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Tiroid
Oleh :
Eli Halimah
FUNGSI
Fungsi Kelenjar Tiroid :
Pengikat Iodida
Sintesis hormon tiroid
Penyimpanan hormon tiroid
Fungsi Hormon Tiroid :
Mengatur kecepatan metabolisme
tubuh
Mengatur produksi panas
Mengatur pelepasan energi dalam
otot
Mengatur pertumbuhan dan
diferensiasi
triiodothyronine (T3)
Required
cells
Influence cell differentiation,
growth, and metabolism
Considered the major metabolic
hormones because they target
virtually every tissue
Thyroid-StimulatingHormone
(TSH)
Regulates
production,
growth
thyroid hormone
secretion,
and
Biosynthesis of T4 and T3
The process includes
Dietary iodine (I) ingestion
Active transport and uptake of
iodide (I) by thyroid gland
Oxidation of I- and iodination of
thyroglobulin (Tg) tyrosine residues
Coupling of iodotyrosine residues
(MIT and DIT) to form T4 and T3
Proteolysis of Tg with release of T4
Iodine Sources
Available through certain foods
Sintesis Hormon
Tiroid
THYROID HORMONES
OH
OH
I
O
O
NH2
Thyroxine (T4)
OH
NH2
OH
3,5,3-Triiodothyronine (T3)
FEEDBACK REGULATION
THE HYPOTHALAMIC-PITUITARYTHYROID AXIS
PITUITARY-THYROID AXIS
Mekanisme Pengaturan
Tiroid
Hypothalamic-Pituitary-Thyroid Axis
Negative Feedback Mechanism
TSH REGULATION OF
THYROID FUNCTION
TSH binds to specific cell surface
BLOOD
I-
organification
COLLOID
Propylthiouracil
(PTU) blocks
iodination of
thyroglobulin
COLLOID
TSH
TSH receptor
TPO
T4
T3
COLLOID
DIT
MIT
TSH
TSH receptor
I-
THYROID HORMONES
IN THE BLOOD
Approximately 99.98% of T4 is
SPECIFIC ACTIONS OF
THYROID HORMONE:
METABOLIC
Regulates of Basal Metabolic
Rate (BMR).
Increases oxygen consumption in
most target tissues.
Permissive actions: TH increases
sensitivity of target tissues to
catecholamines, thereby elevating
lipolysis, glycogenolysis, and
gluconeogenesis.
SPECIFIC ACTIONS OF
THYROID HORMONE:
DEVELOPMENT
TH is critical for normal development
development
and
regulates
synaptogenesis, neuronal integration,
myelination and cell migration.
Cretinism
disease
diagnosis of autoimmune disease
past history of neck irradiation
drug therapies such as lithium and
amiodarone
women over age 50
elderly patients
women 6 weeks to 6 months postpartum
Signs/Symptoms
Hypothyroidism
Weight gain
Hair loss
Lethargy
Menstrual irregularities
(menorrhagia)
Cognitive impairment
Depression
Constipation
Goitre
Dry skin
Cold intolerance
Hyperthyroidism
Weight loss
Hair loss
Palpitations /
Tachycardia / Atrial
fibrillation
Menstrual irregularities
(amenorrhea/oligomenorrh
ea)
Widened pulse pressure
Nervousness and tremor
Muscular weakness
Goitre
Heat intolerance,
diaphoresis, clammy hands
Hypertension
Causes of low
thyroid-stimulating hormone (TSH)
1. Hyperthyroid State
a. Both T3 and T4 elevated
Graves' disease
Toxic multinodular goiter
b. Only T3 elevated with normal T4
T3 toxicosis (e.g. Autonomous nodule)
Exogenous T3 ingestions (liothyronine)
c. Only T4 elevated with normal T3
Hyperthyroidism patient with nausea,
vomiting and starvation causing decreased
conversion of T4 to T3
2. Hypothyroid State
Pituitary or hypothalamic disease (both T4 and
T3 low)
3. Euthyroid State
Sick euthyroid (both T3, T4 low, rT3* elevated)
Drugs such as glucocorticoids, octreotide, and
dopamine
TSH
Low
High
FT4
Low
Low
High
1 Hypothyroid
2 thyrotoxicosis
If
equivocal
Central
1 Thyrotoxic
Hypothyr
oid
TRH Stim.
Endo consult
FT3, rT3
MRI, -SU
High
MRI, etc.
RAIU
A) 1 Hypothyroidism
B) Central Hypothyroidism
C) Euthyroid
D) 1 Thyrotoxicosis
Hypothyroidism
Hypothyroidism is a disorder
with multiple
causes in which the thyroid fails
to
secrete an adequate amount of
thyroid hormone
The most common thyroid disorder
Usually caused by primary thyroid
gland failure
Also may result from diminished
Hyperthyroidism
Hyperthyroidism
refers to
excess synthesis and secretion
of thyroid hormones by the
thyroid gland, which results in
accelerated metabolism in
peripheral tissues
Hypothyroidism
Low
Hyperthyroidism
High
High
T4
T3
Low
Low
High
1 Hypothyroidism
Hyperthyroidism
www.hsc.missouri.edu/~daveg/thyroid/thy_dis.html