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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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Functions of Thyroid Hormones01:18

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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 Gland01:23

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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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Insulin: Dosing Regimen and Adverse Effects01:16

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Target Cell Response to Hormones01:22

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Hormones intricately bind to receptors on the surface or within target cells, initiating a cascade of cellular responses.
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Major Hormones and Their Functions01:27

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Hormones, the biochemical messengers produced by endocrine glands, are pivotal in regulating bodily functions and maintaining homeostasis. Each hormone's balance is crucial; imbalances can lead to significant physiological disruptions. Major hormones include oxytocin, cortisol, epinephrine, estrogen, testosterone, thyroxine, growth hormone, insulin, and glucagon.
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Author Spotlight: In Vivo Assessment of Thyroid Hormone Disruption Using the THAI Mouse Model
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Thyroxine replacement: a clinical endocrinologist's viewpoint.

V Eligar1, P N Taylor1, O E Okosieme2

  • 1Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK.

Annals of Clinical Biochemistry
|April 30, 2016
PubMed
Summary
This summary is machine-generated.

Optimizing thyroid hormone replacement therapy remains a challenge, with many patients experiencing undertreatment or overtreatment despite levothyroxine use. Further research is needed to refine best practices for improved patient outcomes in hypothyroidism management.

Keywords:
Thyroxinehyperthyroidismhypothyroidismthyrotropintriiodothyronine

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Internal Medicine

Background:

  • Hypothyroidism impacts 2-5% of the population, leading to significant morbidity including cardiovascular disease and neurocognitive impairment if untreated.
  • Levothyroxine is the standard treatment, but 30-50% of patients are undertreated or overtreated, with many remaining dissatisfied.
  • Despite treatment, achieving optimal thyroid hormone levels and patient well-being presents ongoing challenges.

Purpose of the Study:

  • To review current literature on best practices for thyroid hormone replacement therapy.
  • To identify persistent challenges and areas for improvement in managing hypothyroidism.
  • To explore the role of pharmacokinetics, adherence, and genetic factors in treatment efficacy.

Main Methods:

  • Systematic literature search for controlled trials, systematic reviews, guidelines, and cohort studies.
  • Focus on studies addressing best practices in thyroid hormone replacement.
  • Analysis of recent advancements in levothyroxine pharmacokinetics and patient management.

Main Results:

  • Levothyroxine pharmacokinetics have improved management, but optimal timing, adherence strategies, and target thyroid-stimulating hormone levels in specific populations (pregnancy, thyroid cancer) remain difficult.
  • Genetic variations in deiodinases and transporters influence local thyroid hormone delivery.
  • Evidence for combination therapy with liothyronine and levothyroxine is limited, with uncertain benefits.

Conclusions:

  • Despite over a century of thyroid hormone replacement, significant practical challenges persist in optimizing patient treatment.
  • Opportunities exist to improve patient outcomes through refined management strategies and further research.
  • Personalized approaches considering genetic predispositions may offer future benefits.