Thursday 26 July 2007

2042 week 2 the wedding

looks like my idea hasn't really taken off but I'll just start this weeks anyway...

Pat

3 comments:

Anonymous said...

robb said...

Hyperthyroidism
Pathophysiology

Normal function of the thyroid gland primarily controlled by the anterior pituitary and hypothalamus. Thyroid hormone secretion is tightly regulated by thyroid-stimulating hormone released by the anterior pituitary. The stimulus for the release of TSH is thyroid releasing factor released by the hypothalamus (positive effect) , and circulating levels of thyroid hormone (negative feedback loop).

The thyroid hormones are thyroxine (T4) and triiodothyronine (T3), and are manufactured from tyrosine and iodine. The thyroid hormones are released into the blood and act to increase metabolism. T3 is the most active form and acts by binding to a nuclear receptor and regulates the transcription of certain cellular proteins.

Hyperthyroidism is the result of an increase in circulating thyroid hormone, the pathogenesis of which varies.

Grave’s Disease:
Hyperthyroidism in Grave’s disease is caused by thyroid-stimulating immunoglobulins (TSIs), which are IgG antibodies that bind to the extracellular domain of the TSH receptor and activate it. This results in growth of the follicles and increased production and secretion of thyroid hormones. The stimulus for production of TSIs is unknown, but may relate to viral infection of the thyroid which may induce MHC II antigens on the surface of the thyroid follicular cells, inducing an immune response.

Toxic adenoma’s/ toxic nodular goitre:
In the case of toxic nodules of the thyroid, a neoplastic tumour forms in the thyroid gland and releases large amounts of thyroid hormone without stimulation from TSH.

McCune-Albright Syndrome:
This rare syndrome is caused by a genetic mutation in the G-protein that links the TSH receptor with adenylate cyclase, causing constant activation of the TSH receptor without TSH.

Subacute Thyroiditis:
Inflammation of the thyroid gland results in release of preformed thyroid hormones, resolves with resolution of inflammation.

Pituitary adenoma:
A tumour in the pituitary that causes inappropriate secretion of TSH, which in turn stimulates the secretion of thyroid hormones.

Pituitary resistance to T4:
A genetic mutation in the thyrotrophs of the anterior pituitary can lead them to become unresponsive to the negative feedback of T4, resulting in continued secretion of TSH despite high levels of circulating T4.

References:
eMedicine; Guyton and Hall

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