Thephysiologicalfunctionsofthyroidgland

Synthesize,reserveandsecretethyroxine

3,5,3’,5’-tetraiodothyronine,T43,5,3’-triiodothyronine,T3

SynthesisofthyroidhormonesConcentratesiodineOrganification:iodineoxidationanditsincorporationintotyrosinetoformmonoiodotyrosine(MIT)anddiiodotyrosine(DIT)Coupling:T4andT3arisefromthecouplingofeither2DITresiduesor1MITand1DITresidue(requiresthyroidperoxidase)

CirculatingT4andT3

Thyroidhormonesexistintwoforms,freeandproteinboundthefreehormoneconcentrationdeterminesthethyroidstatusirrespectiveofthetotalplasmaconcentrationthetotalhormoneisdeterminedbythyroxine-bindingglobin(TGB)andalbumin.Thethyroidcellhasabilitytoconcentrateiodine,therefore,thestationofthyroidglandcanbejudgedbycheckingiodineuptakeThyroidperoxidaseplaysanimportantroleinthecourseoforganificationandcoupling.Compoundsthatinhibitedtheactivityofthyroidperoxidasecanbeusedinthetreatmentofpatientswithhyperthyroidism.SignificanceIncreasedTBG1.

Pregnancy2.

Treatmentwithsupraphysiologicamountsofestrogens,雌激素類includingoralcontraceptives.口服避孕藥3.

Insomepatientswithcirrhosisoracutehepatitis

DecreasedTBG1.Proteinmalnutrition,hepaticfailure,chronicillness2.Nephroticsyndrome3.Duringtreatmentwithandrogenicsteroids雄激素orpharmacologic藥理學dosesofglucocorticoidsthyroxine-bindingglobin(TGB)Testsofthyroidfunction

MeasurementoftotalserumthyroidhormoneconcentrationsSerumfreeT4andT3concentrationsRadioactiveiodineuptake3h24hPeaknormal5%-25%20%-45%24h

hypothalamuspituitaryThyroidglandTRH＋TSH

＋T3T4－－SmalldoseiodoineLargedoseiodine＋－甲狀腺激素分泌的調節(jié)SerumthyrotropinTestsofthyroidregulationAnatomicevaluationofthethyroidglandThethyroidscanThyroidultrasoundNeedlebiopsy

OthertestsspecificallyrelatedtothyroidfunctionordiseaseAnti-thyroidantibodiesthyroidmicrosomalantibody(TMAb)thyroglobulinantibodies(TgAb)thyroidTSHreceptor(TRAb’s)

Therolesofthyroidhormones

regulatetissuemetabolism

centralnervoussystemdevelopmentgrowthandbonematurationGoiterEpithelialcellsbenignhyperplasia,noninflammationandnontumorNontoxicgoiter(simplegoiter):euthyroid甲狀腺機能正常的Classification:endemicsporadiccompensatoryToxicgoiter:hyperthyroidismDiagnosis

thyroidglandintumescence腫大(diffuseor/andnodular)，thefunctionofthyroidglandnormal,antibodiesagainstoneselfarenegativeDifferentialdiagnosisAutoimmunethyroiditis：antibodiesarepositive如橋本氏炎

ThyroidcancerEtiologyandpathogenesisThyroidglandintumescenceT3T4tendtonormal

endemicgoiter：iodinedeficiencyIodinedeficiency

THinsufficience

TSH

EtiologyandpathogenesisSporadicgoiter1.diet

iodineSubstancesleadingthyroidglandintumescence2.drugs3.heredity4.immunity阻止碘吸收及抑制甲狀腺素分泌的物質如水中的鈣和氟、硼、硅等卷心菜、甘藍、芹菜中含有硫氰酸鹽或有機氯酸鹽，能夠妨礙碘向甲狀腺集聚?；前奉愃?、硫脲類藥，鋰、鈷等能抑制碘離子的濃集或碘離子有機化。照影劑，含碘藥物等甲狀腺激素合成障礙檢測出一種自身抗體“甲狀腺生長免疫球蛋白”可刺激甲狀腺增生腫大。Clinicalmanifestations

Simplethyroidglandintumescence，usuallyasymptomatic，severintumescencecancausepresssymptomeI:diameter<3cmII:diameter3-5cmIII:diameter5-7cmIV:diameter7-9cmV:diameter>9cmLaboratoryfindingsT3、T4、TSHnormalRadioactiveiodineuptakeincrease,butthetimeofpeakdosenotmoveforewardThyroidglobulinincreaseAntibodiestothyroidarenegativeDiagnosisanddifferentialdiagnosisDiagnosis

thyroidglandintumescence