THYROID FUNCTION
By Parameswaran
TESTS
Roll no: 51
THYROID
HORMONES
THYROID
HORMONES
• rT3 serves as a regulatory mechanism (competes with T3 at
receptor) to modulate thyroid hormone activity, particularly during
periods of stress, illness, or metabolic changes.
• In such states, the body may increase the conversion of T₄ to rT3,
thereby reducing the availability of active T₃ to tissues, which helps
to conserve energy and adapt to the altered physiological conditions.
• This adaptive response is part of what is known as nonthyroidal
illness syndrome (NTIS) or euthyroid sick syndrome, where
patients exhibit abnormal thyroid function tests—such as low T₃ and
elevated rT3 levels—without having intrinsic thyroid disease
THYROID
HORMONES
THYROID FUNCTION
TESTS
Thyroid function tests assess the levels of
thyroid hormones and related substances in the
blood, providing insights into thyroid gland
activity.
THYROID FUNCTION
Thyroid Stimulating Hormone (TSH):
• Produced by theTESTS
pituitary gland, TSH
stimulates the thyroid to produce T₄ and T₃.
• An elevated TSH level typically indicates
primary hypothyroidism, while a low or
undetectable TSH suggests
hyperthyroidism.
Free Thyroxine (Free T₄):
• The unbound form of thyroxine, free T₄ is
the active hormone that regulates
metabolism.
• Low levels of free T₄ are associated with
THYROID FUNCTION
Free Triiodothyronine (Free T₃):
produced from T₄.
TESTS
• Free T₃ is the active form of triiodothyronine,
• Elevated levels can be seen in
hyperthyroidism, particularly in conditions
like toxic multinodular goiter.
Total T₄ and Total T₃:
• These tests measure both bound and
unbound thyroid hormones.
• They can be influenced by changes in
protein levels, such as during pregnancy or
with oral contraceptive use, which may
THYROID FUNCTION
TESTS
Thyroid Antibodies:
• Tests for antibodies like anti-thyroid
peroxidase (anti-TPO) and anti-thyroglobulin
can help diagnose autoimmune thyroid
diseases, such as Hashimoto's thyroiditis or
Graves' disease.
THYROID FUNCTION
TESTS
HYPERTHYROIDISM
THYROTOXICO
Thyrotoxicosis refers to a state of excessive thyroid
hormone in the body,SISregardless of the source.
This condition can result from:
• Hyperthyroidism (excessive thyroid hormone
production by the thyroid gland),
• Thyroid hormone release from damaged thyroid
tissue (e.g., thyroiditis),
• Exogenous sources (e.g., ingestion of thyroid
hormone).
HYPERTHYROI
DISM
In contrast, hyperthyroidism specifically denotes
excessive thyroid hormone production by the thyroid
gland itself.
Thus, while all hyperthyroidism cases are a form
of thyrotoxicosis, not all thyrotoxicosis cases
are due to hyperthyroidism.
PRIMARY
HYPERTHYROI
DISM
GRAVES
DISEASE
EPIDEMIOLOGY
• Graves’ disease accounts for 60–80% of
thyrotoxicosis
• The prevalence varies among populations,
reflecting genetic factors and iodine intake (high
iodine intake is associated with an increased
prevalence of Graves’ disease)
• Graves’ disease occurs in up to 2% of women but
is one-tenth as frequent in men.
GRAVES
PATHOGENESIS DISEASE
• Combination of environmental and genetic
factors, including polymorphisms in HLA-
DR3,HLA-B8, the immunoregulatory genes CTLA-
4, CD25, PTPN22, FCRL3, and CD226, as well as
the gene encoding the thyroid-stimulating
hormone (TSH) receptor (TSH-R), contributes to
Graves’ disease
• Stress is an important environmental factor,
presumably operating through neuroendocrine
effects on the immune system.
GRAVES
PATHOGENESIS
DISEASE
• The hyperthyroidism of Graves’ disease is caused by
thyroid stimulating immunoglobulins (TSIs) that are
synthesized by lymphocytes in the thyroid gland as
well as in bone marrow and lymph nodes.
• In Graves’ disease, the thyroid is usually diffusely
enlarged to two to three times its normal size.
The consistency is firm, but not nodular.
• Graves’ disease is associated with specific eye signs
that comprise Graves’ ophthalmopathy or Thyroid
Associated Opthalmopathy
GRAVES
DISEASE
TOXIC
• A solitary, autonomously functioning
ADENOMA
thyroid nodule is referred to as toxic
• Also referred to as Hyperfunctioning
adenoma.
Solitary Nodule
• Most patients with solitary hyperfunctioning
nodules have acquired somatic, activating
mutations in the TSH-R
• These mutations, located primarily in the
receptor transmembrane domain,
induce constitutive receptor coupling to
GSα, increasing cAMP levels and leading to
TOXIC
MULTINODULAR
• Toxic MultiNodular Goiter (TMNG) is a
GOITRE
condition characterized by an enlarged
thyroid gland containing multiple nodules
that autonomously produce thyroid
• Patients,
hormones, leading
often to hyperthyroidism
elderly, may present with
symptoms such as atrial fibrillation,
palpitations, tachycardia, nervousness,
tremor, or weight loss.
• Thyroid function tests typically show low
TSH levels, with T₄ possibly normal or
minimally increased, and T₃ often elevated
SECONDARY
HYPERTHYROI
DISM
TSH SECRETING
PITUITARY
• TSH-secreting pituitary adenoma is a rare
cause ofADENOMA
secondary hyperthyroidism,
resulting from an anterior pituitary tumor
that autonomously secretes thyroid-
• stimulating hormone (TSH).
This condition leads to elevated levels of
TSH and thyroid hormones (T3 and T4),
despite the negative feedback mechanism
that typically suppresses TSH secretion
when thyroid hormone levels are high
CLINICAL FEATURES
• Hyperthyroid Symptoms: Patients may
present with typical signs of
hyperthyroidism, such as weight loss,
palpitations, heat intolerance, and tremors.
• Goiter: Enlargement of the thyroid gland
may occur due to continuous TSH
stimulation.
• Pituitary Mass Effects: If the adenoma is
large, it may cause headaches, visual
disturbances, or other neurological
symptoms due to compression of adjacent
EVALUATION OF
THYROTOXICOSIS
TREATMENT
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