MEDICAL PHYSIOLOGY OF THYROID GLAND

1. THYROID GLAND AND
THYROID METABOLIC
HORMONES

2. LEARNING OBJECTIVES
By the end of this lecture you should be able to:
• Describe physiologic anatomy of thyroid gland.
• Describe various steps involved in synthesis of
thyroid hormones.
• Enumerate various functions of TSH.
• Describe difference between T4 and T3.
• Describe how T4 is converted to T3
• Describe how thyroid hormone is transported in
circulation.

3. ANATOMY OF THE THYROID GLAND

4. 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)

5. THYROID SECRETESTWO METABOLIC
HORMONES:
1. THYROXINE (T4 )
2. TRIIODOTHYRONINE (T3)

6. STEPS OF THYROID
HORMONE
SYNTHESIS
T4 and T3

7. Biosynthesis of T4 and T3
• Dietary iodine (I) ingestion
• Active transport and uptake of iodide (I-) by thyroid
gland.
• Synthesis of Thyroglobulin by ER Of thyroid follicular cells
• 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

8. Dietary iodine (I) ingestion
Iodine Sources
• Available through certain foods:
seafood, bread, dairy products, iodized
salt, or dietary supplements, as a trace
mineral
• The recommended minimum intake is
150 g/day 1mg/week

9. ACTIVE TRANSPORT AND I- UPTAKE
BY THE THYROID
Dietary iodine reaches the
circulation as iodide anion (I-)
I- accumulation in the thyroid is
an active transport process that
is stimulated by TSH

10. Iodide Active Transport is Mediated by
the Sodium-Iodide Symporter (NIS)
• NIS is a membrane protein that mediates
active iodide uptake by the thyroid
• It functions as a I- concentrating mechanism
“iodide trapping” for T4 and T3 biosynthesis

18. OXIDATION OF I- AND IODINATION OF
TYROSINE RESIDUES—“ORGANIFICATION” OF
THYROGLOBULIN.
• I- must be oxidized to be able to iodinate tyrosyl residues
of Tg.
• Iodination of the tyrosyl residues then forms
monoiodotyrosine (MIT) and diiodotyrosine (DIT), which
are then coupled to form either T3 or T4
• Both reactions are catalyzed by TPO

20. Thyroperoxidase (TPO)
• TPO catalyzes the oxidation steps involved in
I- activation, iodination of Tg tyrosyl residues,
and coupling of iodotyrosyl residues
• TPO has binding sites for I- and tyrosine
• TPO uses H2O2 as the oxidant.

21. Storage of Thyroglobulin
• Each thyroglobulin molecule contains up to 30
thyroxine molecules and a few T3 molecules.
• The thyroid hormones are stored in the
follicles to supply the body with of thyroid
hormones for 2 to 3 months.

22. RELEASE OF THYROXINE AND
TRIIODOTHYRONINE FROM
THE THYROID GLAND

23. PROTEOLYSIS OF TG WITH
RELEASE OF T4 AND T3
• T4 and T3 are synthesized and stored within the
Tg molecule
• Proteolysis is an essential step for releasing the
hormones
• To liberate T4 and T3, Tg is resorbed into the
follicular cells in the form of colloid droplets,
which fuse with lysosomes to form
phagolysosomes
• Tg is then hydrolyzed to T4 and T3, which are then
secreted into the circulation

25. ION TRANSPORT BY THE
THYROID FOLLICULAR CELL
I-
I- organification
Propylthiouracil (PTU)
blocks iodination of
thyroglobulin
COLLOID
BLOOD
NaI symporter (NIS)
Thyroid peroxidase (TPO)
ClO4
-, SCN-

26. Conversion of T4 to T3 in Peripheral
Tissues

27. Production of T4 and T3
• T4 is the primary secretory product of the
thyroid gland, which is the only source of T4
93%
• The thyroid secretes approximately 70-90
g of T4 per day.

28. T4: A Prohormone for T3
• T4 is biologically inactive in target tissues
until converted to T3
• T3 is the biologically active hormone
responsible for the majority of thyroid
hormone effects

29. Sites of T4 Conversion
• The liver is the major extrathyroidal site
for conversion ofT4 to T3
• Some conversion also occurs in the
kidney and other tissues

30. Hormonal Transport

31. Carriers for Circulating Thyroid Hormones
• More than 99% of circulating T4 and T3 is bound to
plasma carrier proteins
– Thyroxine-binding globulin (TBG), binds about 75%
– Transthyretin (TTR), also called thyroxine-binding
prealbumin (TBPA), binds about 10%-15%
– Albumin binds about 7%
– High-density lipoproteins (HDL) , binds about 3%
• Carrier proteins can be affected by physiologic
changes, drugs, and disease

32. Free Hormone Concept
• Only unbound (free) hormone
has metabolic activity and
physiologic effects
–Free hormone is a tiny percentage
of total hormone in plasma (about
0.03% T4; 0.3% T3)

33. Thyroid-Stimulating Hormone (TSH)
• Regulates thyroid hormone production,
secretion, and growth
• Is regulated by the negative feedback
action of T4 and T3.
• TSH stimulates active transport and i-
uptake by the thyroid

34. Hypothalamic-Pituitary-Thyroid Axis
Negative Feedback Mechanism

35. Changes in TBG Concentration Determine
Binding and Influence T4 and T3 Levels
• Increased TBG
– Total serum T4 and T3 levels increase
– Free T4 (FT4), and free T3 (FT3) concentrations remain
unchanged
• Decreased TBG
– Total serum T4 and T3 levels decrease
– FT4 and FT3 levels remain unchanged

36. Drugs and Conditions That Increase Serum T4 and
T3 Levels by Increasing TBG
• Drugs that increase TBG
– Oral contraceptives and
other sources of estrogen
– Methadone
– Clofibrate
– 5-Fluorouracil
– Heroin
– Tamoxifen
• Conditions that increase
TBG
– Pregnancy
– Infectious/chronic active
hepatitis
– HIV infection
– Biliary cirrhosis
– Acute intermittent porphyria
– Genetic factors

37. Drugs and Conditions That Decrease Serum T4 and T3 by
Decreasing TBG Levels or Binding of Hormone to TBG
• Drugs that decrease serum
T4 and T3
– Glucocorticoids
– Androgens
– L-Asparaginase
– Salicylates
– Mefenamic acid
– Antiseizure medications, eg,
phenytoin, carbama-zepine
– Furosemide
• Conditions that decrease
serum T4 and T3
– Genetic factors
– Acute and chronic illness