【医学PPT课件】甲亢的实验室检查.pptVIP

* Carriers for Circulating Thyroid Hormones. Thyroid hormones are transported in the blood by carrier plasma proteins,1 which bind more than 99% of serum T4 and T3.2 Together, the carrier proteins keep the concentration of thyroid hormone constant over a wide range and provide a means for equal distribution of hormone among the tissues.2 Thyroxine-binding globulin (TBG) is the major carrier of thyroid hormones in the circulation because of its extremely high binding affinity, even though it represents only a small fraction of the total serum proteins.2 TBG binds 75% of T4,2 and has 10-20 times greater affinity for T4 than T3.2-4 Transthyretin (TTR) binds T4, but does not significantly bind T3.4 In spite of its low binding affinity, albumin carries about 7% of T4 because of its high serum concentration.2 The thyroid hormones also bind to plasma lipoproteins, with high-density lipoproteins (HDL) being the major binders.3 HDL transports about 3% of T4 and about 6% of T3 in serum.3 The transport proteins are affected by physiological changes, pharmacologic agents, and disease.3 References 1. Hardman JG, Limbird LE, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 9th ed. New York, NY: McGraw Hill; 1996:1388-1389. 2. Janssen OE, et al. J Clin Endocrinol Metab. 2002;87:1217-1222. 3. Braverman LE, Utiger RD, eds. Werner Ingbar’s The Thyroid: A Fundamental and Clinical Text. 8th ed. Philadelphia, Pa: Lippincott, Williams Wilkins; 2000:108-110,115. 4. Fauci AS, et al, eds. Harrisons Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:2014. * Changes in TBG Concentration Determine Binding and Influence T4 and T3 Levels. Because of the high degree of binding of thyroid hormones to serum carrier proteins, such as TBG, quantitative or qualitative changes in either the concentrations of the proteins or molecular changes in the binding affinity of the hormones for the protein have significant effects on the total serum hormone lev