[PART 3] [THYROID/PARATHYROID GLAND] Clinical Chemistry [RODRIGUEZ]

Endocrinology

The scientfc study of the functon and pathology of the endocrine gland

Hormone

Chemical substance that send message to another cell in the body

somatotropin

GROWTH HORMONE is also know as?

somatostatn

GROWTH HORMONE (somatotropin) Inhibitor

You've come this far! Take a break!

You've come this far! Take a break!

Insulin-like Growth Factor (IGF-1)

Preferred test for assessing GH defciency or excess during childhood and/or adolescent development

o Also used for monitoring recombinant human growth hormone treatment

o Also used for monitoring of treatment of individuals with acromegaly and gigantsm

YES!

Magiging doctor kaba?

Thyroid gland

- is positoned in the lower anterior neck and is shaped like a buterfy, made up of two lobes, restng on each side of the trachea, bridged by the isthmus

Parathyroid gland

posterior/just beneath the thyroid gland.

Regulate serum calcium levels

Thyroid Stimulating Hormone (TSH)

The MOST USEFUL TEST for assessing thyroid function

SECOND-GENERATION TSH

immunometric assays efectvely screen for hyperthyroidism

THIRD-GENERATION TSH

chemiluminometric assays give fewer false-negatve results and more accurately distnguish between "euthyroidism and hyperthyroidism"

THIRD-GENERATION ULTRASENSITIVE TSH TEST (S-TSH)

preferred method for monitoring and adjustng thyroid hormone REPLACEMENT therapy and screening for abnormal thyroid hormone producton in the clinical setting

FOURTH-GENERATION ASSAY

exists providing a 10-fold increase in sensitvity compared to thirdgeneraton assays, it is used primarily for "research purposes"

0.3-4.2 mIU/L - baliktad na number ni CURRY (30) at KOBE (24)

The reference range for s-TSH is

0.4-4.0 mIU/L

reference range for T4

20%

Thyroid gland produces only how many percent (%) of T3?

80%

how many percent (%) of T3 is form from Deiodinaton: conversion of T4 to T3

80-200 ng/dL

The reference range for total T3

FREE THYROXINE (FT4)

It is used as a SECOND-LINE TEST AFTER TSH in the evaluaton of suspected thyroid disorders and, when used in conjuncton with TSH

0.9-1.7 ng/dL

FT4 reference range

Free Triiodothyronine (FT3)

may be required to evaluate clinically euthyroid patents who have an altered distributon of thyroid binding proteins as seen during pregnancy or in patents with dysalbuminemia

2.8-4.4 pg/m

The reference range for FT3 is

Graves disease

Most common cause of hyperthyroidism

HASHIMOTO'S THYROIDITIS

chronic lymphocytic thyroidits is known as?

HASHIMOTO'S THYROIDITIS

The common cause of hypothyroidism

TPO antbody

Most appropriate test for HASHIMOTO'S THYROIDITIS?

Radioactve iodine

useful in assessing the metabolic actvity of thyroid tssue

Assistng in the evaluaton and treatment of thyroid cancer

Fine Needle Aspirate Biopsy

OFTEN frst step and most accurate tool in the evaluaton of thyroid nodules in the absence of hyperthyroidism

Hypothyroidism

defned as low FT4 with a normal or high TSH

Hyponatremia

can also occur from the combinaton of increased urinary sodium excreton and an ability to inappropriate release of ADH

Primary

Thyroid gland dysfuncton

Secondary

Pituitary dysfuncton

Tertiary

Hypothalamic dysfuncton

Levothyroxine (T4)

treatment of choice for hypothyroidism (Hashimoto's thyroidits)

Thyrotoxicosis

excess of thyroid hormone

Amiodarone

- (drug used to treat cardiac arrythmias) interferes with normal thyroid functon o Blocks T4 to T3 conversion

o Leads to hyperthyroidism

Postpartum thyroidits

most common form of subacute thyroidits

Plummer's Disease

T3 Thyotoxicosis is also known as?

T3

Most active form of thyroid hormone

T4

Principal secretory product of thyroid hormone

Riedle's Thyroiditis

Thyroid Hormone becomes woody/ stony hard mass in appearance

Graves disease

Most common cause of thyrotoxicosis

Reverse T3

END product of T4 Metabolism

Thyroxine- Binding Globulin (TBG)

Transports majority of T3

Transports 70-78% of total T4

Thyroxine-BindingPrealbumin(transthyretin)

It transports 15-20% of total T4

T3 has no affinity

Thyroxine-Binding Albumin

It transport T3 and 10% of T4

Hyperthyroidism

It refers to an excess of circulating thyroid hormone.

De Quervain' thyroiditis (painful thyroiditis)

it is associated with neck pain, low-grade fever and swings in thyroid function tests.

Hypothyroidism

bradycardia, weight gain, coarsened skin, cold intolerance and mental dulness is sign of?

Myxedema

it describes the peculiar nonpitting swelling of the skin.

Clinical features: "puffy" face, weight gain, slow speech, eyebrows thinned, dry and yelow skin, andanemia

Radioactive lodine Uptake (RAIU)

it is used to measure the ability of the thyroid gland to trap iodine.

Recombinant Human TSH

It is used to test patients with thyroid cancers for the presence of residual or recurrent disease.

parathyroid

What gland prevents hypocalcemia?

Primary hyperparathyroidism

It is the most common cause of hypercalcemia

Secondary hyperparathyroidism

it develops in response to decrease serum calcium.

True

True or False

Low calcium level will lead to TETANY

Primary Hyperparathyroidism

Increase Calcium, Decrease PTH

Secondary Hyperparathyroidism

Increase Calcium, Increase PTH

Tertiary Hyperparathyroidism

Increase PTH, Calcium precipitates, Increase Phosphate

Secondary Hypothyroidism

↓ TSH | ↓T4

Primary Hyperthyroidism

↓ TSH | ↑T4

Secondary Hyperthyroidism

↑ TSH | ↑T4

Secondary Hyperthyroidism

(N) TSH | ↑T4

Secondary Hypothyroidism

(N) TSH | ↓T4

Primary Hypothyroidism

↑ TSH | ↓T4

Subclinical Hypothyroidism

↑ TSH | (N) T4

Subclinical Hyperthyroidism

↓ TSH | (N) T4

NORMAL

(N) TSH | (N) T4

<0.4 IU/mL

Anti Tg Antibodies Ref range:

<0.9 IU/mL

Thyroperoxidase (TPO) Anitbodies Ref Range:

1.75 IU/mL

Thyrotropin receptor antibodies (TRAb) Ref Range:

Long Acting Thryeoid Stimulator or Thyroid Stimulation Immunoglobulins

Thyrotropin receptor antibodies (TRAb) is also known as

C terminal - C= Cement kaya solid

Solid phase Ab is what terminal?

N terminal - May "N" sa sig(N)al eh

Signal Ab is what terminal?

Sandwich Technique

Common TSH assay uses what technique?

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Follicular cells

Parafollicular or C cells (Calcitonin)

What are the 2 types of cells of THYROID GLAND

Thyroglobulin

is a glycoporotein; it acts as a preformed matrix containing tyrosyl groups; it is stored in the follicular colloid of the thyrcid gland.

Calcitonin

Parafollicular or C secretes?

Thyroperoxidase (TPO)

What autoantibody is involved in the tissue destructive process (Hashimoto's disease)?

TSH receptor (TR)

What autoantibody is is involved in Grave's disease

Hyperthyroidism

It refers to an excess of circulating thyroid hormone.

Graves' disease: (diffuse toxic goiter)

It is the most common cause of thyrotoxicosis

Plummer's disease

T3 thyrotoxicosis is also known as?

It occurs 6x more commonly in women than in men.

True or False

Graves' disease is more commonly in WOMEN than in MEN.

6x

Graves' disease occurs how many times more commonly in women than in men.

exophthalmos (bulgingeyes) and pritibial myxedema (may edema sa paa)

Give 2 Graves' disease features. Ano itchura ng pasyente

Subclinical hyperthyroidism

shows no clinical syrnptoms but TSH level is low, and FT, and FT normal

TSH receptor antibody test

Graves' disease Diagnostic test:

Subacute granulomatous thyroiditis / De Quervain' thyroiditis

painful thyroiditis is known as?

Hypothyroidism

It develops whenever insufficient amounts of thyroid hormone are available to tissues.

Hypothyroidism

bradycardia, weight gain, coarsened skin, cold intolerance and mental dullness are SYMPTOMS of what thyroid disease?

Primary hypothyroidism

it si primarily due todeficiency of elemental iodine

Hashimoto's disease (chronic autoimmune thyroiditis)

It is the most commoncause of primary HYPOthyroidism.

Hashimoto's disease

What disease is associated with enlargement of the thyroid gland (goiter)?

T3,T4 [low]

TSH [high]

TPO antibody [+]

Hashimoto's disease lab result

T3,T4 [high]

TSH [low]

TSH Receptor antibody [+]

Grave's disease lab result

Myxedema

it describes the peculiar nonpittingswelling of the skin.

clinical features: "puffy" face, weight gain, slow speech, eyebrowsthinned, dry and yellow skin, andanemia

Myxedema coma

It is the severe form of primary hypothyroidism