Thyroid Gland

THYROID GLAND
CLINICAL CHEMISTRY | ROMIE BREN G. SOLACITO, RMT

THYROID GLAND
OBJECTIVES
• Discuss the anatomy and physiology of Thyroid
Gland.
• Describe the hypothalamic–pituitary–thyroid axis
and how it regulates thyroid hormone production.
• Explain the principles of each thyroid function test
discussed.
• Describe the appropriate laboratory thyroid function
testing protocol to use to effectively evaluate or
monitor patients with suspected thyroid disease.
THYROID GLAND
ANATOMY
& PHYSIOLOGY
THYROID GLAND
AKA. Butterfly-shape Gland
Thyroid Hormone Calcitonin

THYROID GLAND
ANATOMY AND PHYSIOLOGY

• Positioned in the lower anterior neck and is
shaped like a butterfly
• Made up of two lobes with a band of thyroid tissue
called the isthmus
• Parathyroid Gland – serum calcium levels
regulation
• Thyroid secretion is controlled primarily by thyroid
stimulating hormone (TSH) secreted by the
anterior pituitary gland
THYROID GLAND
ANATOMY AND PHYSIOLOGY

• Composed of large numbers of closed
follicles that are filled with a secretory
substance called colloid.
• Thyroglobulin, glycoprotein manufactured
exclusively by thyroid follicular cells
• C cells that secrete calcitonin for
regulation of plasma calcium ion
concentration
THYROID GLAND
ANATOMY & PHYSIOLOGY

Biosynthesis of
Thyroid Hormone
THYROID GLAND
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Biosynthesis of
Thyroid Hormone
THYROID GLAND

Thyroid Hormones Mechanism of Action
THYROID GLAND

Action of Thyroid Hormone RESULT:
• free T4 is deiodinated into T3 (active form) • Tissue Growth
• Brain Maturation
combines with its nuclear receptor on
• Increased Heat Production
thyroid hormone–responsive genes, • Increased Oxygen
leading to the production of messenger Consumption
RNA that leads to the production of • Increased Number of Β
proteins that influence metabolism and Adrenergic Receptors
development.
THYROID GLAND

Metabolism of Thyroxine
THYROID GLAND
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THYROID GLAND

• Three forms of iodothyronine 5′-deiodinase
• Type 1 iodothyronine 5′-deiodinase - the largest
contribution to the circulating T3 pool
• Type 2 iodothyronine 5′-deiodinase - maintain
constant levels of T3 in the central nervous system
• Type 3 iodothyronine 5’-deiodinase
THYROID GLAND

Major Thyroid Hormones
• Triiodothyronine (T3)/ 3,5,6’ Triiodothyronine
• Most active thyroid hormonal activity
• Almost 75 to 80 % is produced from the tissue
deiodination of T4 – conversion of T4 to T3 takes place
in many tissues, particularly the liver and the kidneys
• Reference Value: 60 to 160ug/dL or 0.9 to 2.46 nmol/L
(adult) or 105 to 245n/dL or 1.8 to 3.8 nmol/L
(children)
THYROID GLAND

Major Thyroid Hormones
• Tetraiodothyronine (T4)/ 3,5,3,5’ Tetraiodothyronine
• The principal secretory product
• Major fraction of organic iodine in the circulation
• Prohormone for T3 production
• All circulating T4 originates in the thyroid gland
• Reference Values: 5.5 to 12.5ug/dL or 71 to 161nmol/L (Adult)
or 11.8 to 22.6ug/dL or 152 to 292nmol/L (children)
THYROID GLAND

Protein Binging of Thyroid Hormone
• Only 0.04% of T4 and 0.4% of T3 are unbound by
proteins and available for hormonal activity.
• The three major binding proteins
1. Thyroxine-binding globulin (TBG)
• Transport majority of T3 and 70 to 75% of total T4
2. Thyroxine-binding prealbumin, and
• Transport 15 to 20% of Total T4
3. Thyroxine-binding Albumin
• Transport T3 and 10% of T4
THYROID GLAND

Control of Thyroid Function
• hypothalamic–pituitary–thyroid
axis is central in the regulation of
thyroid hormone production
THYROID GLAND
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THYROID GLAND
ETIOLOGY
& PATHOPHYSIOLOGY
THYROID GLAND
ETIOLOGY & PATHOPHYSIOLOGY

Diseases of the Thyroid –
Thyrotoxicosis
• Thyrotoxicosis - the state of thyroid
hormone excess
• Hyperthyroidism – the result of excessive
thyroid function.
• 1° Hyperthyroidism - ↑T3 & T4;↓ TSH
• 2° Hyperthyroidism - ↑ FT4 and TSH
THYROID GLAND

Thyrotoxicosis
• Grave’s Disease – autoimmune disease
in which antibodies are produced that
activates the TSH receptor
• Diagnostic Tests: TSH Receptor
Antibody Test
THYROID GLAND

Thyrotoxicosis
• T3 Thyrotoxicosis/Plummer’s Disease –
FT3 increased but FT4 normal with low
TSH
• T4 Thyrotoxicosis – T3 normal or low but
T4 increased with low TSH
THYROID GLAND

Thyrotoxicosis
• Subclinical Hyperthyroidism – Shows no
clinical symptoms but TSH level is low,
and FT3 and FT4 normal
THYROID GLAND

Thyrotoxicosis
• Subclinical granulomatous – associated
with neck pain, low-grade fever and
swings in thyroid function tests. TPO are
absent ESR and thyroglobulin levels are
elevated
THYROID GLAND

Diseases of the Thyroid – Thyrotoxicosis
THYROID GLAND

Diseases of the Thyroid – Hypothyroidism
• Insufficient amounts of thyroid hormone are
available to tissues – low free T4 level with a
normal or high TSH
• Thyroid Goiter
• Cretinism/Congenital Hypothyroidism is
caused by extreme hypothyroidism during
fetal life, infancy, or childhood.
THYROID GLAND

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• Hashimoto Disease characterized by a thyroid
replaced by a nest of lymphoid tissue –
sensitized T lymphocytes/autoantibodies bind
to cell membrane causing cell lysis and
inflammatory reaction
• Lab Results: high TSH and Positive TPO
antibody
THYROID GLAND

• Myxedema – peculiar nonpitting swelling of
the skin – infiltrated by mucopolysaccharides.
• Myxedema coma – severe form of Primary
Hypothyroidism.
• Subclinical hypothyroidism – T3 and T4
normal but TSH is slightly increased
THYROID GLAND

THYROID GLAND

Diseases of the Thyroid – Drug
Induced Thyroid Dysfunction
• Amiodranone-Induced
Thyroid Disease – drug that
interfere with normal thyroid
function.
• Subacute Thyroiditis –
inflammation of the thyroid
gland and then repair
THYROID GLAND

Diseases of the Thyroid – Non Thyroidal
Illness & Thyroid Nodules
• Critically ill patients, often have
abnormalities in their thyroid function
tests.
THYROID GLAND
LABORATORY FINDINGS
& CORRELATIONS
THYROID GLAND
LABORATORY FINDINGS AND CORRELATIONS

Blood Tests: Thyroid-Stimulating Hormone
• Second-generation TSH – screening for hyperthyroidism
(0.1mU/L – detection limit).
• Third-generation TSH – Screening and monitoring and can
detect subclinical disease (0.01mU/L – detection limit)
Blood Tests: Serum T4 and T3
• Radioimmunoassay, Chemiluminometric Assay, and Similar
Immunometric Technique
THYROID GLAND

Blood Tests: Thyroglobulin
• Protein synthesized and secreted exclusively by thyroid follicular
cells.
• Ideal tumor marker for thyroid cancer
• Measured by double-antibody RIA, enzyme-linked
immunoassay, immunoradiometric assay, and
immunochemiluminescent assay
THYROID GLAND

Blood Tests: Thyroid Autoimmunity
• antibodies are directed at thyroid tissue with variable
responses.
• Grave’s Disease – antibody directed at the TSH receptor and
stimulates the receptor
• Thyroid stimulating antibodies - tested using a bioassay to
determine the presence of autoimmune hyperthyroidism
THYROID GLAND

THYROID GLAND

SUMMARY OF THYROID DISORDERS AND LABORATORY TESTS
DISORDERS T3 T4 TSH FT4 rT3 Tg TBG
Graves’ Disease ↑ ↑ ↓ ↑ ↑ ↑ N
Primary Hypothyroidism N/↓ ↓ ↑ ↓ ↓ N/ N
Hashimoto Thyroidism N/↓ N/↓ ↑ N/↓ ↓ N/↓ N
Nonthyroidal Illness ↓ N/↓ V V N/↑ N N
Thyroid Hormone Resistance ↑ ↑ N/↑ ↑ ↑ ↑ N
Neonatal Hypothyroidism ↓ ↓ ↑ ↓ ↓ N/↓ N
THYROID GLAND
TREATMENT & MANAGEMENT

• Hypothyroidism – thyroid hormone replacement therapy;
Levothyroxine (T4).
• Hyperthyroidism (Graves’ Disease) - β-blockers; PTU or
methimazole
• Toxic Adenoma and Multinodular Goiter - surgery, radioactive
iodine, or medication (PTU or MMI)
THYROID GLAND

Thyroid Gland

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THYROID GLAND

CLINICAL CHEMISTRY | ROMIE BREN G. SOLACITO, RMT

AKA. Butterfly-shape Gland

Thyroid Hormone Calcitonin

ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ANATOMY & PHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

ETIOLOGY & PATHOPHYSIOLOGY

LABORATORY FINDINGS AND CORRELATIONS

LABORATORY FINDINGS AND CORRELATIONS

LABORATORY FINDINGS AND CORRELATIONS

LABORATORY FINDINGS AND CORRELATIONS

LABORATORY FINDINGS AND CORRELATIONS

TREATMENT & MANAGEMENT

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