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14-September-2008 18:02:48 - Thyroid-stimulating hormone Thyroid-stimulating hormone, alpha Glycoprotein hormones, alpha polypeptide Identifiers Symbol CGA Alt. Symbols HCG, GPHa, GPHA1 Entrez 1081 HUGO 1885 OMIM 118850 RefSeq NM_000735 UniProt P01215 Other data Locus Chr. 6 q14-q21 Thyroid-stimulating hormone, beta Identifiers Symbol TSHB Entrez 7252 HUGO 12372 OMIM 188540 RefSeq NM_000549 UniProt P01222 Other data Locus Chr. 1 p13 Thyroid-stimulating hormone also known as TSH or thyrotropin is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland which regulates the endocrine function of the thyroid gland.1 Contents 1 Physiology 1.1 Controlling the rate of release 1.2 Subunits of TSH 1.3 The TSH receptor 2 Diagnostic use 3 Therapeutic use 4 Footnotes 5 External links Physiology Controlling the rate of release TSH stimulates the thyroid gland to secrete the hormones thyroxine T4 and triiodothyronine T3.2 TSH production is controlled by a Thyrotrophin Releasing Hormone, TRH, which is manufactured in the hypothalamus and transported to the anterior pituitary gland via the superior hypophyseal artery, where it increases TSH production and release. Somatostatin is also produced by the hypothalamus, and has an opposite effect on the pituitary production of TSH, decreasing or inhibiting its release. The level of thyroid hormones T3 and T4 in the blood have an additional effect on the pituitary release of TSH; When the levels of T3 and T4 are low, the production of TSH is increased, and conversely, when levels of T3 and T4 are high, then TSH production is decreased. This effect creates a regulatory negative feedback loop. Subunits of TSH TSH is a glycoprotein and consists of two subunits, the alpha and the beta subunit. The α alpha subunit i.e., chorionic gonadotropin alpha is identical to that of human chorionic gonadotropin HCG, luteinizing hormone LH, follicle-stimulating hormone FSH. The β beta subunit is unique to TSH, and therefore determines its function. The TSH receptor The TSH receptor is found mainly on thyroid follicular cells3. Stimulation of the receptor increases T3 and T4 production and secretion. Stimulating antibodies to this receptor mimic TSH action and are found in Graves' disease. Diagnostic use TSH levels are tested in the blood of patients suspected of suffering from excess hyperthyroidism, or deficiency hypothyroidism of thyroid hormone. Generally, a normal range for TSH for adults is between 0.4 and 5.0 uIU/mL equivalent to mIU/L, but values vary slightly among labs. The optimal goal TSH level for patients on treatment ranges between 0.3 to 3.0 mIU/L.4. The interpretation depends also on what the blood levels of thyroid hormones T3 and T4 are. The National Health Service in the UK considers a normal range to be more like 0.1 to 5.0 uIU/mL.citation needed TSH levels for children normally start out much higher. In 2002, the National Academy of Clinical Biochemistry NACB in the United States recommended age-related reference limits starting from about 1.3-19 uIU/mL for normal term infants at birth, dropping to 0.6-10 uIU/mL at 10 weeks old, 0.4-7.0 uIU/mL at 14 months and gradually dropping during childhood and puberty to adult levels, 0.4-4.0 uIU/mL.5 The NACB also stated that it expected the normal 95% range for adults to be reduced to 0.4-2.5 uIU/mL, because research had shown that adults with an initially measured TSH level of over 2.0 uIU/mL had an increased odds ratio of developing hypothyroidism over the following 20 years, especially if thyroid antibodies were elevated.6 Source of pathology TSH level thyroid hormone level Disease causing conditions hypothalamus/pituitary high high benign tumor of the pituitary adenoma or thyroid hormone resistance hypothalamus/pituitary low low hypopituitarism thyroid low high hyperthyroidism or Grave's disease thyroid high low congenital hypothyroidism cretinism, hypothyroidism Clearly, both TSH and T3 and T4 should be measured to ascertain where a specific thyroid dysfunction is caused by primary pituitary or by a primary thyroid disease. If both are up or down then the problem is probably in the pituitary. If the one component TSH is up, and the other T3 and T4 is down, then the disease is probably in the thyroid itself. The same holds for a low TSH, high T3 and T4 finding. A TSH assay is now also the recommended screening tool for thyroid disease. Recent advances in increasing the sensitivity of the TSH assay make it a better screening tool than free T4.1 Therapeutic use A drug, recombinant human TSH rhTSH, called Thyrogen, is manufactured by Genzyme Corp. in Cambridge, Massachusetts. The rhTSH is used in patients with thyroid cancer which is related to tumoral factors. Footnotes ^ a b Sacher, Ronald; Richard A. McPherson 2000. Wildmann's Clinical Interpretation of Laboratory Tests, 11th ed.. F.A. Davis Company. ISBN 0-8036-0270-7. ^ Physiology at MCG 5/5ch5/s5ch5_4 ^ Parmentier M, Libert F, Maenhaut C, Lefort A, Gérard C, Perret J, Van Sande J, Dumont JE and Vassart G., Molecular cloning of the thyrotropin receptor, Science 246 1989, 1620-1622 ^ American Association of Clinical Endocrinologists ^ Demers, Laurence M.; Carole A. Spencer 2002. LMPG: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease. National Academy of Clinical Biochemistry USA. Retrieved on 2007-04-13. - see Section 2. Pre-analytic factors ^ Demers, Laurence M.; Carole A. Spencer 2002. LMPG: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease. National Academy of Clinical Biochemistry USA. Retrieved on 2007-04-13. - see Section 3.C.Thyrotropin/ Thyroid Stimulating Hormone TSH measurement External links MedlinePlus Encyclopedia 003684 MeSH Thyrotropin v d e Endocrine system: hormones/endocrine glands Peptide hormones, Steroid hormones Hypothalamic-pituitary Hypothalamus: TRH, CRH , GnRH, GHRH, somatostatin, dopamine - Posterior pituitary: vasopressin, oxytocin - Anterior pituitary: α FSH, LH, TSH, GH, prolactin, POMC ACTH, MSH, endorphins, lipotropin Adrenal axis Adrenal medulla: epinephrine, norepinephrine - Adrenal cortex: aldosterone, cortisol, DHEA Thyroid axis Thyroid: thyroid hormone T3 and T4 - calcitonin - Parathyroid: PTH Gonadal axis Testis: testosterone, AMH, inhibin - Ovary: estradiol, progesterone, inhibin/activin, relaxin pregnancy Other end. glands Pancreas: glucagon, insulin, somatostatin - Pineal gland: melatonin Non-end. glands Placenta: hCG, HPL, estrogen, progesterone - Kidney: renin, EPO, calcitriol, prostaglandin - Heart atrium: ANP - Stomach: gastrin, ghrelin - Duodenum: CCK, GIP, secretin, motilin, VIP - Ileum: enteroglucagon - Adipose tissue: leptin, adiponectin, resistin - Thymus: Thymosin - Thymopoietin - Thymulin - Skeleton: Osteocalcin - Liver/other: Insulin-like growth factor IGF-1, IGF-2 Target-derived NGF, BDNF, NT-3 Retrieved from http://en..org/wiki/Thyroid-stimulating_hormone Categories: Genes on chromosome 6 | Genes on chromosome 1 | Glycoproteins | Peptide hormones | Anterior pituitary hormones | HPT axisHidden categories: Protein pages needing a picture | All articles with statements | Articles with statements since April 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Bosanski ÄŒesky Dansk Deutsch Þ‹Þ¨ÞˆÞ¬Þ€Þ¨Þ„Þ¦Þ?Þ° Español Français Bahasa Indonesia Italiano עברית Lietuvių Magyar МакедонÑ?ки Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий SlovenÄ?ina СрпÑ?ки / Srpski Suomi Svenska This page was last modified on 13 September 2008, at 08:16

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