THYROID FUNCTION TEST
Thyroid Gland
• 1st described by Thomas
Wharton, 1656
• Largest Endocrine gland
present in neck region
• Located in front of the neck
just above the trachea
• Ductless, butterfly shape , two
lobe connected with isthmus ,
• 15-20gm
• Highly vasculer-5ml/g/min
Anatomy
• Ductless endocrine gland
• Right and left lobes united
by a narrow isthmus,
which extends across the
trachea anterior to second
& third tracheal cartilages
• superior thyroid artery &
inferior thyroid artery
Thyroid Follicles
• Thyroid follicles are spherical structures
filled with colloid, a viscous gel consisting
mostly of iodinated thyroglobulin.
• Thyroid follicles are enveloped by a layer
of epithelial cells, called follicular cells,
which in turn are surrounded by Para
follicular cells.
• Thyroid follicles synthesize & store
thyroid hormones.
• Follicular cells are normally cuboidal in
shape
Chemistry
Biosynthesis of thyroid hormone
• Two raw materials required for synthesis of
thyroid hormones
– Thyroglobulin
– Iodine
Thyroglobulin
• Diameric glycoprotein
• Molecular weight 660,000
• 115 tyrosine residues present in thyroglobulin
• Iodination of large tyrosine residues of large protein
• Thyroglobulin synthesized by thyroid acinar cells and stores as colloid in
follicles.
• Follicles also collect the iodide for the synthesis of the hormones in the
colloids and removed T3 &T4 from thyroglobulin
About 70% iodide in thyroglobulin exist as MIT and DIT
Iodine
• Iodine intake from the food mostly vegetables, sea fish,
fruits
• Dietary iodine is converted to iodide and absorbed from
the gut.
• Out of 50mg 10-15mg of iodine is utilized in thyroid
hormones.
• Normally daily intake of iodide is 100-200. Minimum 25is
required for synthesis of thyroid hormones
Thyroid hormone synthesis
• Thyroid hormones produced by thyroid gland
• Thyroid gland have two type of cell
Follicular cell
Para follicular cell
• Hormones are synthesized by following steps.
– Thyroglobulin synthesis
– Iodine uptake(iodine trapping)
– Oxidation of iodide ions
– Iodination's of tyrosine
– Coupling of MIT and DIT
– Release of thyroid hormones
• Thyroid hormones are degraded by several
method.
Deamination:
T3 &T4 Oxidative deamination pyruvic acid
Decarboxylation:
Pyruvic acid decarboxylase tyroacetates
Regulation of thyroid secretion
Thyroid Disorder
Thyroid dysfunction
Hypothyroidism and hyperthyroidism are the 2 primary
pathological conditions which is involved in thyroid glands.
Hypothyroidism
• Its defined as deficiency in thyroid hormone secretion & actions.
• Common disorders occurs in mild & severe forms in 2% to 15%
population.
• Women's are afflicted more than man. Both the sex are affected
more with increasing age.
Hypothyroidism is divided in 2 types:
1. Primary hypothyroidism
2. Secondary hypothyroidism
Laboratory finding of hypothyroidism
Diseases T3 &T4 in blood TSH in blood
Primary hypothyroidism ↓ ↑
Secondary hypothyroidism ↓ ↓
Hyperthyroidism
• Its defines as a hyper metabolic conditions caused by
excessive production of thyroid hormone.
• Women's are affected than man ratio 5: 1.
• Increasing age more than 60 years.
Hyperthyroidism
• SYMPTOMS SIGNS
Weight Loss Fine hair, thin skin
Fatigue Muscle weakness
Menstrual
Low cholesterol
irregularities
Heat Intolerance Glucose intolerance
Increased Sweating Tachycardia
Nervousness Tremors
Restlessness
Laboratory finding of hyperthyroidism
Disease Plasma total FT4 Plasma TSH Response TRH
T3& T4
Graves diseases ↑ ↑↑ ↓ Nil
Goiter ↑ ↑↑ ↓ Nil
T3 toxicosis ↑ ↑ ↓ sluggish
Excess intake of ↑ Mild ↑ ↓ sluggish
thyroxin
Thyroid function test
THYROID FUNCTION TESTS
Total Thyroxin (T4)
Total Triiodothyronine (T3)
Free Thyroxin (FT4)
Free Triiodothyronine (FT3)
Reverse T3
TSH Levels
Primary thyroid function test
• Radio immune assay:
• I131 is most commonly used for detection of thyroid function
• I132 and I123 is used for pediatric and pregnant or lactating women.
• Radio iodine uptake of the gland reflects the iodine trapping
ability.
• Routinely measured 24-hours after the administration of oral
dose.
• RIA high in hyperthyroidism, goiter and non-toxic sporadic goiter
• RIA less in hypothyroidism, administration of large doses of
I2 ,thyroid hormones are also less
“T”- index test
• Renal excretion of I131 is an indirect evidence of thyroid
function
• Proportion of the administration of dose excreted is
inversely proportional to thyroid uptake.
– More uptake less ofI131 will be excreted
• Normal range: 30-60% administrated dose
T-index calculated By :
• T= 0-8 hrs. excretion expressed as% x 100
(0-24 hrs. excretion) X (0-40 hrs. excretion)
expressed as % expressed as%
Normal value of “T”= 2.5-12
T-index > 17 indicate hyperthyroidism
T-index < 2.5 indicate hypothyroidism
Total T4& T3
• Measured by radio immune assay and ELISA
• Advanced techniques are chemilumination and
immunofluorescence
• In hyperthyroidism
T3& T4↑ and TSH ↓(due to feed back inhibition)
• In hypothyroidism
T3 & T4 ↓ TSH↓(due to lack of feed back effect)
• Reference value:
– THYROXINE (T4): 4.5 – 10.5 µgm/dl
– TRIRIODOTHYRONINE (T3): 70 – 200 ng/dl
TSH stimulating test
• Released from Anterior pituitary gland
• Measured by
Radio Immune Assay (RIA).
Immune Radio Metric Assay (IRMA).
• Reference Values: 0.4 - 4.2 mIU/Lit
• Interpretation:
Increased : Primary Hypothyroidism.
Decreased : Secondary Hypothyroidism
Hyperthyroidism
TRH-stimulating test
• TRH is released from the hypothalamus
• Increased level of T4 & T3 inhibiting the TRH
secretion
• Detect the functional integrity of thyrotrophic cells or
factors that influence the secretory response
• TRH levels in serum measured by the RIA
• Interpretation:
• Peak response in normal is about 4times increased at
20 and 40 minutes sample
• In primary hypothyroidism response will be
exaggerated and prolonged.
• In secondary hypothyroidism response will be blunted
• In tertiary hypothyroidism is hypothalamic origin in
which condition TSH is delayed.
Plasma Tyrosine test
• Rivlin et al(1965) studied plasma tyrosine level in normal and in
thyroid disorders.
• Increased tyrosine level in hyperthyroidism sugested that excess
thyroid hormone secretion has been inhibited on hepatic and tissue
as result tyrosine catabolism is reduced and plasma tyrosine level
increased in serum
• Normal level: 11.8
• IN hyper thyroidisum: 70% cases tyrosine is elevated
• In hypothyrodisum: Decreased tyrosine (average 9.8µg/ ml)