医学甲状腺疾病的实验室检查课件.pptVIP

* Production of T4 and T3. The thyroid gland is the sole source of endogenous T4, while only about 20% of T3 is produced in the thyroid.1 T4 is the most abundant iodothyronine in Tg and is about 10-20 times more abundant than T3.2 The thyroid secretes T4 and T3 in a proportion determined by the T4/T3 ratio in thyroglobulin (Tg), which is 15:1 in humans with minimal thyroidal conversion of T4 to T3.3 Normally, the ratio of secreted T4 to T3 is about 11:1.3 The serum concentrations and daily production rates of T4 are higher than those of any other iodothyronine.2 The estimated range of normal daily production of T4 is 70-90 ?g; for T3 the estimated range is about 15-30 ?g.4 Normal circulating concentrations of T4 in plasma range from 4.5-11.0 ?g/dL, while those for T3 are 100-fold less (60-180 ng/dL).4 One third to one half of the T4 that is secreted is converted to T3.2 The production of T4 and its extrathyroidal conversion to T3 provide a more constant source of T3 than were T3 to be solely produced by the thyroid.2 T3 is produced by 2 different and relatively independent processes  about 20% via direct thyroid secretion and about 80% by extrathyroidal 5 deiodination of T4.4,5 References 1. Fauci AS et al, eds. Harrisons Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:2013. 2. Braverman LE, Utiger RD, eds. Werner Ingbar’s The Thyroid: A Fundamental and Clinical Text. 8th ed. Philadelphia, Pa: Lippincott, Williams Wilkins; 2000:122. 3. Bianco AC, et al. Endocr Rev. 2002;23:38-89. 4. Hardman JG, Limbird LE, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 9th ed. New York, NY: McGraw Hill; 1996:1387-1388. 5. Hennemann G, et al. Endocr Rev. 2001;22:451-476. * Sites of T4 Conversion. The major site of extrathyroidal conversion of T4 to T3 is the liver.1 In humans, D1, which is found in the liver, kidney, thyroid,1,2 and pituitary,2 generates circulating T3 for use by most peripheral target tissues.1 D2 was thoug