Alzaytoonah university of

Jordan

Physiology 2
Thyroid function test

-Supervised by:
Dr Mustafa Abu aemer

-Done by:
Huda alrefaee
Majd ahmad
Laila burhan
Eman
Definition
-Thyroid gland: butterfly shaped endocrine gland that is normally located
in the lower front of the neck.
- Thyroid hormone is secreted into the blood and then carried to every
tissue in the body.

- Thyroid hormone is essential to help each cell in each tissue and organ
to work.
- for example: thyroid hormone helps the body use energy stay warm and
keep the brain, heart, muscles and other organs working as they should.

Function:
- The major thyroid hormone is secreted by the thyroid gland
is thyroxin also called T4 because it contains four iodine atoms.
- T4 is converted to triodothyronine(T3) by the removal of an
iodine atoms, this occurs in liver.
- The amount of T4 produced by the thyroid gland is
controlled by another hormone which is made in the pituitary gland
called thyroid stimulating hormone (TSH).
- The amount TSH that pituitary sends into the blood depend on the
amount of T4
- If the pituitary sees very little T4 then it produce more TSH to tell
the thyroid gland to produce more T4 in blood goes above a certain
 level the pituitary production of TSH is shut off.

What Is Thyroid Disease?

Thyroid disease occurs when the thyroid gland doesn't supply
the proper amount of hormones needed by the body. If the
thyroid is overactive, it releases too much thyroid hormone
into the bloodstream, resulting in hyperthyroidism. ("Hyper" is
from the Greek, meaning "over" or "above.") Hyperthyroidism
causes the body to use up energy more quickly than it should,
and chemical activity (like metabolism) in the cells speeds up.
An underactive thyroid produces too little thyroid hormone,
resulting in hypothyroidism. ("Hypo" means "under" or "below.")
When the amount of hormone released into the bloodstream is
below normal, the body uses up energy more slowly, and
chemical activity (metabolism) in the cells slows down.
Although they are two different conditions, in both
hypothyroidism and hyperthyroidism the thyroid can become
larger than normal. An enlarged thyroid gland is a lump that can
be felt under the skin at the front of the neck. When it is
large enough to see easily, it's called a goiter. People who don't
get enough iodine in their diets also can get an enlarged
thyroid.

Hyperthyroidism
Hyperthyroidism can cause nervousness, irritability, increased
perspiration, intolerance to heat, fatigue, difficulty sleeping, a
fast heartbeat, irregular menstrual periods in girls, and muscle
weakness. People with this problem might lose weight even
though they're eating more than usual. The eyes may feel
irritated or look like they're staring. Sometimes the tissues
around the eyes become inflamed and swollen, and the eyes
appear to bulge out, but this is less common in teens than in
adults with hyperthyroidism.
Graves disease, an autoimmune disease, is the most common
cause of hyperthyroidism. The condition makes a person's
immune system produce abnormal types of antibodies (normally
antibodies help the body fight infection). These abnormal
antibodies make the thyroid gland produce more thyroid
hormones. Eventually, the thyroid gland enlarges, which can
result in a goiter. For reasons that doctors don't yet
understand, autoimmune thyroid diseases like Graves disease
are much more common in women and are most likely to occur in
teens and young and middle-aged adults.

Doctors usually diagnose Graves disease based on a person's

symptoms, a physical examination, and blood tests that show
high levels of thyroid hormone in the blood.
Once the diagnosis is made, a teen with Graves disease will
usually start taking an anti-thyroid medication, which blocks
the thyroid's production of thyroid hormones. Medication
usually brings the hormone levels down to the normal range in 1
to 2 months

Hypothyroidism

A person with mild hypothyroidism may feel just fine — in fact,

the condition might cause no symptoms at all. However,
symptoms can become more obvious if hypothyroidism
progresses.

People with underactive thyroids might feel depressed and

sluggish. They might gain weight, even though they're not
eating more or getting less exercise than usual. Teens with
hypothyroidism also might have slow growth in height, slow
sexual development, irregular menstrual periods in girls, muscle
weakness, dry skin, hair loss, poor memory, and difficulty
concentrating.
Hashimoto's thyroiditis (pronounced: hah-she-moe-toes thy-
roy-dye-tiss) is also an autoimmune disease and is the most
common cause of hypothyroidism in teens. In this condition,
the body's immune system attacks the cells in the thyroid
gland, preventing it from producing enough thyroid hormone.
The thyroid responds by working harder to make enough
hormones. This can make it become enlarged and may result in
a goiter.

Hypothyroidism is usually easily diagnosed with a physical

examination and blood tests, and treatment with thyroid
hormone replacement pills can restore normal levels of thyroid
hormone in the blood. This treatment is pretty simple, but it
does require doctor visits once or twice a year for an
examination, blood tests, and medication adjustments as
needed.
Goiters and Thyroid Nodules

It can take months or years for a goiter to develop. In teens,

goiters are usually caused by the autoimmune thyroid
conditions discussed above, which might show no obvious
symptoms until the goiter is visible as a swelling at the front of
the neck. People with this problem might have the sensation
that food is stuck in the throat, especially when they lie down
or sleep on their backs.

Generally, treatment of the thyroid disease causing the goiter

will decrease or control the enlargement. If the thyroid
continues to get larger despite treatment and becomes large
enough to cause discomfort or a lump in the neck, surgery may
be required. However, surgery is not necessary for most
people.

A thyroid nodule is a lump or enlarged area in the thyroid

gland. Sometimes a nodule can appear in a healthy gland. It may
feel like a lump in the throat, or there may be tenderness or
pain in the front of the neck. If the nodule is large enough, it
may be visible at the front of the neck.
Most thyroid nodules are harmless. A nodule may simply be an
overgrowth of normal thyroid tissue, a swelling caused by
inflammation (such as in autoimmune thyroid diseases) or a
collection of fluid called a cyst.
The doctor usually discovers nodules by touch during a physical
examination. If the doctor finds a nodule, blood tests might be
needed to find out how the thyroid gland is working. A doctor
may also take an ultrasound image of the gland to detect
whether the nodule is a cyst or a solid growth or tumor. In
addition to doing a physical examination, the doctor will ask you
about any concerns and symptoms you have, your past health,
your family's health, any medications you're taking, any
allergies you may have, and other issues. This is called the
medical history.
Another test called a thyroid scan can tell the doctor what
type of nodule a person has. For this test, a person swallows a
pill containing a small amount of radioactive iodine or another
radioactive substance. The thyroid absorbs the radioactive
substance. Next, a special camera measures where the
radioactive substance is taken up by the thyroid gland, giving
the doctor a better picture of the location, size, and type of
thyroid nodule.
In addition, a fine-needle biopsy may be done to help
determine whether a nodule is cancerous. During the biopsy,
the doctor inserts a thin needle through the skin into the
thyroid nodule (the skin is numbed with medication first).
Through the needle, the doctor takes a sample of tissue or
some fluid from a cyst. The tissue or fluid is then sent to a lab
to be examined. In some cases, a person might need to have
the nodule surgically removed for more detailed examination in
the lab. Fortunately, cancer is rare in children and teens, and
most thyroid cancers can be cured or controlled with
treatment.

Thyroid Disease, Growth, and Puberty

Once puberty starts, the body goes through some very

noticeable changes. Because thyroid hormones play an
important role in this process, thyroid disease may slow down
or interfere with a teen's physical development.

A thyroid problem also may cause a girl to have changes in her

periods. Girls with thyroid problems may have a decrease or
increase in menstrual flow or there may be a shorter or longer
time between periods than usual.
People who are concerned that they might have a thyroid
problem should visit the doctor. Chances are, the problem is
something simpler. And if a person does have thyroid disease,
diagnosing and treating it properly — including bringing the
blood levels of thyroid hormones back to normal — will usually
prevent or correct any problems

Tests
Tests to measure TSH, T4, T3 are readily available and widely
used .

TSH test (normal range:

0.4-6)
- the best way to initially test
thyroid function is to measure the
TSH level in blood.
- A high TSH level indicate that
the pituitary gland response to a drop in circulating
thyroid hormone its usually indication that thyroid gland
is failing (Hypothyroidism)
- A very low TSH level : the person has an overactive
thyroid that is producing too much thyroid hormone
 (hyperthyroidism) low result may result from abnormality
in the pituitary gland which prevent it from making
enough TSH to stimulate the thyroid.
- Normal TSH value means thyroid functioning
normally.
- T4 test : ( normal range: 4.5-12.5)
- T4 circulate in the blood in two forms:
1) T4 bound proteins that prevent the T4 from
entering the various tissues that need thyroid hormone.
2) Free T4 does enter the various target tissues to
exert its effect.
- The free T4 fraction is the most important to
determine how the thyroid is functioning and test
measure are called free T4 (FT4) its normal range (0.7-2)
-Elevated FT4: hyperthyroidism
- Low FT4: hypothyroidism, under active
thyroid, malnutrition.

Low TSH and low FT4: indicate hypothyroidism due to a problem involving the pituitary gland

Low TSH and elevated FT4: found in individuals with hyperthyroidism

T3 test: (normal range: 80-220)

- Useful to diagnosis hyperthyroidism or determine
the severity of the hyperthyroidism.
- T3 elevated: hyperthyroid in some individuals.

Thyroid antibody test:

- Patients with hypothyroidism or hyperthyroidism the
lymphocyte make antibody against their either stimulate
or damage the gland.
 - The common antibodies that cause thyroid problems
are: thyroid peroxides and thyroglobulin.
- Measuring levels of thyroid antibodies may help
diagnose the cause of thyroid problem.
- Example: positive anti-thyroid peroxidase or
antithyroglobulin antibodies in a patient with
hypothyroidism make a diagnosis of hashimoto thyroiditis
- If the antibodies are positive in a hyperthyroid the
diagnosis is auto immune thyroid disease.

Non – blood tests:

Radioactive iodine uptake:
-measuring how much iodine is taken up
by the thyroid gland.
- because T4 contain much iodine the
thyroid gland must pull a large amount
of iodine out from the blood stream in order the gland make
the required amount of T4.
- this activity can be measured by having an individual swallow a
small amount of iodine which is radioactivity that is taken up by
the thyroid gland (radioactive iodine uptake)(RAIU) doctor may
determine whether the gland is functioning
normally or not.