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Anatomy :
The throid is in the superficial anterior neck
Is bilobed, with a connecting isthmus.
The shape Is often described as that of the H of the
Honda car symbol.
Neoplastic or hyperplastic growth may extend inferiorly
(retrosternal),
The adacent anatomy of the laryngeal ner!es and
parathyroid glands is an important surgical
consideration.
In adults it wheighs approximately "#$%# gram.
The thyroid gland has a rich blood suppy
Iodine metabolism
Iodine enters the body in food or water
The thyroid gland concentrates and traps
iothyroglobulin, which compensates for the
scarcity of iodine.
Most of the dietary iodide is excreted in the
urine,
a 24-hour urinary iodide concentration is
excellent index of dietary intake.
Control of thyroid function
(") The classic hypothalamic$ pituitary$thyroid axis,
(%) The pituitary and peripheral deiodinases,
modify the effects of T
&
and T
'
(
(') )utoregulation of hormone synthesis by the thyroid
gland
(&) *timulation or inhibition by T*H receptor
autoantibodies.
The syntheis of T
4
and T
3
by the thyroid gland
involves six major steps;
". acti!e transport of I$ across the basement membrane
into the thyroid cell (trapping of iodide)(
%. oxidation of iodide and iodination of tyrosyl residues in
thyroglobulin(
'. coupling of iodotyrosine molecules within thyroglobulin,
to form T
'
and T
&
&. proteolysis of thyroglobulin, free iodothyronines and
iodotyrosines(
+. deiodination of iodotyrosines within the thyroid cell,
conser!ation, reuse of the liberated iodide(
,. under certain circumstances,
intrathyroidal +-$deiodination of T
&
to T
'
.
Efects of TSH on the Thyroid cell
Changes in thyroid cell morphology
Cell growth
Iodine metabolism
TSH stimulates all phases of iodide
metabolism,
Other efect of TSH
increased secretion of T
4
and T
3
from the
land.
increased acti!ity of type " #$-deiodinase,
conser!in intrathyroidal iodine.
Stimulation of glucose uptake, oxygen
consumption,
The serum le!el of TSH is about %.#-# m&'()
it is increased in hypothyroidism and
decreased in hyperthyroidism
If iodide intake is below +# g.d,
unable to maintain ade/uate hormonal
secretion,
thyroid hypertrophy (goiter)
hypothyroidism
*+ect of ,odide -e.ciency on Hormone /iosynthesis
) diet !ery low in iodine reduces intrathyroidal iodine content 0
increases the intrathyroidal ratio of 1IT to TIT$
increases the ratio of T' to T& $$$
decreases the secreation of T&,$
increases serum T*H.
*truma
DISORDERS OF THE THYROID
0atients 1ith thyroid disease 1ill usually
complain of
".thyroid enlarement, di+use or nodular)
2.symptoms of thyroid de.ciency
2 hypothyroidism3
3.symptoms of thyroid hormone excess
2 hyperthyroidism3 or
4.complications of a speci.c form of
hyperthyroidism e. 4ra!es$ disease
5 prominence of the eyes 2exophthalmos3
and,
5 thyroid dermopathy
yperthyroidism ! thyrotoxicosis
Thyrotoxicosis 2 clinical syndrome that results when
tissues are exposed to high le!els of
circulating thyroid hormone