Exam 3 Thyroid Function, Disorders, and Lab Analysis

1 in ____: Thyroid Disorders in the U.S.A.
13
For thyroid hormone synthesis, what is required?
Iodine
What does Iodine attach to in order to form hormone precursors?
Thyroglobulin
“Pro-hormone”
Upon stimulation by _____, precursors convert to active hormones
TSH
What are the 3 hormones that are active after stimulation by TSH?
Thyroxine (T4)
Triiodothyronine (T3)
Calcitonin
Most of T3T4 is secreted into the bloodstream and picked up/bound to what?
Carrier proteins
What are the Carrier Proteins that pick up/are bound to T3T4?
Thryoxine-Binding Globulin (TBG)
Prealbumin
Albumin
Only ____ T3T4 is readily available to diffuse into target cells
FREE
What does T4 convert to when free T3T4 diffuses into target cells?
Active T3
T3 binds with a specific gene to produce what?
mRNA
mRNA causes what to be produced?
Proteins
What do proteins influence?
Cell Metabolism
What are the functions of the Thyroid Hormone?
*Neurologic development of the brain
*Regulate metabolic rate & calorie consumption
*Generate heat via lipid and CHO metabolism
*Controls growth & maturation of bone, skeleton, tissues, skin, and nerves
*Regulate GI function and sexual maturation
The Anterior Pituitary secretes TSH in response to what?
Decreased T3T4
The Anterior Pituitary secretes what in response to Decreased T3T4?
TSH
What secretes TSH in response to Decreased T3T4?
The Anterior Pituitary
What tells the pituitary to release TSH?
Hypothalamus
The Hypothalamus tells the pituitary to release TSH, especially under what situations?
Stress
Hypothermia
What is the best test for assessing thyroid function and hormone replacement therapy?
TSH
Is TSH part of the Newborn Screening Process?
Yes
Free T4 represents only ______ of total T4 in circulation
0.04%
True or False:
Free T4 can freely enter cells and convert to T3
True
Define Free T4 Index
Calculation to correct for the effects of protein alterations or interfering drugs
What is the formula for the Free T4 Index?
(T4 x % T Uptake)/100
Total T3 & Total T4 Measures what?
Both free and protein bound (99%)
True or False:
Total T3 & Total T4 levels vary with pregnancy, acute illness, some drugs, and liver disease
True
Why do Total T3 & Total T4 levels vary with pregnancy, acute illness, some drugs, and liver disease?
They affect the Circulating Level of Carrier Proteins
What is used to measure the number of available binding sites on a patient’s TBG?
T-Uptake
What is the Normal Rate for T-Uptake?
30-50%
True or False:
Thyroglobulin “pro-hormone” is normally not detectable in plasma
True
What is used as a thyroid tumor marker?
Thyroglobulin “pro-hormone”
True or False:
Following surgery or treatment, levels of Thyroglobulin “pro-hormone” should be undetectable
True
What are the 3 types of Autoimmune Testing for the Thyroid?
Thyroglobulin ABY
Thyroid-Stimulating ABY
Thyroid Peroxidase ABY
Which of the following consistent with:
Thyroid-Stimulating ABY
HYPERthyroidism
Which of the following consistent with: Thyroid Peroxidase ABY
HYPOthyroidism
What causes Hypothyroidism?
Insufficient T3T4 to meet the body’s metabolic needs
What does Hypothyroidism cause?
Slowly of all bodily processes
Myxedema =
Hypothyroid edema
Myxedema – symptoms of hypothyroidism + swelling of skin caused by what?
infiltration of mucopolysaccharides and water
Myxedema is especially noticeable on what part of the body?
Face
What are the 3 causes of Primary Hypothyroidism?
Hashimoto’s Disease
Congenital Hypothyroidism
Acquired Hypothyroidism
What are the causes of Acquired Hypothyroidism?
Surgical removal or treatment for HYPERthyroidism
Cancer
Iodine Deficiency
In Acquired Hypothyroidism, will the following be increased or decreased:
FT4:
TSH:
FT4: Decreased
TSH: Increased
In Congenital Hypothyroidism, will the following be increased or decreased:
FT4:
TSH:
FT4: Decreased
TSH: Increased
In Hashimoto’s Disease, will the following be increased or decreased:
FT4:
TSH:
FT4: Decreased
TSH: Increased
What is the cause of Congenital Hypothyroidism?
Inborn defect in the development or function of the gland
What is an effect of Congenital Hypothyroidism?
Creatinism
Define Creatinism
Retarded skeletal, sexual, and mental development
What is the most common thyroid disorder in the U.S.A. affecting >1 million?
Hashimoto’s Disease
True or False:
Hashimoto’s Disease – 90% have autoantibodies (TPO ABY)
True
In Hashimoto’s Disease, what are the Thyroid tissues infiltrated by?
Lymphs and Plasma Cells
What are the causes of Secondary Hypothyroidism?
Pituitary or Hypothalamic Disorders
In Secondary Hypothyroidism, will the following be increased or decreased:
FT4:
TSH:
FT4: Decreased
TSH: Decreased
In Grave’s Disease, will the following be increased or decreased:
FT4:
TSH:
FT4: Increased
TSH: Decreased
In Secondary Hyperthyroidism, will the following be increased or decreased:
FT4:
TSH:
FT4: Increased
TSH: Increased
What is the cause of Secondary Hyperthyroidism?
TSH-secreting Pituitary Adenoma
What are some other thyroid conditions?
Thyroid cancer
Toxic Goiter / Nodules
Subclinical Thyroid Disease
Drug-Induced Thyroid Diseases
What is another name for Hyperthyroidism?
Thyrotoxicosis
With Hyperthyroidism, what is in high levels in circulation?
T3T4
What are 2 conditions that are associated with a Thyrotoxicosis crisis?
Hypermetabolic state
Tachycardia
What is the most common cause of Thyrotoxicosis affecting >3 million?
Grave’s Disease
In Grave’s disease what do the autoantibodies stimulate?
T3T4 Production
Define Dermopathy
Skin texture changes
“orange peel”
Define Ophthalmopathy
Bulging Eyes
Double Vision
Corneal Disease
What can you use to treat Grave’s Disease?
Radioactive Iodine
Surgery
Medicine
Which thyroid hormone is:
In greatest concentration in plasma?
T4
Which thyroid hormone is:
The most biologically potent?
T3
Which thyroid hormone is:
Involved in calcium regulation?
Calcitonin
Name the primary carrier proteins for thyroid hormones.
TBG & prealbumin
If T3T4 levels become low in plasma, what hormone is secreted that stimulates T3T4 production?
TSH
What gland secretes this hormone?
Anterior pituitary
What gland stimulates T3T4 production under situations of stress or cold?
Hypothalamus
Name the two primary tests that are used to assess thyroid status.
FT4 & TSH
What is the purpose of the THBR (T-Uptake) test?
To measure available binding sites on TBG
What is the purpose of the Free T4 Index?
To correct the FT4 value when protein levels are altered due to renal dz, liver dz, etc.
Match the disorder with the proper description:
Grave’s disease
The most common cause of hyperthyroidism
Match the disorder with the proper description:
Congenital hypothyroidism
Arrested skeletal and mental development in babies
Match the disorder with the proper description:
Secondary hyperthyroidism
Often caused by a TSH-secreting tumor
Match the disorder with the proper description:
Thyrotoxicosis
Term describing the overall effects of hyperthyroidism
Match the disorder with the proper description:
Myxedema
Hypothyroid symptoms including swelling of the skin
Match the disorder with the proper description:
Hashimoto’s disease
The most common thyroid condition in the U.S
What disease/disorder is the following consistent with:
FT4:Increased
TSH:Decresed
Primary Hyperthyroidism
What disease/disorder is the following consistent with:
FT4:Decreased
TSH:Increased
Primary Hypothyroidism
What disease/disorder is the following consistent with:
FT4:Decreased
TSH:Decreased
Secondary Hypothyroidism
What disease/disorder is the following consistent with:
FT4:Increased
TSH:Increased
Secondary Hyperthyroidism
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