Tt testing done right on the way to home

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1. Differential Diagnosis Diagnosis Treatment

2. THYROID FUNCTION TESTS

3. Objectives Synthesis Mechanism of Action Function tests – Clinical utility

4. SYNTHESIS I - Uptake Oxidation Iodination Coupling Storage Pinocytosis Proteolysis Release Deiodination Na + /I - TPO I - → I * Tyrosine( thyroglobulin ) MIT & DIT T3 & T4

5. STEPS IN SYNTHESIS I - Uptake Thiocyanate , Perchlorate , Iodine Oxidation Propylthiouracil , Carbimazole , I Iodination Coupling Storage Pinocytosis I Proteoolysis Release I, Lithium Deiodination Propranolol , Amiodarone , Propylthiouracil , Glucocorticoid TSH

6. REGULATION

7. MECHANISM OF ACTION

8. SYSTEM THYROID HORMONE EFFECTS 1. Metabolic ↑ calorigenesis and O 2 consumption ↑ heat dissipation ↑ protein catabolism ↑ glucose utilisation and production ↑ cholesterol degradation 2. Cardiovascular ↑ adrenergic activity and sensitivity ↑ heart rate ↑ myocardial contractility ↑ cardiac output ↑ blood volume ↓ peripheral vascular resistance 3. Central Nervous ↑ adrenergic activity and sensitivity 4. Gastrointestinal (GI) ↑ motility FUNCTIONS

9. Thyroid disorders Hyperthyroidism Hypothyroidism Primary secondary Primary secondary

10. Primary hypothyroidism Causes: Iodine deficiency (Most common) Auto immune disorders (Hashimoto’s disease) Removal of thyroid gland. Congenital hypothyroidism ( cretinism)

11. Secondary hypothyroidism Trauma, surgery, tumors, infiltrative disorders of pituitary / hypothalamus

12. Primary hyperthyroidism Causes: Grave’s disease Toxic multinodular goiter (Plummer’s disease) Thyroid adenoma Thyroid carcinoma Excess intake of thyroid hormones Secondary hyperthyroidism Pituitary adenoma/carcinoma

13. THYROID FUNCTION TESTS Primary hyperthyroidism T3 & T4 – increased TSH – decreased Secondary hyperthyroidism T3 & T4 – increased TSH – increased Primary hypothyroidism T3 & T4 – decreased TSH – increased Secondary hyperthyroidism T3 & T4 – decreased TSH – decreased

14. Normal values T3 – 80-200 ng /dl T4 – 4-12 µg/dl TSH – 0.5 – 4.5mIU/L

15. TBPs – TBG, TTR, Albumin 0.3% of T3 0.03% of T4 TBG TTR Albumin T 3 67% 20% <13% T 4 53% 1% 46%

16. FACTORS ALTERING TBG LEVELS TBG TBG Genetic Chronic hepatitis, porphyrias Pregnancy, newborn Drugs – estrogen , OC pills Genetic Chronic liver disease, protein losing enteropathy , nephrotic syndrome Drugs – androgens, anabolic steroids, Salicylate , phenytoin

17. FT3 – 200 – 600pg/dl FT4 – 0.8 – 1.8 ng /dl

18. TRH Stimulation Test. TSH Stimulation Test. T3 suppression Test. Resin uptake Free T4 index

19. TESTS to FIND THE CAUSE Anti TPO Anti Tg LATS( TsIg ) Radioactive Iodine Uptake and Thyroid Scan.

20. Tests based on metabolic effects of thyro i d hormones Tests Hypothyroidism Hyperthyroidism BMR ↓ ↑ 2. S. creatinine ↓ ↑ 3. S. cholesterol (normal: 150-240 mg%) ↑ ↓

21. Summary T3 & T4 increased decreased hyperthyroidism hypothyroidism TSH AME OP OSITE ECONDARY RIMARY S P

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