Thyroid Hormone Physiology Flashcards

(49 cards)

1
Q

In a series of lectures in 1905 to the Royal College of Physicians in London, Starling first used the term ‘hormone’ - what did this describe?

A

‘Hormone’ described those chemical messengers which ‘have to be carried from the organ where they are produced to the organ which they affect by means of the blood stream’

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2
Q

The thyroid gland plays a pivotal role in what?

A

human and animal physiology

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3
Q

The thyroid gland hormones determine what?

A

the rate at which chemical reactions take place in cells

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4
Q

What is this image showing?

A

The anterior and posterior parts of the thryoid gland

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5
Q

What does the thyroid gland look like?

A

The thyroid is a butterfly-shaped gland that sits low on the front of the neck.

It is also lumpy / has nodules

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6
Q

How many lobes in the thyroid gland?

What joins them?

A

Two - left and right lobe

Two lobes are joined by a small bridge called the isthmus

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7
Q

Posterior view of thyroid gland - it wraps around the …

A

trachea - not the whole way round

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8
Q

Blood supply to the thyroid:

What Arteries? branches of what?

sometimes the … … artery is present which is a branch from the arch of … or brachiocephalic trunk can be found

A

superior thyroid artery - branch of external carotid artery

inferior thyroid artery - from thyrocervical trunk branch of the first part of subclavian artery

thyroidea ima artery

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9
Q

Blood supply to the thyroid: Veins

3 major veins drain the thyroid gland. These are…

they drain to what?

A

Superior thyroid vein drains to the internal jugular vein

middle thyroid vein drains to the internal jugular vein

inferior thyroid vein drains to innominate veins

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10
Q

Lymphatic drainage of the thyroid gland:

The drainage is to …

A

pretracheal and prelaryngeal then to deep cervical, supraclavicular and mediastinal lymph nodes

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11
Q

Nerve supply of thyroid - isnt innervated but is the risk during a thyroidectomy? also want to avoid removing what?

good surgeon figure will be near to

A

surgeon who doesnt know what they are doing - can damage the recurrent laryngeal nerves when they do thyroidectomy

avoid removing parathyroid

zero

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12
Q

Microscopic structure of the thyroid

The thyroid gland is composed of … each consisting of a … of epithelial cells enclosing a large core of viscous homogenous …

this acts as a reservoir of … …

A

follicles - each consisting of a monolayer of epithelial cells enclosing a large core of viscous, homogenous colloid

thyroid hormone reservoir

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13
Q

The primary hormones secreted by the thyroid gland are …, … and …

A

tri-iodothyronine (T3), tetraiodothyronine (T4) and calcitonin

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14
Q

Calcitonin is concerned with … homeostasis, is secreted independently of the other thyroid hormones

A

calcium homeostasis

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15
Q

What is this diagram showing?

A

thyroid hormone physiology

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16
Q

Chemical structures of thyroid hormones

A
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17
Q

MIT and DIT are rapidly degraded by … to free the …, which is then re-utilised by combination with …

The T3 and T4 leave the … cells and enter the blood stream for distribution to the …

approximately … % of the thyroid hormone leaving the thyroid gland is in the form of …

A

halogenases to free iodide which is then re-utilised by combination with thyroglobulin

The T3 and T4 leave the follicular cells and enter the blood stream for distribution to the target tissues

Approximately 95% of the thyroid hormone leaving the thyroid gland is in the form of T4 (thyroxine)

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18
Q

What structures are shown? left to right

A

tyrosine, thyroxine (T4), Triiodothyronine (T3), Reverse T3 (inactive)

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19
Q

2 biological active thyroid hormone (… and …), reverse … is inactive

T4 product of what?

… largely produced in other tissues

… gland stores large quantities of thyroid hormones

A

T3 & T4, reverse T3 is inactive

T4 product of thyroid gland

T3 largely produced in other tissues

Thyroid gland stores large quantities of thyroid hormones

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20
Q

Mechanism of thyroid hormone action

The receptors for the thyroid hormones are …, specifically …

The effect of the interaction of the thyroid hormones with their receptors is to influence … … and thus protein …;

A

intracellular, specifically nuclear

influence gene transcription, thus protein synthesis

21
Q

Thyroid hormones control rate at which what reactions take place?

A

chemical reactions take place in every cell in the body

22
Q

The main effect of the thyroid hormones is to increase basal metabolic rate:

increased in … metabolism

increased in the synthesis, mobilisation and degradation of …

increased protein …

A

carbohydrate

lipids

protein synthesis

23
Q

Thyroid hormones are essential for the normal development of the …, especially … of … fibres

A

CNS, especially myelination of nerve fibres

24
Q

Overview of thyroid hormone biosynthesis:

Thyroid follicles - each composed of a single layer of epithelial cells which surrounds a fluid substance called …

the follicle cells produce a glycoprotein called … - secreted into lumen

these molecules contain the amino acid … residues and generate the thyroid …

In between thyroid follicles in the connective tissue there are scattered … “…” cells

Which form is more active?

These produce the hormone called … - not a thyroid hormone - involved in … and … regulation

thyroid has a rich … supply - multiple blood vessels in between the thyroid follicles - two types of hormones?

The The thyroid gland secretes …% T4 and …% T3

A

thyroid follicles - each composed of a single layer of epithelial cells which surrounds a fluid substance called colloid

the follicle cells produce a glycoprotein called thyroglobulin - secreted into lumen

these molecules contain the amino acid tyrosine residues and generate the thyroid hormones

In between thyroid follicles in the connective tissue there are scattered parafollicular “C” cells

C cells produce the hormone called calcitonin - not a thyroid hormone - involved in calcium and phosphate regulation

thyroid has a rich vascular supply - multiple blood vessels in between the thyroid follicles - two types of hormones

thyroxine (T4) or triiodothyronine (T3)

The thyroid gland secretes 90% T4 and 10% T3

T3 is more active

25
Regulation of thyroid hormone synthesis: Production of thyroid hormones T3 and T4 are stimulated by a hormone called
TSH (thyroid stimulating hormone)
26
TRH stands for what? where is it released from?
Thyrotropin releasing hormone hypothalamus
27
TSH stands for what? where is it released from?
Thyroid stimulating hormone / thyrotropin Anterior pituitary
28
Within the target tissues, ... enzymes convert the T4 to either ... (80%) or ... (20%)
Deiodinase enzymes convert T4 to either T3 (80%) or reverse-T3 (20%)
29
T3 has a biological ... approximately 40 times greater than that of T4, whilst reverse-T3 is biologically ...
activity reverse-T3 inactive
30
Up to 90% of the biologically active thyroid hormone within the cell is in the form of what?
T3
31
The plasma half-life of T4 is ...-... days whilst that of T3 is ... day
T4 - 6-8 days T3 - one day
32
The thyroid hormones in the blood are bound to ... They bind to Thyroxine binding ..., thyroxine binding ... and thyroxine binding ... **a very small amount is unbound** this is called ... and biologically ... ... T4 = what %? ... T3 = what %?
proteins Thyroxine binding globulin, thyroxine binding albumin, thyroxine binding prealbumin very small amount unbound - free and biologically active Free T4 - 0.04% , Free T3 -0.4%
33
_Control of thyroid hormone secretion_ ... increases secretion of ... ... stimulates secretion of T3 and T4 T3 and T4 inhibit ... direactly and indirectly by suppressing release of ... T4 converted to ... in liver and other tissues
TRH increases secretion of TSH TSH stimulates secretion of T3 and T4 T3 and T4 inhibit TSH directly and indirectly by suppressing release of TRH T4 converted to T3 in liver and other tissues
34
_Hypothalamic releasing hormones_ The median ... secretes small peptides and ... These hormones control the secretion of ..., ..., ..., ..., and ... (all end in tropes) Discovery of these hormones and the blood supply connecting the hypothalamus and pituitary led to the Nobel Prize physiology/medicine in ... for Andrew Schally and Roger Guillemin
The median eminence secretes small peptides and dopamine These hormones control the secretion of gonadotropes, somatotropes, lactotropes, corticotropes, and thyrotropes Discovery of these hormones and the blood supply connecting the hypothalamus and pituitary led to the Nobel Prize physiology/medicine in 1977 for Andrew Schally and Roger Guillemin
35
TRH increase secretion of ... ... stimulates secretion of both ... and ... These inhibit ... directly and indirectly by suppressing release of TRH ... converted to T3 in ... and other tissues Both ... and ... conjugated and excreted in ...
TRH increase secretion of **TSH** **TSH** stimulates secretion of both **T3** and **T4** These inhibit **TSH** directly and indirectly by suppressing release of TRH **T4** converted to T3 in **liver** and other tissues Both **T4** and **T3** conjugated and excreted in **bile**
36
What is shown in this image? (thyroid hormone physiology)
10 yo with severe hypothyroidism due to primary myxedema before and after treatment
37
What is shown in this image?
prominent thyroid gland - goitre - was known as derbyshire neck in the past
38
_Hyperthyroidism_ treated by ... thyroid hormones with drugs or ... out the thyroid or radioactive iodine
reducing or removing thyroid (surgery)
39
_Hypothyroidism_ treated with ... therapy what is used?
replacement therapy T4 (thyroxine)
40
... is used to treat thyroid deficiency It can be used to suppress ... secretion in the treatment of some thyroid ... it can be given by ... or injection
levothyroxine used to suppress TSH secretion in the treatment of some thyroid tumours it can be given by mouth or by injection
41
_Levothyroxine_ oral bioavailability - ? protein binding - ? metabolism ? half-life ? excretion ? standard maintenance dose?
100% \> 99% metabolised in liver by glucoronidation half-life - approx 7 days 20-40% excreted in urine maintenance dose - 50-100 micrograms daily
42
Levothyroxine - adverse effects at excessive doses: (6 things)
palpitations, arrhythmias, diarrhoea, insomnia, tremor, weight loss
43
... and ... are both used to treat hyperthyroidism
carbimazole and propylthiouracil
44
_Carbimazole_ used to treat ... it is a ...-drug, after absorption it is converted to the ... form, methimazole which prevents peroxidase iodinating the tyrosine residues on thyroglobulin, hence reduing the production of the thyroid hormones T3 and T4
Hyperthyroidism pro-drug converted to active form after absorption
45
_Carbimazole_ oral bioavailability? protein binding? metabolism? half-life? excretion? standard maintenance dose ?
oral bioavailability - \>90% protein binding - 85% metabolism - rapidly metabolized to methimazole half-life - 6.4 hours (methimazole) excretion - 90% excreted in urine as metabolites standard maintenance dose - 5-15mg/day
46
Carbimazole - adverse effects .. and ... are common which can often be treated with ... the most serious rare side effect is ... and .... Also is ...
rashes and pruritus are common - use antihistamines side effect - serious - neutropenia and agranulocytosis also is teratogenic (can cause abnormal fetal development)
47
_Propylthiouracil_ oral bioavailability? protein binding? metabolism? half-life? excretion? standard maintenance dose ?
oral bioavailability - 80-95% protein binding - 70% metabolism - 90% hepatic glucoronidation half-life - 2 hours excretion - renal standard maintenance dose - 50-150mg / day
48
_Propylthiouracil adverse effects_ ... and ... are common which can be treated with ... notable side effects include a risk of ... and risk of serious ... injury, including failure and ...
**rashes** and **pruritus** are common which can be treated with ... notable side effects include a risk of **agranulocytosis** and risk of serious **liver** injury, including failure and **death**
49
Chernobyl nuclear accident - lots of radioactive ... released
iodine