1、The physiological functions of thyroid gland,Synthesize, reserve and secrete thyroxine 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) an

2、d 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 irrespec

3、tive 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 uptake Thyroid peroxidase plays an important role in the

4、course 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,雌激素類including oral contraceptives.口服避孕藥 3.I

5、n some patients with cirrhosis or acute hepatitis Decreased TBG 1. Protein malnutrition, hepatic failure, chronic illness 2. Nephrotic syndrome 3. During treatment with androgenic steroids 雄激素or pharmacologic藥理學(xué)doses of glucocorticoids,thyroxine-binding globin (TGB),Tests of thyroid function,Measure

6、ment 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,甲狀腺激素分泌的調(diào)節(jié),Serum thyrotropin,Tests of thyroid regulation,Anatomic evaluation of the thyroid gland,T

7、he 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 ne

8、rvous system development growth and bone maturation,Goiter,Epithelial cells benign hyperplasia, non inflammation and non tumor Nontoxic goiter (simple goiter): euthyroid甲狀腺機能正常的 Classification: endemic sporadic compensatory Toxic goiter: hyperthyroidism,Diagnosis thyroid gland intumescence 腫大 (diffu

9、se or/and nodular)，the function of thyroid gland normal , antibodies against oneself are negative Differential diagnosis Autoimmune thyroiditis：antibodies are positive如橋本氏炎 Thyroid cancer,Etiology and pathogenesis,Thyroid gland intumescence,T3 T4 tend to normal,endemic goiter：iodine deficiency,Iodin

10、e deficiency,TH insufficience,TSH,Etiology and pathogenesis,Sporadic goiter 1. diet iodine Substances leading thyroid gland intumescence 2. drugs 3. heredity 4. immunity,阻止碘吸收及抑制甲狀腺素分泌的物質(zhì) 如水中的鈣和氟、硼、硅 等 卷心菜、甘藍(lán)、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。,磺胺類藥、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

11、“甲狀腺生長免疫球蛋白”可刺激甲狀腺增生腫大。,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,Diagnosis thyroid gland intumescence (diffuse