甲状腺功能亢进症与甲状腺功能减退症课件

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1、ThyroidpathophysiologyGuoQinglianNewwordsandexprssionsThyroxine(T4)甲状腺素Triiodothyronine(T3)三碘甲腺原氨酸Pathophysiology病理Iodination碘化Tyrosine酪氨酸Thyroglobulin甲状腺球蛋白Congenital先天的Skeletal骨骼Albumin白蛋白Prealbumin前白蛋白Titre(titer)效价Goitre(goiter)甲状腺肿Euthyroid甲状腺功能正常的IntroductionThyroidhormone

2、saresynthesizedinthethyroidgland,including:thyroxine(T4)triiodothyronine(T3)ThethyroidglandsecretesmostlyT4(100nmol/Linplasma)andnearly20%T3.Theperipheraltissues(liver,kidney)deiodinateT4toproduceapproximatelytwo-thirdsofthecirculatingT3(around2nmol/L).T3hasbiologicallyactivity.

3、T3canbindtoreceptorsandtriggerstheend-organeffectsofthethyroidhormones.Inpathophysiologicsituations,thequantityofreverseT3(rT3)willincrease.ThyroidhormoneactionThyroidhormonesareessentialforthenormalmaturationandmetabolismofallthetissuesinthebody.So,insufficientthyroidhormonesca

4、nresultsomeabnormalsituations:permanentbraindamage(congenitalhypothyroidism)delayedskeletalmaturationshortstaturedelayedpuberty(青春期)ThyroidhormoneactionThyroidhormoneeffectsonmetabolismarediverse.Forproteinsynthesis:normalconcentrationimprovehighconcentrationsuppressForcarbohydr

5、atesynthesis:improveliver-glycogen(糖原)decomposioninprovethemetabolismofcarbohydrateForlipidmetabolism:improvethesynthesisofcholesterolimprovethemetabolizingofcholesterolBindinginplasmaInplasma,over99.95%ofT4istransportedboundtoprotein.70%carriedbythyroxinebindingglobulin(TBG)25%

6、byalbumin5%byprealbuminInplasma,over99.5%ofT3istransportedbythesameprotein.ThefreeT3orT4areimportantforthebiologicaleffectsofthehormones.RegulationofthyroidhormonesecretionOutlineofthehypothalamic-pituitary-thyroidaxisRegulationofthyroidhormonesecretionConclusionIfapatient’sthyr

7、oidisproducingtoomuchthyroidhormone,thenthecirculatingTSHwillbesuppressed.Ifthethyroidisnotsecretingenoughthyroidhormone,theTSHlevelswillbeveryhighinanattempttostimulatetheglandtosecretemore.ThyroidfunctiontestsThyroidfunctiontestmeansbiochemicalmeasurementsinthediagnosisofthyro

8、iddisease.Testingitems:T4status(totalT4andfreeT