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What is the role of thyroid hormonse?
Thyroid hormones increase the metabolism and protein synthethis.
Necessary for growth and development in children (including mental and sexual)
T3 binds to nuclear receptor.
What is the role of TSH
TSH increases the thyroglobulin breakdown and release of hormones from follicles into the bloodstream, activation Iodide pump (increasing NIS activity), oxidation of iodide to tyrosine and increasing the number and size of follicle cells.
TSH stimulates the Thyroid gland to secrete T3 and T4
99% of T3 and T4 are bound to TBG, transthyretin and albumin in the blood.
What can cause low levels of TBG (transporter of Thyroid hormones)
X-linked TBG deficiency, Gluccocorticoid medications, systemic conditions, protein malnutrition, nephrotic syndrome, cirrhosis, drugs.
actions of thyroid hormones
- Metabolic rate
- Cardiovascular function
- GI function
actions of thyroid hormones: metabolic function
Increases metabolism with 60-100%
Resulting in: a higher rate of glucose, proteins and fat use
actions of thyroid hormones: cardiovascular function
Due to increased metabolism there is a rise in oxygen consumption and production of metabolic end products --> vasodilation.
BF to skin dissipating body heat
Blood volume, CO, ventilation increased to maintain blood flow and oxygen delivery.
actions of thyroid hormones: GI function
Increased motility, and prod. of GI secretions --> diarrhea.
actions of thyroid hormones: neuromuscular effects
Thyroid has effect in neural control. Muscles react more vigorously. Slight tremor due to increased sensitivity of the neural synapses. Can cause nervousness, anxiety, difficulty sleeping.
Strong interaction between thyroid and sympathetic nervous system.
In infant: necessary for brain development
Tests for thyroid function
Blood tests: T3, T4 (both free and bound), TSH
Thyroid antibodies (e.g. anti-TPO in Hashimoto thyroiditis)
Radioiodine uptake test (the ability of the thyroid gland to concentrate and retain iodine from the blood)
Ultrasonography, CT, MRI, biopsy
Cretenism! Usually normal function when born, because supply from the mother.
Intellectural disability and impairment of physical growth.
Acquired Hypothyroidism (myxedema) Etiology
Destruction or dysfunction of the gland, or impaired pituitary or hypothalamus function.
- certain goitrogenic agents
- large amounts of iodine
- iodine deficiency
- autoimmune (Hashimoto thyroiditis, women )
Acquired Hypothyroidism (myxedema) Manifestations
Mucus type of edema due to accumulation of hydrophilic mucopolysaccharide substance in the connective tissue.
Can lead to myxedematous coma. Cardiovascular collapse, hypoventilation, hyponatremia, hypoglycemia --> lactic acidosis.
Hyperactivity of the thyroid gland.
Graves: autoimmune with abnormal stimulation of the thyroid gland by thyroid stimulation antibodies. May be associated with Myasthenia Gravis. Associated with MHC class 1 chain related gene A (MICA). Genotype MICA A5 correlated with Graves.
Hyperthyroidism: Clinical manifestations, se hæfte
Increase in oxygen consumption and use of metabolic fuels. Hypermetabolic state, increase in sympathetic nervous system activity.
Might heighten the sensitivity to catecholamines.
a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism. Can cause high fever, extreme cardiovascular effects, severe CNS effects.
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