What are the pituitary gonadotropins?
LH = Luteinizing hormone
FSH = Follicle stimulating hormone
What does the Gonadotropin releasing hormone (GnRH), LH, and FSH regulate?
Sexual differentiation
Sex steroid production
Fertility
How does LH and FSH affect women?
FSH promotes follicular development
LH promotes ovulation
How does LH and FSH affect men?
LH stimulates testosterone production from Leydig cells in the testes
FSH is required for spermatogenesis
What do estradiol, progesterone, and testosterone do?
Effects pituitary and hypothalamus
Negative feedback
Reduces LH and FSH release
What would cause a defect in reproductive function?
◦Primary failure of gonads
serum gonadotropin concentrations will be high
◦Primary failure of hypothalamus or pituitary
serum gonadotropin concentrations will be low
What does the thyroid stimulating hormone stimulate?
Production of T3 and T4
Which thyroid hormone is capable of exerting a biological affect?
Free hormone
The bound hormone is not able to enter the cell
T - uptake
The addition of labeled T3 or T4 to the serum
Saturates unbound TBG sites
Resin takes up excess T3 or T4
Low uptake
Increase unbound TBG
High uptake
Decrease unbound TBG
[total T4] * % Tuptake
FT4 Index
[total T3] * %Tuptake
FT3 Index
Resin takes up excess (unbound) T in an amount….
INVERSELY related to the amount of free binding sites
Which hormone is this?:
Stimulated by TRH
Inhibited by T4 and T3
TSH
Are more thyroid disorders primary or secondary?
Primary
Diagnosis?
TSH : Down
T4: Up
T-up: Up
FTI: Up
Primary hyperthyroid
Diagnosis?
TSH : Up
T4: Down
T-up: Down
FTI: Down
Primary Hypothyroid
Diagnosis?
TSH : Up
T4: Up
T-up: Up
FTI: Up
Secondary hyperthyroid
Diagnosis?
TSH : Down
T4: Down
T-up: Down
FTI: Down
Secondary hypothyroid
Diagnosis?
TSH : nl
T4: Up
T-up: Down
FTI: nl
Increased TBG
Diagnosis?
TSH : nl
T4: Down
T-up: Up
FTI: nl
Decreased TBG
What causes elevated TBG?
Pregnancy, birth control pills, other high estrogen states
What causes decreased TBG?
chronic liver disease, other low protein states
Best screening test for thyroid disorders?
TSH
Normal TSH levels
0.3 - 5.0
TSH > 5.0
FT4
TSH < 0.3
FT4*
*Consider FT3
Primary hypothyroidism
Autoimmune with lymphocytic infiltration and destruction of the thyroid gland
can be caused by thyroidectomy or post treatment for Grave’s disease with radioactive iodine
Hashimoto’s thyroiditis
Associated with circulating antibodies to thyroglobulin
Symptoms of Moderate Primary hypothyroidism
cold intolerance, weight gain, thinning of hair, voice changes, and other basic metabolic processes
Severe hypothyroidism
may develop life threatening myxedema coma
replacement thyroid hormone is given very slowly to prevent metabolic collapse
Grave’s Hyperthyroidism
less common
Grave’s disease
LATS, IgG immunoglobulin directed against TSH receptor, mediates thyroid stimulation of Grave’s disease
Signs and symptoms of Grave’s disease
hand tremors, heat intolerance, weight loss, increased appetite, warm moist skin, stare and lid lag
Treatment of Grave’s disease
Thyroid ablation by surgery or radioactive iodine, or chemical blockage of hormone production