THYROID GLAND I

By Dr. M. Anthony David, MD Professor of Physiology
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THE THYROID GLAND
 

“Thyreos” Greek for Shield. Morphology:

Largest Endocrine gland: 15 – 25 Gms in weight. Has two lobes connected by an Isthmus Is richly vascular; 4 -6ml/g/min Has sympathetic innervation
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Anatomy:
  

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T H Y R O I D G L A N D

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THYROID GLAND

EMBRYOLOGY:
Begins development in the 4thwk of IUL  Hormones secreted from the 12th week.  Fetal Thyroid Hormones useful for:

 Normal

Fetal Bone maturation.  Normal development of the CNS.
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THYROID GLAND
 HISTOLOGY:
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Million spherical follicles  50 - 500µ in diameter  Each follicle has clear viscid protein colloid called Thyroglobulin  The Parafollicular ‘C’ cells secrete (Thyro) Calcitonin.
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BIOSYNTHESIS OF THYROID HORMONES
IODINE UPTAKE & TRAPPING  IODINATION & COUPLING

Tyrosine + Iodine = Mono Iodo Tyrosine (MIT)  MIT + MIT = Di Iodo Tyrosine (DIT)  MIT + DIT = Tri Iodo Tyrosine T 3

DIT + DIT = Tetra Iodo Thyronine 02/09/08 (T4) NOMAD:ENDOPHYSIOL: THYROID PARA

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I O D I N A T I O N & C O U P L I N G
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BIOSYNTHESIS OF THYROID HORMONES
 COUPLED

HORMONES COMBINE WITH THYROGLOBULIN, COLLOID.  ARE FREED BY PROTEOLYSIS  THE FREE THYROID HORMONES ARE THEN RELEASED INTO THE BLOOD
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TRANSPORT OF THYROID HORMONES

60% : THYROXIN BINDING GLOBULIN (TBG) 30% : THYROXIN BINDING PRE ALBUMIN (TBPA) 10% : ALBUMIN

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EFFECTS OF THYROID HORMONES: Metabolic

CALORIGENESIS:
Heat Production.

REGULATION:

Transport:
Ions  Water

Intermediary metabolisms:
CHO  Fats  Proteins

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EFFECTS OF THYROID HORMONES: Developmental
 REGULATION:
 Growth

in Homeotherms  Metamorphosis in Poikilotherms.
 CONTROL:  Protein 02/09/08

Synthesis.

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CALORIGENESIS: Heat Production
 

How? By increasing Oxygen consumption in:
     

Heart Gastric Mucosa Smooth Muscles Kidneys Liver Skeletal Muscles.
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CALORIGENESIS: Heat Production

No response to Thyroxine in
    

T: Testes U: Uterus L: Lymph nodes S: Spleen A: Anterior Pituitary Tachycardia  Sensitivity to Adrenal Lipolysis.
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Results:
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THYROID HORMONES: PHYSIOLOGIC ACTIONS
 

ON THE HEART: POSITIVE CHRONO & IONOTROPIC EFFECT

 No & affinity of β adrenergic receptors   Response to Catecholamines   Proportion of 02/09/08 alpha Myosin heavy NOMAD:ENDOPHYSIOL: THYROID PARA

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THYROID HORMONES: PHYSIOLOGIC ACTIONS

ON THE ADIPOSE TISSUE:

Thyroid hormones are catabolic. They cause  Lipolysis. Catabolic  Protein lysis.
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ON MUSCLES:
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THYROID HORMONES: PHYSIOLOGIC ACTIONS

ON THE BONE:

Developmental effect: Normal growth & development.

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THYROID HORMONES: PHYSIOLOGIC ACTIONS

ON THE NERVOUS SYSTEM:
 

DEVELOPMENTAL Promotes normal development

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THYROID HORMONES: PHYSIOLOGIC ACTIONS

ON THE GUT:
 

METABOLIC EFFECT:  CHO Absorption

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THYROID HORMONES: PHYSIOLOGIC ACTIONS

ON LIPOPROTEINS:
 

METABOLIC EFFECT: LDL Receptor formation.

  

OTHER: CALORIGENESIS  BMR:

 Oxygen consumption in most tissues except Testes, Uterus, Lymph nodes, Spleen & Anterior Pituitary.
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THYROID HORMONES: METABOLIC EFFECTS

CARBOHYDRATES:

 GLUCOSE PRODUCTION BY:
 Glycogenolysis   Gluconeogenesis   Hunger -  Intake of food

ANTI INSULIN EFFECT:
 Catabolism of Insulin  Secretion of Insulin

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THYROID HORMONES: METABOLIC EFFECTS

LIPIDS:
  

 Synthesis  Lysis Hypothyroidism:

S. Cholesterol: 400 – 700 mg% S. Cholesterol: 100 – 150 mg%

Hyperthyroidism:

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THYROID HORMONES: METABOLIC EFFECTS

PROTEINS:

 Anabolism Converts β Carotene to Vit A & Retinene. Metabolism disturbed in Hypothyroidism Causes ‘Myxedema’: Dry Coarse Puffy skin.
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VITAMINS:

MUCOPOLYSACCARIDES:
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THYROID HORMONES: METABOLIC EFFECTS

BMR:
Increases by 60 to 100 %  How? By increasing the size and number of Mitochondria.

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THYROID HORMONES: A NEGATIVE FEEDBACK REGULATION
HYPOTHALAMUS

TRH ANT PIT TSH

STIMULATING INHIBITORY

TARGET TISSUES
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T3 & T4 THYROID GLAND
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APPLIED ASPECTS
 

EUTHYROIDISM: Normal thyroid status HYPOTHYROIDISM:
 

In infancy: Cretinism (Thyroid dwarfism) In adults: Myxedema, Hypothyroidism Thyrotoxicosis
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HYPERTHYROIDISM:

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HYPOTHYROIDISM

CHILDREN: CRETINISM:
    

Congenital Hypothyroidism Dwarfism Mentally Subnormal: MR Enlarged, Protruding tongue Pot bellies.

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C R E T I N I S M
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P R O T R U D I N G

T O N G U E
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HYPOTHYROIDISM: ADULTS
 

MYXEDEMA: CAUSES:

Primary: Thyroid diseases Secondary: Pituitary or Hypothalamic cause.

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MYXEDEMA: CLINICAL FEATURES
 

Low BMR: - 40 Coarse & Sparse Hair Dry & Yellow skin ( Carotenemia) Poor Cold toleration Voice: Husky & slow
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MYXEDEMA: CLINICAL FEATURES

  

 Plasma Cholesterol Slow mentation Poor memory Severe mental symptoms: Myxedema madness Depression
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HYPOTHYROIDISM: TREATMENT
Very effective treatment available.  Replacement of the deficient Tab Eltroxin Thyroxine by Oral One tablet tablets. a day  Brand name Life long Eltroxin  This causes all the clinical features 02/09/08 NOMAD:ENDOPHYSIOL: THYROID PARA to disappear.

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HYPERTHYROIDISM

  

Also called Thyrotoxicosis Hyperphagia + Weight loss Heat Intolerance  Pulse Pressure Sleeping Pulse Rate >90/min
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HYPERTHYROIDISM
Nervousness, Anxiety  Fine Tremor: Paper test  Warm, soft skin  Sweating   BMR: +10 to +100

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HYPERTHYROIDISM: GRAVE’S DISEASE

EXOPHTHALMIC GOITRE:  Exophthalmos: Protruding eyeballs  Is an autoimmune disorder  Can be also Hashimoto’s Thyroiditis
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TREATMENT OF HYPERTHYROIDISM

Antithyroid drugs:  Most drugs interfere with Iodide trapping.  Others block iodisation of Tyrosine.  Examples:  Perchlorates  Thiocyanates Decrease Goitrogen consumption:
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GOITROGENS

Goitrogens: Goitrin & Progoitrin seen in:  Cabbage  Rutabagas & Turnips
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