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Evaluation of Patient with Thyroid Disorders

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Evaluation of Patient with Thyroid Disorders IJRPC 2013, 3(2) Roshni et al. ISSN: 22312781 INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY Available online at www.ijrpc.com Review Article EVALUATION OF PATIENT WITH THYROID DISORDERS Roshni PR*, Rajan VK, Meenuvijayan and RemyaReghu Department of Pharmacy Practice, Amrita School of Pharmacy, Kochi, Kerala, Thiruvanthapuram, India. The thyroid gland is one of the is difficult to demarcate the gland's upper and largest endocrine glands. The thyroid gland is lower border with vertebral levels because it found in the neck, below the thyroid moves position in relation to these during cartilage (which forms the laryngeal swallowing. prominence, or "Adam's apple"). The isthmus The thyroid gland is covered by a thin fibrous (the bridge between the two lobes of the sheath, the capsulaglandulaethyroidea, thyroid) is located inferior to the cricoid composed of an internal and external layer. cartilage. The external layer is anteriorly continuous with The thyroid gland controls how quickly the the lamina pretrachealis fasciae cervicalis and body uses energy, makes proteins, and posteriorolaterally continuous with the carotid controls how sensitive the body is to sheath. The gland is covered anteriorly other hormones. It participates in these with infrahyoid muscles and laterally with processes by producing thyroid hormones, the the sternocleidomastoid muscle also known as principal ones being tri iodothyronine (T3) and sternomastoid muscle. On the posterior side, a thyroxin which can sometimes be referred to the gland is fixed to the cricoid and tracheal as tetraiodothyronine (T4). These hormones cartilage and cricopharyngeus muscle by a regulate the rate of metabolism and affect the thickening of the fascia to form the posterior growth and rate of function of many other suspensory ligament of Berry1,2. The thyroid systems in the body. T3 and T4 are gland's firm attachment to the underlying synthesized from both iodine andtyrosine. The trachea is the reason behind its movement thyroid also produces calcitonin, which plays a with swallowing3. In variable extent, Lalouette's role in calcium homeostasis. Pyramid, a pyramidal extension of the thyroid Hormonal output from the thyroid is regulated lobe, is present at the most anterior side of the by thyroid-stimulating hormone (TSH) lobe. In this region, the recurrent laryngeal produced by the anterior pituitary, which itself nerve and the inferior thyroid artery pass next is regulated by thyrotropin-releasing to or in the ligament and tubercle. hormone (TRH) produced by Between the two layers of the capsule and on the hypothalamus. the posterior side of the lobes, there are on The thyroid gets its name from the Greek word each side two parathyroid glands. for "shield", due to the shape of the related The thyroid isthmus is variable in presence thyroid cartilage. The most common problems and size, can change shape and size, and can of the thyroid gland consist of an overactive encompass a cranially extending pyramid lobe thyroid gland, referred to as hyperthyroidism, (lobuspyramidalis or processuspyramidalis), and an underactive thyroid gland, referred to remnant of the thyroglossal duct. Thethyroid is as hypothyroidism. one of the larger endocrine glands, weighing The thyroid gland is a butterfly-shaped organ 2-3 grams in neonates and 18-60 grams in and is composed of two cone-like lobes or adults, and is increased in pregnancy. wings, lobusdexter (right lobe) and lobus The thyroid is supplied with arterial blood from sinister (left lobe), connected via the isthmus. the superior thyroid artery, a branch of The organ is situated on the anterior side of the external carotid artery, and the inferior the neck, lying against and around thyroid artery, a branch of the thyrocervical the larynx and trachea, reaching posteriorly trunk, and sometimes by the thyroid ima theoesophagus and carotid sheath. It starts artery, branching directly from the cranially at the oblique line on thethyroid brachiocephalic trunk. The venous blood is cartilage (just below the laryngeal prominence, drained via superior thyroid veins, draining in or 'Adam's Apple'), and extends inferiorly to the internal jugular vein, and via inferior thyroid approximately the fifth or sixth tracheal ring. It 244 IJRPC 2013, 3(2) Roshni et al. ISSN: 22312781 veins, draining via the plexus thyroideus peroxide generated by the enzymethyroid impar in the left brachiocephalic vein. peroxidase (TPO)7 and linked to the 3' and 5' Lymphatic drainage passes frequently sites of the benzene ring of the tyrosine the lateral deep cervical lymph nodes and residues on Tg, and on free tyrosine. Upon the pre- and parathracheal lymph nodes. The stimulation by the thyroid-stimulating gland is supplied by parasympathetic nerve hormone (TSH), the follicular cells reabsorb Tg input from the superior laryngeal nerve and and cleave the iodinated tyrosines from Tg in the recurrent laryngeal nerve. lysosomes, forming T4 and T3 (in T3, one At the microscopic level, there are three iodine atom is absent compared to T4), and primary features of the thyroid4 releasing them into the blood.Deiodinase 15 enzymes convert T4 to T3 . Thyroid hormone (a)Follicles secreted from the gland is about 80-90% 5,6 The thyroid is composed of spherical follicles T4 and about 10-20% T3 . that selectively absorb iodine (as iodide ions, Cells of the developing brain are a major target ) I from the blood for production of thyroid for the thyroid hormones T3 and T4. Thyroid hormones, but also for storage of iodine hormones play a particularly crucial role in in thyroglobulin, in fact iodine is necessary for brain maturation during fetal development8. A other important iodine-concentrating organs as transport protein that seems to be important breast, stomach, salivary glands, thymus etc. for T4transport across the blood–brain (see iodine in biology). Twenty-five percent of barrier (OATP1C1) has been identified9 A all the body's iodide ions are in the thyroid second transport protein (MCT8) is important 9 gland. Inside the follicles, in a region called for T3 transport across brain cell membranes . the follicular lumen, colloid serves as a Non-genomic actions of T4 are those that are reservoir of materials for thyroid hormone not initiated by liganding of the hormone to production and, to a lesser extent, acts as a intranuclear thyroid receptor. These may begin reservoir for the hormones themselves. Colloid at the plasma membrane or within cytoplasm. is rich in a protein calledthyroglobulin. Plasma membrane-initiated actions begin at a receptor on the integrin alphaV beta3 that (b)Thyroid epithelial cells activates ERK1/2. This binding culminates in The follicles are surrounded by a single layer local membrane actions on ion transport of thyroid epithelial cells, which systems such as the Na(+)/H(+) exchanger or secrete T3 and T4. When the gland is not complex cellular events including cell secreting T3/T4 (inactive), the epithelial cells proliferation. These integrins are concentrated range from low columnar to cuboidal cells. on cells of the vasculature and on some types When active, the epithelial cells become tall of tumor cells, which in part explains the columnar cells. proangiogenic effects of iodothyronines and proliferative actions of thyroid hormone on (c)Parafollicular cells some cancers including gliomas. T4 also acts Scattered among follicular cells and in spaces on the mitochondrial genome via imported between the spherical follicles are another isoforms of nuclear thyroid receptors to affect type of thyroid cell, parafollicular cells, which several mitochondrial transcription factors. secrete calcitonin. Regulation of actin polymerization by T4 is critical to cell migration in neurons and glial Physiology cells and is important to brain development. The primary function of the thyroid is T3 can activate phosphatidylinositol 3- production of the kinase by a mechanism that may be hormones triiodothyronine (T3), thyroxine (T4), cytoplasmic in origin or may begin at integrin and calcitonin. Up to 80% of the T4 is alpha V beta3. converted to T3 by peripheral organs such as In the blood, T4 and T3 are partially bound the liver, kidney and spleen. T3 is several to thyroxine-binding times more powerful than T4, which is largely globulin (TBG), transthyretin, and albumin. a prohormone, perhaps four5 or even ten times Only a very small fraction of the circulating 6 more active . hormone is free (unbound) - T4 0.03% and T3 0.3%. Only the free fraction has hormonal T3 and T4 production and action activity. As with the steroid Thyroxine (T4) is synthesised by the follicular hormones and retinoic acid, thyroid hormones cells from free tyrosine and on the tyrosine cross the cell membrane and bind residues of the protein tointracellular receptors (α1, α2, β1 and β2), called thyroglobulin (Tg). Iodine is captured which act alone, in pairs or together with with the "iodine trap" by the hydrogen 245 IJRPC 2013, 3(2) Roshni et al. ISSN: 22312781 the retinoid X-receptor as transcription The thyroid gland is located in the front of the factors to modulate DNA transcription1. neck just below the voice box (larynx). It releases hormones that control metabolism. T3 and T4 regulation Hypothyroidism, or underactive thyroid, is The production of thyroxine and more common in women and people over age triiodothyronine is regulated by thyroid- 50. stimulating hormone (TSH), released by The most common cause of hypothyroidism is theanterior pituitary. The thyroid thyroiditis. Swelling
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