LESSON :

THYROID GLAND CLINICAL CHEMISTRY 2

Ms. Debbie Ann Rivera-De leon || Feb 2, 2023 (LABORATORY)

Thyroid Gland Thyroid Hormones: Functions

Outline: 1. For tissue growth
1. Anatomy of the Thyroid Gland 2. Development of the CNS
2. Thyroid Hormones 3. Disorders of the Thyroid Gland 3. increases heart rate, cardiac contractility and cardiac output
4. Thyroid Function Tests 4. Balances mental state
5. Influence carbohydrate and protein metabolism
butterfly shaped” gland 6. Energy conservation
Production of calcitonin (Ca homeostatis) and thyroid hormones (regulate 1. disabilities/ impaired movement/ short stature
body metabolism, neurological development, etc. 2. essential for CNS development, not enough during embryogenesis /
post natal development, intellectual
Anatomy of the Thyroid Gland 3.
4. decrease= mentally sluggish: increase: anxiety and nervousness
 Located in the lower anterior neck below the larynx
 Consists of 2 lobes which rests on the side of the trachea Conversion of carotene to vit. A
o Butterfly shaped gland
o Just below the voice box or larynx, 2 lobes (one on the either
side of the trachea ) are connected by narrow band cell called
ISTHMUS.
Thyroid Hormones
o By 11 weeks of gestation, the gland begins to produce • Triiodothyronine (T3 ) and Thyroxine (T4 )
measurable amount of hormone • tyrosine-based hormones produced by the thyroid gland
• 11th week of gestation – ↑ thyroid hormone production
• Iodine – most important component in thyroid hormone biosynthesis
o Critical to fetal neurological development (production of brain
development for fetus)

o Iodine is found in seafood, daily products, iodine-

Thyroid Hormones: Synthesis

• Iodine + tyrosine residues of thyroglobulin = monoiodotyrosine (MIT) or
diiodotyrosine (DIT)
o T3 = MIT + DIT
o T4 = DIT + DIT
o Catalyzed by thyroid peroxidase (TPO)
• T3 and T4
o Active forms which are stored in thyroglobulin matrix
o Secretion
 TSH signals follicular cells → ingest colloid droplets
→ lysosomal degradation into T3 and T4 → thyroid
cells secrete T3 and T4 into circulation
 Follicles – fundamental structural unit of thyroid gland • 80% of T4 is metabolized into T3 or reverse T3
 Types of thyroid cells o Catalyzed by 5’- deiodinase
o Follicular cells o T3 : 3-8x metabolic active than T4
o Parafollicular cells (C cells) o rT3 : metabolically inactive
 Colloid – viscous substance surrounded by thyroid cells

o Basic structural unit of thyroid gland characterized as ring Forms of iodothyronine 5′-deiodinase
shaped like structures which is the sit for TH synthesis and • Type 1
storage o Most abundant form
o COLLOID: o Target compound of anti-hyperthyroidism drugs
o major component: thryglobulin glycoprotein produced by the • Type 2
follicular cells contains tyrosine residues that can be iodinated o Maintains constant T3 levels in CNS
o Decreased if  circulating T4
o Follicular cells – secretes T3 and T4 • Type 3
o Parafollicular cells (C cells)- secretes calcitonin (plays a role in o inner ring
calcium and phosphorus metabolism)
o Parafollicular cells: calcitonin (lowers CA) nagpapasok ng
calcium sa bone. (blood to bone) (antagonist is parathyroid.
Parathyroid- (bone to blood)
[CC2LAB] Title– professor
• Transports 15-20% of total T4
3. Thyroxine -Binding Albumin
• Transports most of the T 3
• Transports 10% of total T 4

Thyroid Hormones: Binding Proteins

• Most circulating T 3 and T 4 are bound to transport proteins
• Unbound/Free: 0.4% T 3 and 0.04% T 4
• Biologically active
• fT 3 and fT4 are better indicators of thyroid function than total T 3 and
total T 4
• Not affected by TBG levels
• ↑ TBPs = ↑ T 3 and T 4
• ↑ TBPs ≠ ↑ fT 4 or TSH

Thyroid Hormones: Control of Thyroid Function

•Hypothalamic– pituitary–thyroid axis
o Neuroendocrine system that regulates the production and
secretion of thyroid hormones
Thyroid Hormones: Triiodothyronine (T3 )
• 3,5,3’–triiodothyronine
• Most active thyroid hormone
• Almost 75-80% is produced from tissue deiodination of T4

• Principal application: diagnosis of T3 thyrotoxicosis

• Clinical importance:
o T3 thyrotoxicosis Thyroid Disorders
o Indicator of recovery from hyperthyroidism I. Hyperthyroidism
o Recognition of recurrence of hyperthyroidism 1. Thyrotoxicosis
2. Grave’s disease
• Marker for: 3. Riedel’s thyroiditis
o Recovery from hyperthyroidism 4. Subclinical hyperthyroidism
o Recurrence of hyperthyroidism 5. De Quervain’s thyroiditis

Thyroid Hormones: Thyroxine (T4 ) II. Hypothyroidism

• 3,5,3’5’–tetraiodothyronine 1. Primary hypothyroidism
• Principal secretory product i. Hashimoto’s disease
• Prehormone for T3 production ii. Myxedema
• All circulating T4 originates in the thyroid gland 2. Secondary hypothyroidism
• Serum T4 – good indicator of thyroid secretory rate 3. Tertiary hypothyroidism
4. Subclinical hypothyroidism
5. Congenital hypothyroidism

Thyroid Hormones: Reference Values

 Triiodotyronine (T3)
o 80-200 ng/dL or 1.2-3.1 nmol/ (adult)
o 105-245 ng/dL or 1.8-3.8 nmol/L(children)
 Thyroxine (T4)
o 5.5 µg/dL or 71-161 (adult)
o 11.8- 22.6 µg/dL or 152-192 nmol/L (children)
Thyroid Hormones: Binding Proteins
• 3 major thyroxine -binding proteins (TBPs)
1.Thyroxine -Binding Globulin (TBG) • Hyperthyroidism
• Affinity for T 3 is lower than T 4 o Excess of circulating T3 and T4
• Transports 70 -75% of total T 4  Primary hyperthyroidism
2. Thyroxine -Binding Prealbumin (Transthyretin)  Secondary hyperthyroidism
• T3 has no affinity for prealbumin
Transcriber: Geronimo, Claudine E.
[CC2LAB] Title– professor
Thyroid Disorders: Hypothyroidism
Thyroid Disorders: Hyperthyroidism
• Thyrotoxicosis
o Group of syndromes caused by high levels of free thyroid
hormones in the circulation
• Grave’s disease (diffuse toxic goiter)
o Autoimmune disease
o • Features: exophthalmos (bulging eye), pretibial myxedema

• Primary hypothyroidism
• Riedel’s thyroiditis o caused by destruction or ablation of the thyroid gland
o Thyroid turns into a woody or stony-hard mass
• Other causes:
o surgical removal of the gland
o used of radioactive iodine for hyperthyroidism
treatment
o radiation exposure
o drugs such as lithium

• Primary hypothyroidism
• Hashimoto’s disease
o Chronic autoimmune thyroiditis
o Thyroid is replaced by a nest of lymphoid tissue
o Associated with enlargement of the thyroid gland
o Lab testing:
• Positive TPO antibody test
• ↑TSH

• Subclinical hyperthyroidism
o Showing no clinical symptoms
o ↓ TSH, [N] fT3 and [N] fT4

• De Quervain’s thyroiditis
o Subacute granulomatous/Subacute nonsuppurative
thyroiditis/painful thyroiditis
o Neck pain, low grade fever and swings in thyroid function
tests • Primary hypothyroidism
o Thyroidal peroxidase (TPO) antibodies are absent • Myxedema
o ↑ ESR and thyroglobulin o Describes the peculiar nonpitting swelling of the skin
o The skin becomes infiltrated by mucopolysaccharides
Drug induced Thyroid Dysfunction o Clinical features: puffy face, weight gain, slow speech,
• AMIODARONE INDUCED THYROID DISEASE eyebrows thinned, dry and yellow skin, anemia
o inhibits thyroid hormone synthesis and blocks T4 to T3
conversion

• Secondary hypothyroidism
• Due to pituitary destruction of pituitary adenoma

• Tertiary hypothyroidism
• Due to hypothalamic disease

• Subclinical hypothyroidism
• [N] T3 and T4, slightly ↑ TSH

Congenital hypothyroidism
• Cretinism

Transcriber: Geronimo, Claudine E.

[CC2LAB] Title– professor
• Defects in the development of function of the gland  Increased: thyroid cancer and hyperthyroidism
• Retarded physical and mental development in children  Decreased: infants with goitorous hypothyroidism
• Screening test: ↓ T4 o Methods of testing: Double-antibody RIA, ELISA, IRMA and
• Confirmatory test: ↑ TSH o Immunochemiluminescent assay (ICMA)

Reverse T3
• Used for diagnosis of euthyroid sick syndrome
• ↑ rT3

Free thyroxine index

• Indirectly assesses the fT4 in blood
• ↑ in hyperthyroidism and ↓ in hypothyroidism

Total T3 , free T3 and free T4

 fT4 → differentiate drug-induced TSH elevation from
• Goiter
hypothyroidism
• Non-malignant enlargement of thyroid gland
 Measurement of triiodothyronine
o Have limited clinical value
o RIA: uses 125I- T3 tracer
o NONISOTOPIC IMMUNOASSAYS: uses peroxidase or
ALP
o Specimen collection & storage
o Serum or plasma

T3 uptake test
• Indirect estimate of the binding capacity of the plasma thyroid-binding
proteins
• Increased in hyperthyroidism, euthyroid patients, chronic liver dse
Thyroid Function Tests • Decreased in hypothyroidism, oral contraceptives, pregnancy, acute
1. TRH stimulation test hepatitis
2. TSH test
3. Radioactive iodine uptake TBG test
4. Thyroglobulin assay
5. Reverse T3  Differentiates hyperthyroidism from euthyroidism
6. Free thyroxine index  tT3 and tT4 are dependent on TBG levels
7. Total T3 , free T3 and free T4  Increased in hypothyroidism, pregnancy, estrogen
8. T3 uptake test  Decreased in anabolic steroids, nephrosis
9. TBG test
10. FNAB Fine Needle Aspiration
11. Recombinant human TSH  Most accurate tool in evaluating thyroid nodules
TRH stimulation test Recombinant human TSH
 Measure relationship between TRH and TSH secretions  For residual or recurrence of thyroid cancer
 Differentiates euthyroid from hyperthyroid patients
o Both may have undetectable TSH levels Tanned Erythrocyte hemagglutination
 ↑ in primary hypothyroidism
 ↓ in hyperthyroidism  Measure antithyroglobulin antibodies

TSH test Serum Calcitonin

 Detects primary thyroid disorders  Tumor marker for detecting residual thyroid metastasis in medullary
carcinoma
 Used to monitor thyroid hormone replacement therapy
 Should before and 6 months after surgery
 Specimen collection & storage
o Serum or plasma
o Whole blood
Pentagastrin stimulation test
o Circadian rhythm  Used to diagnose MTC

 Decreased in:
o Primary hyperthyroidism
 Secondary and tertiary hypothyroidism
 Treated Grave’s dse
 Euthyroid sick syndrome
 Over replacement of thyroid hormones in hypothyroidism

Radioactive iodine uptake (RAIU)

 Measure ability of thyroid to trap iodine
 High uptake = metabolically active thyroid

Thyroglobulin (Tg) assay

 Postoperative marker of thyroid cancer

Transcriber: Geronimo, Claudine E.