CC 3- Lab FKM ‘17

Thyroid hormones: Tetra-iodothyronin/Thyroxine(T4) and Tri-iodothyronin(T3)

Binds to:
 Thyroxine binding globulin (TBG)
 Thyroxine binding pre-albumin (TBPA)
 Albumin
 Apolipoproteins

Free fractions are metabolically active.

Differences between T3 and T4:

T3 T4
Secretion 30 microgram/day 80 microgram/day
Source 20-25% by gland Solely by gland
75-80% by conversion
Half-life 1 day 7 days
Potency 3-4 times more potent than T4 Potent
Binding 0.4% is unbound 0.04% is unbound

Thyroid Disorder:

 Hypothyroidism –“more important”

 Hyperthyroidism

Symptoms of Hypothyroidism:
 Lethargy
 Constipation
 Dry and Coarse Skin and Hair
 Facial puffiness
 Cold intolerance
 Decreased Sweating
 Impaired memory
 Confusion
 Dementia
 Low speech and motor activity
 Anemia

Causes of Hypothyroidism:

Primary Secondary
 Iodine deficiency Hypopituitarism
 Excess Iodide Intake  Adenoma
 Thyroid Ablation (surgery)  Ablative Therapy
 Hashimoto’s Thyroiditis  Pituitary destruction
 Subacute Thyroiditis
 Genetic Abnormalities Why hypothalamus?
 Goiterogenic Food (Cabbagge)  Because it’s the main regulatory system for thyroid
 Drugs (Lithium, Amiodarone, Anti-Thyroid Agent) hormone.

Tertiary:
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Symptoms of Hyperthyroidism:
 Super fast metabolism
 Nervousness
 Fatigue
 Weight loss
 Heat intolerance
 Increase sweating
 Tachychardia
 Atrial fibrillation
 Warm and moist skin
 Exophthalmos – bulging of eyeballs around the orbit

Causes of hyperthyroidism:
1. Overproduction of Thyroid Hormone
 Grave’s Disease
 TSH Secreting Pituitary Adenoma
 Multinodular Goiter

2. Leaking thyroid hormone due to thyroid destruction

 Lymphocytic Thyroiditis
 Subacute Thyroiditis
 Radiation
3. Drugs
 Thyroid replacement drugs
 Amiodarone
 Iodinated radio contrast agents – used in radio-optic test
4. Metastatic Thyroid Carcinoma

Thyroid Tests:
 Measures the concentration of products secreted by the thyroid gland:
 Free T4
 Ref. Range: 0.8-2.7 nanogram/dL
 Measure: Unbound fraction of T4
 Method: Direct Equilibrium Dialysis
 Used to different drug induced TSH elevation and hypothyroidism .
 Primary hypothyroidism: Decrease FT4 / Increase TSH
 Non-Pituitary Hyperthyroidism: Increase FT4 / Decrease TSH

 Total Serum T4
 Ref. Range: 5.5-12.5 ug/dL or 71-161 nmol/L (adult)
 11.8-22.6 ug/dL or 152-292 nmol/L (neonate)
 Method: Radioimmunoassay, Chemilluminometric Assay, Immunometric Assay

Increase Decrease
Hyperthyroidism Hypothyroidism
Increase concentration of Thyroid binding Protein Decrease concentration of Thyroid Binding Protein
Non-Thyroidal Illness (DM, Liver Disease)
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 Serum T3 Resin Uptake:
 Ref. Range: 25-35%
 Indirectly estimates the number of binding sites on thyroid binding protein occupied by T3.
 The T3 resin uptake is high when decrease number of binding sites.
 The T3 resin uptake is low when increase number of binding sites.

 Free Thyroxine (T4) Index

 Ref. Range: 78-195 nanogram/dL
 Used to detect T3 Thyrotoxicosis
 Better indicator of recovery/recurrence from hyperthyroidism (minimally increase of T4)
 First abnormally seen in hyperthyroidism

 Test specific to Thyroid Status:

 TSH
 Ref. Range: 0.5-5 mU/mL
 Considered best method: Clinically significant thyroid dysfunction
 Most sensitive assay: Primary Thyroid Disorder
 Helps in the detection in the early detection of hypothyroidism
 Used to differentiate Primary from Secondary hypothyroidism
 For monitoring thyroid hormone replacement therapy
 Uses Immunometric and Chemilluminometric Assay

Increase Decrease
Primary Hypothyroidims Primary Hyperthyroidism
Hashimoto’s Thyroiditis Secondary and Tertiary Hypothyroidism
Thyrotoxicosis due to Pituitary Tumor Treated Grave’s Disease (Normal function of Thyroid gland but
decrease TSH)
TSH Antibodies Euthyroid Sick Disease
Thyroid Hormone Resistance Over replacement of Thyroid Hormone in hypothyroidism

 TRH Stimulation Test

 Regulates the TSH secretion from Pituitary
 Used to differentiate euthyroid and hyperthyroid patients (undetectable TSH)
 Used to confirm borderline cares and euthyroid Grave’s Disease.
 Dose neede: 500 ug TRH by IV
 Increase: Primary Hypothyroidism
 Decrease: Hyperthyroidism

 Radioactive Iodine Uptake (RAIU)

 Used to assess intrinsic function of the thyroid gland
 Helpful in establishing the cause of hyperthyroidism
 High uptake: metabollicaly active gland (active hormone production)
 Increase uptake + TSH deficiency: autonomous thyroid activity
 Needs training from PNRI (Philippine Nuclear Research Institute)
 Subject with normal Thyroid Gland
 12-20% of radio-active iodine is observed after 6 hrs.
 5-25% of radio-active iodine is absorbed after 24 hrs.
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Cont. RAIU.
Increase Decrease
Thyrotoxicosis Hypothyoidism
Pituitary thyroiditis Patients taking anti-thyroid drugs
Withdrawal refun Acute Thyroiditis
After thyroid hormonal Euthyroid patients
Anti-thyroid drug therapy Patients with exogenous thyroid hormone therapy