复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）内分泌和代谢_Thyroid Disorders

Diseases of Thyroid Gland The department of Endocrinology and metabolism Huashan Hospital, Fudan University Dr Hongying Ye dryehongyingahotmail.com

The department of Endocrinology and metabolism Huashan Hospital, Fudan University Dr. Hongying Ye dryehongying@hotmail.com

Main contents Basic knowledge of thyroid Overview of thyroid diseases Hyperthyroidism/Graves'disease Other causes of thyrotoxicosis hypothyroidism o Thyroid nodule ● Case discussion

Main contents  Basic knowledge of thyroid  Overview of thyroid diseases  Hyperthyroidism/Graves’ disease  Other causes of thyroitoxicosis  Hypothyroidism  Thyroid nodule  Case discussion

Basic knowledge of thyroid

Anatomy of the Thyroid Gland Thyroid Cricoid Parathyroid Cartilage Gland C Larynx Thyroid Thyroid Trachea Gland Recurrent Laryngeal Nerve Trachea

Anatomy of the Thyroid Gland

ollicles the functional Units of the Thyroid Gland Section of thyroid gland Follicles are the sites gael sobdoder Where Key Thyroid e Elements Function. 必 Thyroglobulin (tg) Tyrosine lodine Thyroxine ( T4) Colloid Triiodotyrosine(T3) c cell Follicular

Follicles: the Functional Units of the Thyroid Gland Follicles Are the Sites Where Key Thyroid Elements Function: • Thyroglobulin (Tg) • Tyrosine • Iodine • Thyroxine (T4) • Triiodotyrosine (T3)

The Thyroid Produces and Secretes 2 Metabolic Hormones o Two principal hormones Thyroxine (4)and triiodothyronine(t Required for homeostasis of all cells Influence cell differentiation, growth, and metabolism Considered the major metabolic hormones because they target virtually every tissue

The Thyroid Produces and Secretes 2 Metabolic Hormones  Two principal hormones  Thyroxine (T4 ) and triiodothyronine (T3)  Required for homeostasis of all cells  Influence cell differentiation, growth, and metabolism  Considered the major metabolic hormones because they target virtually every tissue

Thyroid-Stimulating Hormone(TSH) o Produced from pituitary Regulates thyroid hormone production, secretion, and growth the sodium-iodide symporter (nis) thyroglobulin tg thyroperoxidase (tpo) e Is regulated by the negative feedback action oft, and t

Thyroid-Stimulating Hormone (TSH)  Produced from pituitary  Regulates thyroid hormone production, secretion, and growth the sodium-iodide symporter (NIS) thyroglobulin (Tg) thyroperoxidase (TPO)  Is regulated by the negative feedback action of T4 and T3

Hypothalamic-Pituitary-Thyroid Axis Negative Feedback Mechanism Hypothalamus TRH Stimulation hibition Pituita Free Hormone Bound Hormone T4 Liver T3 TSH Stimulation Thyroid

Hypothalamic-Pituitary-Thyroid Axis Negative Feedback Mechanism

Regulation of thyroid function ● hPt axon e Wollf-chaikoff effect ● others

Regulation of thyroid function  HPT axon  Wollf –chaikoff effect  others

Biosynthesis of Ta andT3 Dietary iodine(I)ingestion Active transport and uptake of iodide(i) by thyroid gland Oxidation of I and iodination of thyroglobulin(tg) tyrosine residues o Coupling of iodotyrosine residues(mit and dit)to form T and t 3 Proteolysis of Tg with release of T, and t, into the circulation

Biosynthesis of T4 and T3  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 and T3 into the circulation