all the flashcards

Thyroid Gland Embryology

The thyroid gland develops in the embryo and descends from the base of the tongue to its final position in the neck, leaving a remnant of the pathway called the thyroglossal duct.

Signup and view all the flashcards

What is Thyroid Hormone?

Thyroid hormone synthesis involves the use of iodide ions and tyrosine residues of thyroglobulin. The thyroid gland produces two primary hormones: T3 (triiodothyronine) and T4 (thyroxine).

Signup and view all the flashcards

T3 and T4: Thyroid Hormones

T3 (triiodothyronine) and T4 (thyroxine) are produced from iodide and tyrosine. T3 is the more active form.

Signup and view all the flashcards

Mechanism of Action for Thyroid Hormone

Thyroid hormone (T3) binds to specific receptors inside the nucleus of cells, leading to alterations in gene expression and protein synthesis. These changes ultimately influence cellular metabolism and various bodily functions.

Signup and view all the flashcards

Metabolic Role of Thyroid Hormone

Thyroid hormone plays a crucial role in regulating metabolism by influencing carbohydrate, fat, and protein metabolism. It increases basal metabolic rate and oxygen consumption.

Signup and view all the flashcards

T4 secretion and plasma levels

The thyroid gland mostly releases T4, with plasma concentrations around 100 nmol/L. Although less potent, it's the major form circulating in the blood.

Signup and view all the flashcards

T3 secretion and plasma levels

T3, though present at a much lower level (around 2 nM), packs a powerful punch, 2-10 times more active than its precursor T4.

Signup and view all the flashcards

What are thyroid hormone's major effects on metabolism?

Thyroid hormone regulates metabolic activity in all tissues except the brain, spleen, and testes. It has a significant impact on the basal metabolic rate, oxygen consumption, and heat production through the stimulation of the Na+-K+ ATPase.

Signup and view all the flashcards

Why is iodine essential for the body?

Iodine is a vital micronutrient for thyroid hormone synthesis, obtained from food sources like seafood, dairy, and iodine-rich soils. The recommended daily intake varies based on age and physiological state.

Signup and view all the flashcards

What is goiter and where is it common?

Goiter is an enlargement of the thyroid gland, commonly found in areas with iodine deficiency. This occurs because the thyroid tries to compensate for insufficient iodine.

Signup and view all the flashcards

What is cretinism and why is it so dangerous?

Cretinism is a severe form of hypothyroidism occurring due to iodine deficiency during pregnancy and early life, resulting in developmental delays, cognitive impairment, and physical stunting.

Signup and view all the flashcards

What role does thyroglobulin play in thyroid hormone synthesis?

Thyroglobulin, a large protein synthesized by the thyroid follicular cells, serves as the foundation for thyroid hormone synthesis. It contains tyrosine residues essential for building these hormones.

Signup and view all the flashcards

What are the key steps in thyroid hormone synthesis?

Thyroid hormone synthesis involves several steps, including iodine trapping, oxidation/organification, coupling, endocytosis, proteolysis, and transport. These steps lead to the formation of T3 and T4.

Signup and view all the flashcards

What is the difference between T3 and T4?

T3 is the active form of thyroid hormone, regulating metabolism and various bodily functions. T4 acts as a precursor to T3, its conversion happening in peripheral tissues.

Signup and view all the flashcards

How does thyroid hormone exert its effects on target cells?

Thyroid hormone receptors are located inside target cells. When activated by T3, they bind to DNA, triggering gene transcription and leading to the production of proteins involved in various metabolic processes.

Signup and view all the flashcards

How does thyroid hormone affect muscle contraction?

Thyroid hormone increases the rate of skeletal muscle contraction.

Signup and view all the flashcards

What are some effects of thyroid hormone on growth and development?

Thyroid hormone promotes the growth and maturation of bone, teeth, skin, hair follicles, and nails.

Signup and view all the flashcards

What is the role of thyroid hormone for brain development?

Thyroid hormone is crucial for normal brain development and function.

Signup and view all the flashcards

What is the impact of thyroid hormone on cognitive function?

Thyroid hormone increases wakefulness, alertness, memory, and learning capacity.

Signup and view all the flashcards

How does thyroid hormone influence growth hormone release?

Thyroid hormone stimulates growth of somatotrophs in the anterior pituitary gland, leading to increased growth hormone release.

Signup and view all the flashcards

What is the first step in thyroid hormone action?

A complex of thyroid hormone (T3) and its receptor binds to a specific DNA segment called the thyroid response element. This binding initiates a cascade of events, including the recruitment of coactivators and the release of corepressors, ultimately leading to the activation of gene transcription.

Signup and view all the flashcards

What is the impact of thyroid hormone on fat metabolism?

Thyroid hormone promotes the breakdown of fat, leading to increased mobilization of lipids from adipose tissue, enhancing β-oxidation, and ultimately reducing fat stores. This also reduces cholesterol levels, phospholipids, and triglycerides.

Signup and view all the flashcards

How does thyroid hormone affect metabolism at the cellular level?

Thyroid hormone increases mitochondria production within cells, enhancing the activity of the Na+/K+ ATPase pump, which drives essential processes like energy production and cell function. It also increases oxygen consumption, protein synthesis, and ultimately the body's basal metabolic rate.

Signup and view all the flashcards

How does thyroid hormone influence cardiovascular function?

Thyroid hormone increases cardiac output and blood flow, likely due to increased oxygen demand. It also increases heart rate through a synergistic effect with catecholamines, and enhances heart strength, especially at slightly elevated levels.

Signup and view all the flashcards

Thyroid Stimulating Hormone (TSH)

A hormone secreted by the pituitary gland that stimulates the thyroid gland to produce and release thyroid hormones (T3 and T4).

Signup and view all the flashcards

TSH-Free T4 Relationship

The relationship between TSH and Free T4 is logarithmic and inverse. When Free T4 is high, TSH is low and vice versa. This is the body's way of maintaining a balance in thyroid hormone levels.

Signup and view all the flashcards

Graves' disease

An autoimmune disease in which the immune system attacks the thyroid gland, causing it to produce excessive amounts of thyroid hormone (hyperthyroidism).

Signup and view all the flashcards

Secondary Hypothyroidism

A form of hypothyroidism where the problem arises in the pituitary gland, leading to insufficient TSH production, resulting in reduced thyroid hormone secretion.

Signup and view all the flashcards

Hypothyroidism

A condition where the thyroid gland is not able to produce enough thyroid hormone, often due to iodine deficiency, autoimmune disease, or other factors.

Signup and view all the flashcards

Study Notes

Thyroid Hormone Synthesis, Transport and Cellular Mechanism

  • Learning Outcomes: Describe the structure and location of the thyroid; Describe the origin of the thyroid gland and its functional relationships; Explain the mechanisms and control of thyroid hormone synthesis; Outline the biochemical and clinical functions of thyroid hormones.

Thyroid Gland: Location and Structure

  • Location: Situated below the thyroid cartilage, behind the strap muscles.
  • Structure: Comprises two lobes joined by an isthmus, located below the cricoid cartilage.
  • Further variation: Pyramidal lobe present in ~50% of adults; non-palpable, enlarges with disease.

Thyroid Gland & Follicles

  • Functional unit: The thyroid follicle (or acinus).
  • Components: Follicular (epithelial) cells and a lumen filled with colloid.
  • Follicular cells: Deliver nutrients and transport hormones; sympathetic nervous system influences hormone synthesis/secretion, and lymphatic system drains excess fluid.
  • Parafollicular cells (C cells): Produce calcitonin.

Thyroid Gland: Blood Supply & Innervation

  • Arterial supply: Superior thyroid artery (from external carotid), inferior thyroid artery (from thyrocervical trunk).
  • Venous drainage: Superior and middle thyroid veins; inferior thyroid vein → brachiocephalic vein.
  • Innervation: Recurrent laryngeal nerve (branch of vagus); damage may cause vocal cord paralysis.
  • Emergency airway: Cricothyrotomy through the cricothyroid membrane.

Thyroid Gland Origin - Embryology

  • Development: The thyroid is the first endocrine gland to develop, on about the 24th day of gestation (3rd week).
  • Origin: Arises from the 1st pharyngeal arch.
  • Early development: Begins as a diverticulum (thyroid diverticulum) in the floor of the pharynx.
  • Descent: Descends in the neck as an initially hollow structure, later solidifying and becoming bilobed, connected by an isthmus.
  • Later development (5 weeks): Initial descent anterior to pharyngeal gut; still connected to the tongue by the thyroglossal duct; eventually bifurcates into two lobes.
  • Further development (7th week): Forms mature shape and location anterior to trachea; thyroglossal duct obliterates by 7-10 weeks, but remnants may persist.
  • Ectopic tissue: Ectopic thyroid tissue can arise along this pathway.

Ectopic Thyroid Gland

  • Lingual Thyroid: A 4-year-old girl may have slowed growth with elevated TSH (55 ulU/ml) and low T4 (3.5 mcg/dL). (Example)

Thyroid Hormone: An Overview

  • Synthesis: Thyroid hormones (T3 and T4) are synthesized from iodide (I) and tyrosine residues of thyroglobulin.
  • Types of thyroid hormones: Tyrosine, Thyroxine (T4), Triiodothyronine (T3) and Reverse T3 (rT3).

What is Thyroid Hormone?

  • Essential functions: Critical for brain development, skeletal function, and growth in infants; Regulates metabolic activity (except brain/spleen/testes); increases basal metabolic rate and oxygen consumption, increasing heat production by stimulating Na+-K+ ATPase; affects virtually all tissues.

Thyroid Hormone Synthesis - Building Blocks

  • Ingredients: Iodine, thyroglobulin, and tyrosine.

Iodine

  • Importance: Essential micronutrient found in seafood, dairy products, and vegetables.
  • Recommended daily intake (IOM): Kids (90-130 mcg); Adults (150 mcg); Pregnant women (220 mcg); Lactating women (290 mcg).

Thyroid Hormone Mechanisms and Control

  • Iodide trapping: Active transport of iodide from bloodstream against gradient, stimulated by TSH, inhibited by perchlorate; Pendrin transports iodide into colloid. (details on specific transporters)
  • Oxidation/Organification: Iodide is converted to iodine (I2), catalyzed by thyroid peroxidase (TPO).
  • Coupling: Formation of T3 and T4 (through coupling of MIT and DIT) (details on specific coupling reactions).
  • Endocytosis: Thyroglobulin containing T3 and T4 is endocytosed into the follicular cell.
  • Proteolysis: Lysosomal proteases digest thyroglobulin, releasing T3 and T4.
  • Transport: T3 and T4 are bound to proteins (TBG, TBPA, albumin) to travel in the bloodstream. (Details of protein binding for T4 and T3).
  • Conversion: T4 is converted into T3 by peripheral tissues (liver and kidney) via deiodinases. (Mechanisms of deiodination).
  • Regulation: TRH from hypothalamus triggers TSH release from the anterior pituitary stimulating thyroid hormone synthesis and release. Negative feedback loop regulates these processes., (exact negative feedback loop).

Thyroid Response to TSH

  • Effects: Increased cAMP, calmodulin, and kinase activity, Increased uptake of colloid, Increased liberation of T3 and T4, Increased production/uptake of thyroglobulin, Increased Iodination of thyroglobulin, Increased size/activity of thyroid cells. (More detail on the specific response pathways)

Inhibitor of Thyroid Hormone Synthesis

  • Important factors: Iodine availability, integrity of thyroid gland/tissue, conversion of T4→T3, and proper regulation (details).
  • Possible Inhibitors: Drugs, goitrogens, and specific examples.

Thyroid Hormone Action

  • Mechanism: T3 binds to the thyroid receptor (TR), forming a complex that binds to thyroid response elements in DNA, affecting gene transcription, including additional details on the role of RXR (retinoid X receptor).
  • Functions: Metabolic effects (carbohydrate and lipid metabolism, temperature), Cardiovascular effects (cardiac output), CNS effects (development), growth effects, and intermediary effects on carbohydrate, lipid, and protein metabolism. (More in-depth description of each function).

Tests of Thyroid Function

  • TSH: Measures pituitary secretion of TSH in response to T4 and T3 feedback.
  • Free T4: Assesses free unbound T4 levels, including specific units (pmol/L).
  • Free T3: Measures free unbound T3 levels.
  • Total T4: Measures bound and free T4.
  • Total T3: Measures bound and free T3.

TSH Inverse Relationship with T4

  • Variation: Wide variation in individual TSH:T4 “setpoints” (and more detail).
  • Usefulness: Specific TSH:T4 setpoint for each individual.

TSH Assay in Healthy Patients

  • Optimality: TSH assay is the optimal screening test for ambulatory healthy patients to evaluate thyroid status (hypothyroid/euthyroid/hyperthyroid), along with specific ranges.

Thyroid Disorders

  • Disorders: Primary hypothyroidism (more details on specific symptoms), Graves' disease (autoimmune mimicking TSH stimulation), TSH deficiency (secondary hypothyroidism), further defining each, including the signs and symptoms.
  • Patterns of TSH, T4, T3, FT4, FT3: Each disorder results in characteristic patterns in the assessed values.

Case Presentations (Examples)

  • Case 1 (Hyperthyroidism): A 46-year-old woman with elevated total T4 (256 nmol/L), free T4 (34.6 pmol/L), and low TSH (<0.01 mU/L) (Examples with specific test results and interpretations).
  • Case 2 (Hypothyroidism): A 72-year-old woman with low free T4 (<5 pmol/L) and elevated TSH (150 mU/L). (Examples with specific test results and interpretations)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

More Like This

Use Quizgecko on...
Browser
Browser