天津医科大学内科学课件 Thyroid disease.pptVIP

Thyroid disease Jia hongwei, M.D. Department of Endocrinology General Hospital of Tianjin Medical University Email:jh Guide Overview Thyroid disorder hyperthyroidism Graves disease hypothyroidism thyroiditis thyroid nodule OVERVIEW Anatomy The two lateral lobes of thyroid is located anterior to the thyroid cartilage The isthmus of thyroid is just below the cricoid cartilage Arterial supply is from superior and inferior thyroid arteries Venous drainage from three paired thyroid veins: superior, middle, inferior Anatomy Histology Functional unit of thyroid gland is the thyroid follicle cuboidal epithelial cells surrounding a lumen filled with proteinaceous colloid material consisting over 75% thyroglobulin active follicles are smaller responsible for thyroid hormone synthesis Parafollicular “C” Cells (“Clear” cells) secrete calcitonin to decrease serum calcium level respond to serum ionized calcium levels Histology Hypothalamic Pituitary Axis Basic Science - Physiology TSH can stimulate the release of T4 and T3 from thyroid gland, while T4 and T3 act as negative feedback to the release of TSH (hyperthyroidism, hypothyroidism) TSH is stimulated by thyrotropin releasing hormone (TRH) of the hypothalamus TRH is believed to be continually secreted Pituitary gland is more sensitive to negative feedback of T4 and T3 than to the stimulatory action of TRH Thyroid Hormone Synthesis and secretion 1. Iodide trapping 2. Oxidation of iodide and iodination of thyroglobulin 3. Coupling of iodotyrosine molecules within thyroglobulin (formation of T3 and T4) 4. Proteolysis of thyroglobulin (secretion of T3 and T4) 5. Deiodination of iodotyrosines Thyroid Hormone Synthesis and Secretion TSH joins follicular cell receptor, then thyroid hormone is synthesized and secreted. cAMP mediates: active transport of iodide synthesis of thyroglobulin (TG) Thyroperoxidase (TPO) mediates: conversion of iodide to iodine coupling of iodine to t