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Related Concept Videos

Synthesis and Regulation of Thyroid Hormones01:20

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Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
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The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
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Skeleton and Calcium Homeostasis01:21

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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Hormones and Bone Tissue01:17

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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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Should Free Thyroxine Go Back into the Routine Thyroid Profile?

M Livingston1, P J Twomey2, A Basu3

  • 1Department of Blood Sciences, Walsall Manor Hospital, Walsall.

Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [And] German Diabetes Association
|November 25, 2015
PubMed
Summary
This summary is machine-generated.

A combined thyroid-stimulating hormone (TSH) and free thyroxine (fT4) test is crucial for detecting secondary hypopituitarism. This strategy identifies cases missed by TSH-only testing, improving diagnostic accuracy for thyroid dysfunction.

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Area of Science:

  • Endocrinology
  • Clinical Chemistry
  • Diagnostic Medicine

Background:

  • Many labs use thyroid-stimulating hormone (TSH) as a sole first-line thyroid function test.
  • This approach risks missing secondary hypothyroidism cases with normal TSH and low free thyroxine (fT4).
  • Secondary hypothyroidism requires assessing both TSH and fT4 for accurate diagnosis.

Purpose of the Study:

  • To evaluate the diagnostic yield of combining TSH and fT4 testing for thyroid function.
  • To assess the cost-effectiveness of including fT4 in the initial thyroid function test profile.
  • To identify cases of secondary hypopituitarism missed by TSH-only testing.

Main Methods:

  • Analysis of 26,106 consecutive thyroid function test (TFT) results.
  • Identification of hypopituitarism based on low fT4 and TSH within or below reference ranges.
  • Estimation of costs for identifying pituitary insufficiency using combined fT4 and TSH testing in 2004 and 2013.

Main Results:

  • 121 patients presented with normal TSH and low fT4.
  • Eight new cases of secondary hypopituitarism were identified by combining fT4 and TSH testing.
  • The cost per identified case of pituitary insufficiency significantly decreased from 1998 to 2013.

Conclusions:

  • TSH-only testing strategies miss significant cases of secondary hypopituitarism.
  • Adding fT4 to the routine TFT profile is recommended for comprehensive thyroid function assessment.
  • The cost-effectiveness of combined testing has improved over time, making it a viable diagnostic approach.