Thyroid Hormones
K.Ramachandran
M.Sc. Medical Biochemistry
SRM Medical college
Anatomy of the Thyroid Gland
Histology of thyroid gland
Thyroid hormones
• Thyroxin (T4, tetraiodothyronine)
• Tri-iodothyronine (T3)
• calcitonin
Structure of thyroid hormones
Biosynthesis of thyroid hormones
The process includes
• active uptake of iodide from the plasma (iodide
pump)
• Oxidation of I- and iodination of thyroglobulin (Tg)
tyrosine residues
• Coupling of iodotyrosine residues (MIT and DIT)
to form T4 and T3
• Proteolysis of Tg with release of T4 and T3 into the
circulation
Synthesis and secretion of thyroid
hormones
Regulation of thyroid hormones
Adult Reference Ranges:
• T4 = 5.6-13.7 ug/dl
• FT4 = 0.8-1.5 ng/dl
• T3= 87-180 ng/dl
• FT3 = 230-420 pg/dl
• TSH = 0.4-4.5 mIU/L
Carriers for Circulating Thyroid
Hormones
• More than 99% of circulating T4 and T3 is bound to
plasma carrier proteins
– Thyroxine-binding globulin (TBG), binds about 75%
– Transthyretin (TTR), also called thyroxine-binding
prealbumin (TBPA), binds about 10%-15%
– Albumin binds about 7%
• Only ~0.02% of the total T4 in blood is unbound or free.
• Only ~0.4% of total T3 in blood is free
Thyroid Hormones Stimulate
Metabolic Activities in Most
Tissues
• Thyroid hormones (specifically T3) regulate
rate of overall body metabolism
– T3 increases basal metabolic rate
• Calorigenic effects
– T3 increases oxygen consumption by most
peripheral tissues
– Increases body heat production
Metabolic Effects of T3
Carbohydrate metabolism :
• Increases absorption of glucose from GIT
• Enhances the glucose uptake by cells
• Increases glycogenolysis
• Accelerate gluconeogenesis
Lipid metabolism
• Stimulates lipolysis and release of free fatty
acids and glycerol
• Induces expression of lipogenic enzymes
• Decreases cholesterol in plasma by Stimulates
metabolism of cholesterol to bile acids
• Facilitates rapid removal of LDL from plasma
Protein metabolism
• Increases the synthesis of protein in the cells
Effects Of Thyroid Hormones On
The Cardiovascular System
• Increase heart rate
• Increase force of cardiac contractions
• Increase stroke volume
• Increase Cardiac output
Effects Of The Thyroid Hormones
In Growth And Tissue
Development
• Increase growth and maturation of bone
• Increase tooth development and eruption
• Increase growth and maturation of epidermis,hair
follicles and nails
• Increase rate and force of skeletal muscle contraction
• Inhibits synthesis and increases degradation of
mucopolysaccharides in subcutaneous tissue
Effects Of The Thyroid Hormones
On The Nervous System
• normal CNS neuronal development
• Enhances wakefulness and alertness
• Enhances memory and learning capacity
• Required for normal emotional tone
• Increase speed and amplitude of peripheral nerve
reflexes
Effects Of The Thyroid Hormones
On The Reproductive System
• Required for normal follicular development
and ovulation in the female
• Required for the normal maintenance of
pregnancy
• Required for normal spermatogenesis in the
male
Overview of Thyroid Disease
States
• Hypothyroidism
• Hyperthyroidism
Hypothyroidism
Hypothyroidism is a disorder with multiple causes
in which the thyroid fails to secrete an
adequate amount of thyroid hormone
– The most common thyroid disorder
– Usually caused by primary thyroid gland failure
– Also may result from diminished stimulation of
the thyroid gland by TSH
Cretinism
- congential absence of T3 and T4 or chronic
iodine deficiency during childhood
- retarded growth
- sluggish movements
- mental deficiencies
Congenital Hypothyroidism
Myxoedema
• adult hypothyroidism
- low rate of metabolism and lethargy
- decreased body temp
- decreased heart rate
- outer skin becomes scaley
- swelling of sub-cu connective tissues
Clinical Features of
Hypothyroidism
• Tiredness
• Forgotfullness
• Weight gain
• Cold intolerance
• Dry,patches skin
• Menstrual irregularities
• Infertility
• Constipation
• Muscle weakness,cramps
• Puffy eyes
Weight Ga
Hyperthyroidism
• Hyperthyroidism refers to excess synthesis and secretion
of thyroid hormones by the thyroid gland, which results
in accelerated metabolism in peripheral tissues
causes for hyperthyroidism :
Graves disease:
Most common
Autoimmune disease
Thyroid stimulating autoantibodies produced by
plasma cells
Activate TSH receptors,
I ncrease thyroid hormone secretion
Signs and Symptoms of
Hyperthyroidism
• Heat intolerance
• Weight loss
• Tachycardia
• Mental disturbance
• Irritability
• Nervousness
• Difficult in sleeping
• Exophthalmos
• Muscular weakness
Hyperthyroid
Thyroid Hormone Levels in
Thyroid Disease
TSH T4 T3
Hypothyroidism High Low Low
Hyperthyroidism Low High High
Goiter
• swelling in neck
• both hypo- and hyperthyroidism
Thyroid Function Tests
• TSH
• Thyroxine (T4)
• Ttriiodothyronine (T3)
• Thyroid Antibodies
Imaging
Thyroid Ultrasound scan
Thyroid Isotope Scan
Treatment for thyroid disorders
Treatment for hyperthyroidism :
• Antithyroid substances:
• Thyiocyanate
• Thiourylenes
• Surgical removal of thyroid gland
• High concentration of inorganic iodides
Treatment for hypothyroidism :
• Administration of thyroxine in the form of
tablets orally
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