thyriod gland anatomy physiology and pathology
TRANSCRIPT
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Nugaal university
Dr.siciid awil ahmed
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Endocrine PhysiologyThyroid
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Thyroid gland One of largest pure endocrine glands in the
body ( 20gms). Its size depends on: 1. age … age size. 2. sex … female > male. 3. physiological condition … (pregnancy,
lactation) Site: Located in the neck just below the larynx, on either side of & anterior to the trachea.
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Thyroid gland … (Continued)
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Thyroid gland … (Continued)
Thyroid gland is well vascularized (rich in blood supply).
Embryologically: Originates from an envagination of the
floor of the pharynx.
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Thyroid gland … (Continued)
Formed of 2 lobes (Rt & Lt), that are connected by band of tissue called “isthmus”.
Not visible under normal conditions, but can be felt during swallowing.
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Thyroid gland structure
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Thyroid gland structure - Euthyroid (normal thyroid)
1. Multiple Follicles (Acini): Are the functional unit. Thousands in no. 100 to 300 µmeters in diameter. Each follicle is spherical in structure. Follicular wall is lined with a single layer of cuboidal epithelioid cells that secrete into the interior of the follicles.
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Structure of thyroid follicle – Euthyroid follicle
Each follicle is filled with pink-staining proteinaceous
material called colloid. ● When the gland is INACTIVE: colloid is abundant, follicles are large, & lining
cells are flat. ● When the gland is ACTIVE: follicles are small, lining cells are cuboid or
columnar, & the edge of colloid is scalloped, forming many
small “reabsorption lacunae”.
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Structure of thyroid follicle - Euthyroid follicle
Thyroid C-cell
Basal membrane of epithelial cellsApical membrane of epithelial cells
Cuboidal epithelial cells
Basement membrane
Colloid(glycoprotei
n)
Capillary(Rich blood supply)
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Structure of thyroid follicle - Euthyroid follicle
● Each follicle is surrounded by a good & rich blood supply.
● Individual thyroid cells rest on a basal lamina that separates them from the adjacent capillaries.● Endothelial cells are attenuated at places, forming gaps (fenestrations) in the walls of the capillaries.● There are microvilli projections into the colloid from
apex of thyroid cells, & canaliculi extend into them.● Prominent endoplasmic reticulum ( a common
feature in most glandular cells), & secretory droplets of thyroglobulins.
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Structure of thyroid follicle - Euthyroid follicle
2. Colloid: Jell-like substance that contains large
glycoproteins (proteins linked by carbohydrates) called
thyroglobulin, which stores thyroid hormones within its
molecules. 3. Parafollicular cells or “C-cells: - Spherical cell, which has no relation to colloid
or cuboidal cells. - Secrete Calcitonin, which is involved in
calcium homeostasis.
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Thyroid gland secretions
- Secreted by Parafollicular cells.- Important hormone for Ca2+ metabolism & homeostasis.
● 2 important thyroid hormones: ● Thyroxine (T4) or tetraiodothyronine ● Triiodothyronine (T3)- Secreted by Follicular cells.- Can be stored in thyroid gland for couple of months (2-3 months). - Having significant effect on metabolic rate of the body.● Calcitonin
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Chemical nature of thyroid hormones
IHO
COOHCH2-CHO
T3 has : - 2 benzene rings - 3 iodine atoms. - COOH & NH2 groups like an amino acid.
NH2
I
I T4 has : - 2 benzene rings - 4 iodine atoms. - COOH & NH2 groups like an amino acid.
OI I
ICH2-CHHO
I
COOHNH2
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Thyroid hormones
- Thyroxine (T4) or tetraiodothyronine …93%- Triiodothyronine (T3) …7%
Amount secreted:
Almost all T4 is converted to T3 in tissues.
Target cell
T4T4
T4
Capillary(Rich blood supply)
T3
Reverse T3
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Thyroid hormones … (continued)
T3 is the active form of T4. T3 4 times > potent (active/important) than
T4 in tissue, but it present in much smaller quantities in blood, & persists for a much shorter time than does T4. T3 has great affinity to nuclear receptors than
T4.
Reverse T3 (RT3) is inactive.
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Transfer of
thyroid hormones in blood
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Transfer of thyroid hormones in blood
Almost all THs are carried in the blood, mostly in an
inactive form, bound to 3 different types of proteins:
a. Thyroxine binding globulin … 80% b. Thyroxine binding pre-albumin … 10% c. Plasma albumin (serum albumin) … 10% N.B. T4 has greater affinity to bind proteins than T3.
Only very little T3 (0.25-0.3%) & T4 (0.03%) are carried
in the blood in the free active form.
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Mechanism of action of
thyroid hormones
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Mechanism of action ofthyroid hormones THs are lipophilic amino acid derivative
hormones. Their receptors are located within the
nucleus of target cells.
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Synthesis of
thyroid hormones
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How thyroid hormones are synthesized?
T3 & T4 are synthesized in the colloid by:
1. Iodine formation.2. Thyroglobulin formatiom.3. Iodination.4. Condensation (coupling).5. Thyroid hormones secretion.
6. Deiodination.
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How thyroid hormones are synthesized?1. Iodine formation:
Iodine (Io) is a raw material essential for THs synthesis. Found in food, e.g. salt, & sea food, in the form of “iodide
(I-)”. 120-150 µg of I- is needed daily to maintain normal thyroid
fx in adults (or 1mg/wk). Iodide (I-) actively transported (trap) into the follicle (90 –
95%). (I-) will be 30X in thyroid cells > blood concentration. (I-) secreted into colloid along concentration gradient. Peroxidase enzyme found near apex of follicular cells. Peroxidase oxidize iodide (I-) to iodine (Io).
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How thyroid hormones are synthesized?2. Thyroglobulin formatiom:
Thyroglobulin is a glycoprotein, made up of 2 subunits, & has a MW of 660,000.
Synthesized in the thyroid cells following entry aa from ECF.
Secreted into colloid by exocytosis of granules that also contain thyroid Peroxidase.
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How thyroid hormones are synthesized?3. Iodination:
Iodine attach to tyrosine within thyroglobulin chain.
Iodinase enzyme is found in the apical membrane Colloid start iodination process.
1 Iodine + 1 tyrosine Mono-iodo-tyrosine (MIT) iodinase
2 Iodine + 1 tyrosine Di-iodo-tyrosine (DIT)
Colloid
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How thyroid hormones are synthesized?4. Condensation (coupling):
MIT & DIT or 2 DIT molecules coupled together.
MIT + DIT = T3
DIT + DIT = T4
N.B. - Not all DIT & MIT thyroid hormones. - Only 25% of DIT & MIT give rise to thyroid hormones. - T3 can also be formed by de-iodination
(removing 1 iodine atom) of T4 by deiodinase enzyme.
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How thyroid hormones are synthesized?5. Thyroid hormones secretion: After formation of THs, they remain bound to
thyroglobulin in the colloid until secreted. Hormones are surrounded in colloid by acid pool,
then converted into ‘colloid droplet’. TSH stimulates pinocytosis of thyroglobulin into the
follicular cell. Lysozome enzymes hydrolyze peptide bonds &
release T3 & T4 from thyroglobulin. T3 & T4 will be discharged freely & secreted into
the capillaries (blood), attaching to TBG.
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How thyroid hormones are synthesized?6. Deiodination:
Inside follicular cells, DIT & MIT forms are NOT secreted into the blood. DIT & MIT will be deiodinized to (Io) &
tyrosine. Deiodized tyrosine will recycled back to
synthesize New MIT & DIT.
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How thyroid hormones are synthesized?
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Remember: ● All hormones are formed in colloid ‘lumen’.
● Colloid stores enough hormones for next 2 – 3 months.
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Control ofthyroid hormones
secreations
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Control of thyroid hormones secretions Hypothalamus (TRH) Anterior pituitary gland (TSH) (+) thyroid gland (+) THs via cAMP dependent mechanism. THs -ve feed back mechanism to Hypothalamus
inorder to inhibit (TRH) secretion to anterior pituitary gland.
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Control of thyroid hormones secretions
THs also -ve feed back mechanism to Anterior pituitary gland in order to inhibit responsiveness to Hypothalamus (TRH).
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Functions of
thyroid hormones
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Functions of thyroid hormones Generally, THs: 1. Increases metabolic rate.
Stimulates increased consumption of glucose, fatty acids and other molecules.
2. Increases metabolic heat, by mitochondrial No & activity ATP,
3. Stimulates rate of cellular respiration by: Production of uncoupling proteins. Increase active transport by Na+/K+
pumps. Stimulates O2 consumption of most of cells
in the body.
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Functions of thyroid hormones
4. Necessary for normal growth & maturation.5. Promotes maturation of nervous system.6. Stimulates protein synthesis.7. Help regulating lipid & CHO metabolism.
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Abnormal thyroid hormones
secretions
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I: Hyperthyroidism (thyrotoxicosis)
Females > males (4:1).
Hyperthyoidism THs. Could be: 1ry hyperthyroidism … (diseases is in the
gland), e.g. Grave’s disease Exerts TSH-like effects on thyroid.
Not affected by negative feedback. T3 & T4 reflex TSH. 2ry hyperthyroidism … (disease is
higher up) TRH TSH T3 & T4. Follicular cells become overactive.
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I: Hyperthyroidism … ‘Grave’s disease’ 90% of hyperthyoidism is due to “Grave’s disease”. GD is an autoimmune disease thyroid stimulating
antibodies IgG Symptoms of GD: - Exophthalmous, due to retro-orbital oedema (irreversible). - Lid lag, due to weakness of extraoccular muscles
(reversible).- Anxiety & restlessness.- Sleeplessness.- appetite, weight & diarrhea.- Intolerence to heat.
Treatment: - drugs to iodination process, such as PTU ‘Propylthiouracil’; MMI ‘methylmercaptoimidazole’.
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II: Hypothyroidism Adult (Myxedema)
Hypothyroidism in adults THs. Could be: 1ry hypothyroidism … (diseases is in the gland) - autoimmune disease such as “Hashimoto’s throiditis”. - lack of iodine. - absence of deiodination enzyme. T3 & T4 reflex TSH. 2ry hypothyroidism … (disease is higher up) TRH TSH T3 & T4. Follicular cells become less active.
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II: Hypothyroidism (myxedema) … cont.
If No Iodine T3 & T4 TRH TSH growth (size) of the gland simple goiter.
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How goiter ‘swollen neck’ is formed?With lack of iodine …
Hypothalamus
Anterior
pituitary
NO or low feedback inhibition
PoorLow T3 or T4
release Growth of the gland
Thyroid
gland
+
+
TRH
TSH
+++
COLD
Lack of iodine
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II: Hypothyroidism (myxedema) … cont.
If there is absence of deionization enzyme
NO recycle synthesis of DIT & MIT accumulate.
DIT & MIT will not be used for new THs formation
THs.
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II: Hypothyroidism (myxedema) … cont.
Symptoms of Hypothyroidism: - Decreased metabolic rate. - Slow heart rate & pulse. - Slow muscle contractions - appetite, weight gain, & constipation. - Prolonged sleep, & dizziness. - Coarse skin. - Slow thinking, lethargy, & mask face. - Intolerence to cold ( ability to adapt cold). - Myxoedema swollen & puffy appearance of body, due to deposition of protein-carbohydrate complexes ‘mucopolysaccharides’ & fluid in subcutaneous tissue.
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II: Hypothyroidism Children (Cretinism)
Hypothyroidism in children THs.• Hypothyroid from end of 1st trimester to 6
months postnatally, or in the 1st few years of life. T3 & T4 reflex TSH.
Additional Signs & Symptoms: - Severe mental retardation. - Short stature (due to growth of bones, muscle, & brain). Treatment: Thyroxine.
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