Approach to Hypothyroidism

Background of thyroid disease

Type Clinical features 
Thyroid hormone synthesis 
  • Hypothalamus  
    • Releases Thyrotropin Releasing Hormone (TRH)  
  • Pituitary  
    • TRH stimulates pituitary to release thyroid stimulating hormone (TSH) to stimulate thyroid gland 
  • Thyroid gland 
    • Takes up iodide and traps it in thyroid follicular cells 
    • Thyroglobulin incorporates iodide to form tetraiodothyronine (T4), also known as thyroxine 
    • Thyroglobulin can also incorporate iodide to form 3,5,3′-triiodothyronine (T3) 
    • Thyroid releases mainly T4 and some T3 into serum 
      • Mainly bound to thyroxine-binding globulin (TBG), transthyretin (TTR) 
  • Majority of T3 is produced by peripheral conversion of T4 to T3 
Thyroid hormone regulation   
  • T4 and T3 bind with receptors on tissues to promote actions 
  • Small increase in serum T3 and T4 inhibits TSH release  
  • Small decrease in serum T3 and T4 increases TSH production 
(Next Lesson) Action of thyroid hormones
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