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    #30 Thyroid and Thyroid Testing

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    asclswisconsin
    The document discusses the thyroid gland, thyroid hormones, and thyroid testing. It describes: 1) The thyroid gland's role in producing thyroid hormones which regulate metabolism and are essential for development. 2) The regulatory pathways of thyroid hormones including negative feedback loops between the hypothalamus, pituitary gland, and thyroid. 3) Common thyroid diseases like hypothyroidism and hyperthyroidism, their causes and symptoms. 4) The importance of TSH testing in evaluating thyroid function and diagnosing hypo- or hyperthyroidism, as it is the primary indicator of thyroid axis homeostasis. Additional tests may be used to further elucidate a diagnosis.

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    #30 Thyroid and Thyroid Testing

    Uploaded by

    asclswisconsin
    172 views25 pages
    The document discusses the thyroid gland, thyroid hormones, and thyroid testing. It describes: 1) The thyroid gland's role in producing thyroid hormones which regulate metabolism and are essential for development. 2) The regulatory pathways of thyroid hormones including negative feedback loops between the hypothalamus, pituitary gland, and thyroid. 3) Common thyroid diseases like hypothyroidism and hyperthyroidism, their causes and symptoms. 4) The importance of TSH testing in evaluating thyroid function and diagnosing hypo- or hyperthyroidism, as it is the primary indicator of thyroid axis homeostasis. Additional tests may be used to further elucidate a diagnosis.

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    The document discusses the thyroid gland, thyroid hormones, and thyroid testing. It describes: 1) The thyroid gland's role in producing thyroid hormones which regulate metabolism and are essential for development. 2) The regulatory pathways of thyroid hormones including negative feedback loops between the hypothalamus, pituitary gland, and thyroid. 3) Common thyroid diseases like hypothyroidism and hyperthyroidism, their causes and symptoms. 4) The importance of TSH testing in evaluating thyroid function and diagnosing hypo- or hyperthyroidism, as it is the primary indicator of thyroid axis homeostasis. Additional tests may be used to further elucidate a diagnosis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    172 views25 pages

    #30 Thyroid and Thyroid Testing

    Uploaded by

    asclswisconsin
    The document discusses the thyroid gland, thyroid hormones, and thyroid testing. It describes: 1) The thyroid gland's role in producing thyroid hormones which regulate metabolism and are essential for development. 2) The regulatory pathways of thyroid hormones including negative feedback loops between the hypothalamus, pituitary gland, and thyroid. 3) Common thyroid diseases like hypothyroidism and hyperthyroidism, their causes and symptoms. 4) The importance of TSH testing in evaluating thyroid function and diagnosing hypo- or hyperthyroidism, as it is the primary indicator of thyroid axis homeostasis. Additional tests may be used to further elucidate a diagnosis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 25

    Thyroid and Thyroid Testing

    Edgar Betancourt, MD
    Aspirus Wausau Hospital
    Where is it?
    Histologic Section of Normal
    Thyroid

    C cells

    Follicular cells
    colloid
    What Does It Do?
    • Sole source of thyroid hormone (T3&T4)
    • Thyroid hormone is essential in
    development
    • In conjunction with other endocrine
    hormones is essential to the regulation of
    body metabolism
    Thyroid Hormone Regulatory
    Pathways
    Thyroid Hormone Regulatory
    Pathways
    • As in most endocrine systems the main
    regulatory hormone, TSH is produced by
    the pituitary gland.
    • The hypothalamus produces TRH which in
    turn induces the pituitary to produce TSH
    • Secretion of TSH and TRH are inhibited by
    a negative feedback loop by T3 & T4
    Thyroid Hormone Physiology
    • T4 is secreted in a 20 fold excess to T3
    • T3 is the most active fraction
    • After secretion the hormone is rapidly bound to
    plasma proteins (>99%):
    Thyroid binding globulin (TBG)
    Transthyretrin (Prealbumin)
    Albumin
    –
    Thyroid Hormone Physiology
    • T4 to T3 conversion happens both before
    and after secretion.
    • Only the unbound fraction (free) is
    metabolically active.
    • Thyroid hormone receptors are ubiquitous
    nuclear receptors in all tissues and lead to
    promotion or inhibition of transcription
    depending the particular cell.
    Thyroid Disease
    • Two conditions are possible hypo or
    hyperthyroidism
    • Congenital hypothyroidism leads to the
    syndrome known as Cretinism characterized
    by short stature and mental retardation.
    • Since the disorder is preventable neonatal
    screening is performed
    Thyroid Disease
    • Adult hypothyroidism usually has an
    autoimmune etiology (Hashimoto’s) and is
    characterized by:
    – Asthenia
    – Dry skin
    – Cold intolerance
    – Hair loss
    – MINOR weight gain
    Thyroid diseases
    • Most common in Females (4:1)
    • Associated with anti TPO antibodies
    Don’t Blame this on
    hypothyroidism!
    Thyroid Disease
    • Hyperthyroidism
    • Usually autoimmune, characterized by
    antibodies against the TSH receptor which
    lead to receptor activation.
    • One tenth as common as hypothyroidism.
    Thyroid Disease
    • Grave’s disease is the most common syndrome
    – Irritability
    – Heat intolerance
    – Palpitations
    – Weight loss
    – Ophthalmopathy
    – Goiter
    Thyroid Disease

    Exophthalmos
    Thyroid Testing
    Finally 

    • A little history….. (before TSH)


    • Only total T3, T4 and TBG were widely
    available
    • Total T3 and T4 varied widely particularly
    depending on TBG levels.
    Thyroid Testing
    • Total T3 and T4 are not accurate
    measurements of the thyroid axis
    metabolism.
    • Values vary widely due to Binding protein
    levels as seen pregnancy, nephrotic
    syndrome, etc.
    Thyroid Testing
    • TSH to the Rescue!
    • TSH was established as prime indicator of
    thyroid axis homeostasis.
    • The initial problem with TSH was
    technological, assays did not have adequate
    sensitivity to accurately measure analytes in
    the micromolar range
    Thyroid Testing
    • Once sensitive immunoassays were
    established only one test could evaluate
    whether the patient was hypo, hyper or
    euthyroid.
    • Additional tests, Anti TPO, free T4 and free
    T3 could then elucidate the most likely
    cause of hyper or hypo function.
    Thyroid Testing
    Hypothyroid
    Thyroid Testing
    Hyperthyroid
    Thyroid Testing
    • Thyroid testing is a classic example of a test
    that best fits the “Reflex test” model.
    • Instead of the clinician ordering from a
    battery of different tests only 2 orders are
    necessary:
    – Thyroid Function Cascade (for diagnosis)
    – TSH (for monitoring)
    Thyroid Testing
    • The cascade testing model saves time,
    money and resources and provides a
    standardized method for thyroid
    dysfunction evaluation.
    • Transforms the laboratory from a simple
    provider of analytical data to a
    consultational service.
    Thyroid Testing
    • One caveat!
    • Thyroid testing should not be performed on
    severely ill patients. During severe illness
    physiologic alterations to baseline thyroid
    homeostasis are common as a response to the
    acute illness.

    •
    Thank You!

    Meyers Beach, Cornucopia Wisconsin

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