1、The physiological functions of thyroid gland,Synthesize, reserve and secretethyroxine 3,5,3,5-tetraiodothyronine, T4 3,5, 3-triiodothyronine , T3,Synthesis of thyroid hormones,Concentrates iodine Organification : iodine oxidation and its incorporation into tyrosine to form monoiodotyrosine (MIT) and
2、 diiodotyrosine (DIT)Coupling: T4 and T3 arise from the coupling of either 2 DIT residues or 1 MIT and 1 DIT residue (requires thyroid peroxidase),Circulating T4 and T3,Thyroid hormones exist in two forms, free and protein bound the free hormone concentration determines the thyroid status irrespecti
3、ve of the total plasma concentration the total hormone is determined by thyroxine-binding globin (TGB) and albumin.,The thyroid cell has ability to concentrate iodine, therefore, the station of thyroid gland can be judged by checking iodine uptakeThyroid peroxidase plays an important role in the cou
4、rse of organification and coupling. Compounds that inhibited the activity of thyroid peroxidase can be used in the treatment of patients with hyperthyroidism.,Significance,Increased TBG 1. Pregnancy 2. Treatment with supraphysiologic amounts of estrogens,雌激素类including oral contraceptives.口服避孕药 3. In
5、 some patients with cirrhosis or acute hepatitisDecreased TBG 1. Protein malnutrition, hepatic failure, chronic illness 2. Nephrotic syndrome 3. During treatment with androgenic steroids 雄激素or pharmacologic药理学doses of glucocorticoids,thyroxine-binding globin (TGB),Tests of thyroid function,Measureme
6、nt of total serum thyroid hormone concentrations Serum free T4 and T3 concentrations Radioactive iodine uptake,hypothalamus,pituitary,Thyroid gland,TRH,TSH,T3 T4,Small dose iodoine Large dose iodine,甲状腺激素分泌的调节,Serum thyrotropin,Tests of thyroid regulation,Anatomic evaluation of the thyroid gland,The
7、 thyroid scan Thyroid ultrasound Needle biopsy,Other tests specifically related to thyroid function or disease,Anti-thyroid antibodies thyroid microsomal antibody (TMAb) thyroglobulin antibodies (TgAb) thyroid TSH receptor (TRAbs),The roles of thyroid hormones regulate tissue metabolism central nerv
8、ous system development growth and bone maturation,Goiter,Epithelial cells benign hyperplasia, non inflammation and non tumor Nontoxic goiter (simple goiter): euthyroid甲状腺机能正常的 Classification: endemic sporadic compensatory Toxic goiter: hyperthyroidism,Diagnosisthyroid gland intumescence 肿大 (diffuse
9、or/and nodular)，the function of thyroid gland normal , antibodies against oneself are negative Differential diagnosis Autoimmune thyroiditis：antibodies are positive如桥本氏炎Thyroid cancer,Etiology and pathogenesis,Thyroid gland intumescence,T3 T4 tend to normal,endemic goiter：iodine deficiency,Iodine de
10、ficiency,TH insufficience,TSH,Etiology and pathogenesis,Sporadic goiter 1. dietiodine Substances leading thyroid gland intumescence 2. drugs 3. heredity 4. immunity,阻止碘吸收及抑制甲状腺素分泌的物质如水中的钙和氟、硼、硅 等 卷心菜、甘蓝、芹菜中含有硫氰酸盐或有机氯酸盐，能够妨碍碘向甲状腺集聚。,磺胺类药、硫脲类药，锂、钴等能抑制碘离子的浓集或碘离子有机化。,照影剂，含碘药物等,甲状腺激素合成障碍,检测出一种自身抗体 “甲状腺生长
11、免疫球蛋白”可刺激甲状腺增生肿大。,Clinical manifestations,Simple thyroid gland intumescence，usually asymptomatic，sever intumescence can cause press symptome I: diameter9cm,Laboratory findings,T3、T4 、TSH normal Radioactive iodine uptake increase, but the time of peak dose not move foreward Thyroid globulin increase Antibodies to thyroid are negative,Diagnosis and differential diagnosis,Diagnosisthyroid gland intumescence (diffuse or/and nodular)，the function of thyroid gland normal , antibodies against oneself are negativeDifferential diagnosisAutoimmune thyroiditis：antibodies are positiveThyroid cancer,
