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I'm Depressed, I Cant Sleep, I'm

Starting to Lose My Hair…


Ryan Peterson and Ben Tate
History

• In 1600 BC the Chinese were using burnt sponge and


seaweed for the treatment of goitres (enlarged
thyroid glands)
History
• Rogerius Salernitanus (around 1180)
▫ Salernitan surgeon and author of "Post mundi
fabricam"
▫ In the chapter "De bocio" of his magnum opus he
describes several pharmacological and surgical
cures for thyroid disorders, some of which
nowadays are reappraised quite scientifically
effective.
History
• Wang Hei (1475)
▫ anatomically described the thyroid gland and
recommended that the treatment of goitre should
be dried thyroid.
• Thomas Wharton (1656)
▫ named the gland the thyroid, meaning shield, as its
shape resembled the shields commonly used in
Ancient Greece.
History
• Bernard Courtois (1811)
▫ discovered iodine in the burnt ashes of seaweed
and the idea that this was the active ingredient in
the treatments that were prescribed for goitre
developed.
• Theodor Kocher (1882, 1888)
▫ demonstrated that total thyroidectomy caused
hypothyroidism. It was not until 1888 that it was
realized that the cause of the symptoms was the
lack of thyroid.
History

•Theodor Kocher (1882, 1888)


demonstrated that total thyroidectomy caused
hypothyroidism. It was not until 1888 that it was
realized that the cause of the symptoms was the lack
of thyroid.
History (Modern Day)
• Kendall, Edward Calvin (1914)
▫ 1914 isolated an iodine-containing substance from
thyroid tissue
• 1920
▫ Thyroid surgery becomes commonplace
• Pitt-Rivers and Harrington (1940)
▫ determined the structure of the first thyroid
hormone to be recognized.
Thyroid Gland
• Butterfly shaped structure that
lies on the trachea below the
larynx.
• Composed of 2 asymmetrical
lobes, and isthmus (body)
• The isthmus usually lies over the
second and third tracheal rings
opposite the fifth, sixth and
seventh cervical vertebrae.
• The total weight of the thyroid is
approximately 20-25 grams but
is smaller in parts of the world
where supplies of iodine are
abundant.
Thyroid Gland

1) Superior Thyroid Artery 1) Superior thyroid vein


2) Inferior Thyroid Artery 2) Middle thyroid vein
3) Thyroid Ima 3) Inferior thyroid vein
Thyroid Hormones
• Secreted by the Hypothalamus
▫ TRH
• Secreted by pituitary
▫ TSH
• Secreted by thyroid
▫ Thyroxine (T4)
▫ Triiodothyronine (T3)
• Actions
▫ increase metabolic rate
▫ accelerate food use for energy
The HPT axis
• The production of release of
thyroid hormone is controlled
by thyroid-releasing hormone
(TRH) from the hypothalamus
• TRH reaches the anterior
pituitary via the portal system,
where the thyrotropic cells are
stimulated to produce thyroid-
stimulating hormone (TSH)
• TSH is released to the systemic
blood, by which it travels to the
thyroid gland

T3
T4
The HPT axis
• TSH stimulates the uptake of
iodide, and all other processes
that promote formation and
release of T4 and T3
• TSH activates adenylcyclase
bound to the cell membranes of
the follicular cells and increases
their cAMP.
• T3 has a strong inhibitory effect
on TRH secretion, as well as on
the expression of the gene for
the TRH precursor
Thyronine Binding Globulin (TBG)
• Both T3 and T4 are released from the thyroid, but
much more T4 is produced than T3. When released
into the circulation, they combine with plasma
proteins, mainly Thyronine Binding Globulin (TBG)
• In the blood we have only small amounts of
thyroxine-binding globulin, but the affinity for T4 is
high.
▫ total T4 is 10-7 mol per l equal to 77.7 g per l of blood
serum, because 777 g of T4 equals one mol.
• Approximately 70% of T4 and T3 binds to TBG, and
the rest to thyroxine-binding albumin (TBA) and to
transthyrenin. Oestrogens stimulate the synthesis of
TBG.
T3 and T4
• In the peripheral tissues, T4 is converted into the
more active iodothyronine T3.
• This is brought about by a deiodination reaction.
T3 is a more potent hormone than T4 but it has a
shorter half-life.
• ( T3: 24hrs/ T4: 7 days)
Reverse T3
• There is another important conversion in the periphery
where T4 is deiodinated to an inactive iodothyronine
called reverse T3 (rT3). The precise role of rT3 is not fully
understood, but it is thought to regulate the amount of
active iodothyronines in the periphery.
Actions of thyroid hormones
• Lipid-soluble and pass through • Stimulates oxygen consumption
cell membranes easily in almost all cells
• Cellular constituents are • Stimulates the rate of
stimulated by T3 ▫ Hepatic glucose output and
▫ Mitochondria peripheral glucose utilisation
▫ Na+ - K+ pump ▫ Hepatic matabolism of fatty
▫ Myosin ATPase acids, cholesterol and
▫ Adrenergin B-receptors triglycerides
▫ Many enzyme systems and ▫ Synthesis of important proteins
proteins for growth and ▫ Absorption of carbohydrates in
maturation including CNS the intestine and the gut
development excretion of cholesterol
▫ Modulation of reproductive
function
Actions of Thyroid Hormones
• Stimulates the overall increase
in oxygen consumption
▫ Slow, but long lasting
calorigenic and thermogenic
effect is confined to the
mitochondria
• Thyroid hormones and the
catecholamines work together in
metabolic acceleration
• Thyroid hormones increase
cardiac rate and output as well
as ventilation
Parathyroid Gland
• four tiny glands located within
the thyroid gland
• Produces parathyroid hormone
(PTH) that helps control the
amount of calcium in the blood.
Parathyroid Gland
• Calcium-sensing proteins in the
parathyroid glands sense serum
calcium levels.
• In response to slight declines in
serum calcium, the parathyroid
glands secrete parathyroid
hormone (PTH).
• PTH stimulates the activity of
the 1-hydroxylase enzyme in the
kidney, resulting in increased
production of calcitriol, the
biologically active form of
vitamin D.
Parathyroid Gland
• Calcitriol activates the vitamin
D-dependent transport system
in the small intestine, increasing
the absorption of dietary
calcium and phosphorus.
• Calcitriol and PTH act on the
skeleton to increase the
mobilization of calcium and
phosphorus into the circulation.
• In the kidneys, calcitriol and
PTH increase calcium
reabsorption and increase
phosphorus excretion.
Thyroid Disorders
• Hypothyrodism
▫ Fatigue or lack of energy
▫ Weight gain
▫ Feeling cold
▫ Dry skin and hair
▫ Heavy menstrual periods
▫ Constipation
▫ Slowed thinking
• The most common cause of
hypothyroidism is Hashimoto's
thyroiditis. In this condition,
the body's immune system
mistakenly attacks the thyroid
gland
Thyroid Disorders
• Hyperthyroidism
▫ Jitteriness, shaking, increased
nervousness, irritability
▫ Rapid heart beat or
palpitations
▫ Feeling hot
▫ Weight loss
▫ Fatigue, feeling exhausted
▫ More frequent bowel
movements
▫ Shorter or lighter menstrual
periods
Thyroid Disorders
• Graves Disease
▫ increased metabolic rate and
sympatho-adrenergic
activity dominate the patient
▫ anxious with warm and
sweaty skin, tachycardia,
palpitations, fine finger
tremor, and pretibial
myxoedema
▫ Typically is a symmetrical,
warm pulsating goitre
▫ The cardiac output is high
even at rest and arrhythmias
are frequent

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