DMMA COLLEGE OF SOUTHERN PHILIPPINES ANATOMY AND PHYSIOLOGY OF ENDOCRINE SYSTEM

By: Asher Flores Pulgo, Junior

INTRODUCTION GLANDS The body contains two kinds of glands: EXOCRINE GLANDS (means outside) secrete their products into ducts that carry the secretions into the body cavities, into the lumen of an organ, or to the outer surface of the body. ENDOCRINE GLANDS (means within) secrete their products into the interstitial fluid surrounding the secretory cells rather than into the ducts. From the interstitial fluid, hormones diffuse into blood capillaries and blood carries them to target cells throughout the body. The endocrine glands include the pituitary, thyroid, parathyroid, adrenal, and pineal glands. In addition, several organs and tissues are not exclusively classified as endocrine glands but contain cells that secrete hormones. These include the hypothalamus, thymus, pancreas, ovaries, testes, kidneys, stomach, liver, small intestine, skin, heart, adipose tissue, and placenta. Taken together, all endocrine glands and hormone-secreting cells constitute the ENDOCRINE SYSTEM. THE NERVOUS AND THE ENDOCRINE SYSTEMS The nervous and endocrine system act together to coordinate functions of all body system. The nervous system acts through nerve impulse (action potential) conducted along axons of neurons. At synapses, nerve impulses trigger the release of mediator (messenger) molecules called neurotransmitter. Endocrine system also controls body activities by releasing mediators (hormones), but the means of control of the two systems are very different. A HORMONE is a mediator molecule that is released in one part of the body but regulates the activity of the cells in other parts of the body. Most hormones enter the interstitial fluid and then the bloodstream. The circulating blood delivers hormones to cells throughout the body. Both neurotransmitters and hormones exert their effects by binding to receptors on their target cells. Responses of the endocrine system often are slower than responses of the nervous system; although some hormones act within seconds; most take several minutes or more to cause a response. The effects of nervous system activation are generally briefer than those of the endocrine system. The nervous system acts on specific muscles and glands. The influence of the endocrine system is much broader; it helps regulate virtually all types of body cells.

HORMONE ACTIVITY RECEPTORS Although a given hormone travels throughout the body in the blood, it affects only specific target cells. Hormones influence their target cells by chemically binding to specific protein receptors. Only the target cells for a given hormone have receptors that bind and recognize the hormone. Generally, a target cell has 2,000 to 100,000 receptors for a particular hormone. ROLE OF HORMONE RECEPTORS Down-regulation if a hormone is present in excess, the number of target-cell receptors may decrease. Makes a target cell less sensitive to a hormone. Up-regulation when a hormone is deficient, the number of receptors may increase. Makes a target cell more sensitive to a hormone. NOTE! Endocrine Principle: If a hormone is prevented from interacting with its receptors, the hormone cannot perform its normal function. CIRCULATING AND LOCAL HORMONES Circulating hormone most endocrine hormones circulate by passing from the secretory cells that make them into interstitial fluid then into the blood. Local hormones act locally on neighboring cells or on the same cell that secreted them without first entering the bloodstream. Paracrines local hormones that act on neighboring cells. Autocrines local hormones that act on the same cell that secreted them. HORMONES INTERACTION The responsiveness of a target cell to a hormone depends on: The hormones concentration, the abundance of target cells hormone receptors, and influences exerted by other hormones. Permissive effect the action of some hormones on target cells require a simultaneous or recent exposure to a second hormone. Synergistic effect when the effect of two hormones acting together is greater or more extensive than the effect of each hormone acting alone. Antagonistic effect when the hormone opposes the actions of another hormone. CONTROL OF HORMONE SECRETION Signals from the nervous system. Chemical changes in the blood. Other hormones.

ENDOCRINE SYSTEM
HYPOTHALAMUS AND PITUITARY GLAND Hypothalamus is a small region of the brain below the thalamus, a major link between nervous system and endocrine system. Pituitary gland is a pea shaped structure that measures 0.5 inch in diameter and lies in the hypophyseal fossa of the sella turcica of the sphenoid bone. It attaches to the hypothalamus by a stalk, the infundibulum (a funnel), has two anatomically and functionally separate portions: ANTERIOR PITUITARY (adenohypophysis) The anterior pituitary secretes hormones that regulate a wide range of bodily activities, from growth to reproduction. Release of anterior pituitary hormones is stimulated by releasing hormones and suppressed by inhibiting hormone from hypothalamus. HUMAN GROWTH HORMONE Somatotrophs are the most numerous cells in the pituitary, and the growth hormone (hGH) is the most plentiful anterior pituitary hormone. The main function of hGh is to promote synthesis and secretions of small protein called INSULINLIKE GROWTH FACTORS (IGFs) or somatomedins. In response to human growth hormone , cells in the liver, skeletal muscles, cartilages, bones and other tissues secretes IGFs, which may either enter to the bloodstream from the liver or act locally in other tissues as autocrines and paracrines. FUNCTIONS OF IGFs: IGFs cause cells to grow and multiply by increasing uptake of amino acids into the cells and accelerating protein synthesis. IGFs also decreases the breakdown of proteins and the use of amino acids for ATP production. Due to this effects the IGFs, Human growth hormone increases the growth rate of the skeleton and skeletal muscles during childhood and the teenage years. In adults, human growth hormone and IGFs help maintain the mass of muscles and bones and promote healing injuries and tissue repair. IGFs enhance lipolysis in adipose tissue, which results in increased use of the released fatty acids for ATP production by body cells. In addition to affecting protein and lipid metabolism, human growth hormone and IGFs influence carbohydrate metabolism by decreasing carbohydrate uptake, which decreases the use of glucose for ATP production by most body cells. This action spares glucose so that it is available to neurons for ATP production in times of glucose scarcity. IGFs and human growth hormone may also stimulate liver cells to release glucose in the blood.

THYROID-STIMULATING HORMONE Thyroid-stimulating hormone (TSH) stimulates the synthesis and secretion of two thyroid hormones; Triiodothyronine (T3) and thyroxine (T4), both produced by thyroid gland. Thyrotropinreleasing hormone (TRH) from the hypothalamus controls TSH secretion. Release of TRH in turn depends on blood levels of T3 and T4; high levels of T3 and T4 inhibit secretion of TRH via negative feedback. FUNCTION OF T3 AND T4: T3 A hormone that helps regulate growth and development, helps control metabolism and body temperature. T4 Hormone that influences metabolic rate. FOLLICLE-STIMULATING HORMONE IN FEMALES: the ovaries are the targets for follicle stimulating hormone (FSH). Each month FSH initiates the development several ovarian follicles, a sac like arrangements of secretory cells that surround a developing oocyte. FSH also stimulates follicular cells to secrete estrogens. IN MALES: FSH stimulates sperm production in the testes. Gonadotropin-releasing hormone from the hypothalamus stimulates FSH release. LUTEINIZING HORMONE IN FEMALES: luteinizing hormone (LH) triggers ovulation, the release of secondary oocyte (future ovum) by an ovary. LH stimulates formation of the corpus luteum (structure formed after ovulation) in the ovary and secretion of progesterone by the corpus luteum. Together, FSH and LH also stimulate secretion of estrogens by ovarian cells. Estrogens and progesterone prepare the uterus for Implantation of a fertilized ovum and help prepare the mammary glands for milk secretion. IN MALES: LH stimulates cells in the testes to secrete testosterone. Secretion of LH, like that of FSH, is controlled by gonadotropin releasing hormone (GnRH). PROLACTIN Prolactin (PRL), together with the hormones, initiates and maintains milk secretion by the mammary glands. Ejection of milk from the mammary glands depends on the hormone oxytocin, which is released from the posterior pituitary gland. ADRENOCORTICOTROPIC HORMONE Corticotrophs secrete mainly adrenocorticotropic hormone (ACTH). ACTH controls production and secretion of cortisol and other glucocorticoids by the cortex (outer portion) of the adrenal glands. Corticotrophin-releasing hormone (CRH) from hypothalamus stimulates secretion of ACTH by corticotrophs.

POSTERIOR PITUITARY (neurohypophysis) Although the posterior pituitary gland does not synthesize hormones, it does store and release two hormones. It consists of axons and axon terminals of more than 10,000 hypothalamic neurosecretory cells. The cell bodies of neurosecretory cells are: PARAVENTRICULAR NUCLEUS synthesizes the hormone oxytocin SUPRAOPTIC NUCLEUS produces antidiuretic hormone (vasopressin) OXYTOCIN DURING AND AFTER DELIVERY OF A BABY affects two target tissues, the mothers uterus and breast. DURING DELIVERY enhances contraction of smooth muscle cells in the wall of uterus. AFTER DELIVERY it stimulates milk ejection from the mammary glands in response to the mechanical stimulus provided by a sucking infant. MALES AND NONPREGNANT FEMALES not clear. Experiments with animals have suggested that it has actions within the brain that foster parental caretaking behaviour toward young offspring. It may also be responsible, in part, for the feelings of sexual pleasure during and after intercourse. ANTIDIURETIC HORMONE (vasopressin) A substance that decreases urine production. ADH causes kidneys to return more water to the blood, thus decreasing urine volume. In the absence of ADH, urine output increases more than tenfold, From 1 litre to 2 litres to about 20 litres a day. Drinking alcohol often causes frequent and copious urination because alcohol inhibits secretion of ADH. ADH also decreases the water lost through sweating and causes constriction of arterioles, which increases blood pressure. THYROID GLAND The butterfly-shaped thyroid gland is located just inferior to the larynx (voice box). It is composed of left and right lateral lobes; one on either side of trachea, the normal mass of the thyroid is about 30 grams. It is highly vascularised and receives 80 120 ml of blood per minute. CALCITONIN The hormone produced by the parafollicular cells of the thyroid gland. CT can decrease the level of calcium in the blood by inhibiting the action of osteoclasts, the cells that breakdown bone extracellular matrix. The secretion of CT is controlled by a negative feedback system, when its blood level is high; calcitonin lowers the amount of blood calcium and phosphates by inhibiting bone resorption by osteoclast and by accelerating uptake of calcium and phosphates into the bone extracellular matrix.

Miacalcin, a calcitonin extract derived from salmon that is 10 times more potent than human calcitonin, is prescribed to treat osteoporosis. PARATHYROID GLAND Partially embedded in the posterior surface of the lateral lobes of the thyroid gland are several small, round masses of tissue. Each has a mass of about 40 mg. usually, one superior and one inferior parathyroid gland are attached to each lateral thyroid lobe, for a total of four. PARATHYROID HORMONE Parathyroid hormone is the major regulator of the levels of calcium (Ca2+), magnesium (Mg2+), and phosphate (HPO42-) ions in the blood. The specific action of PTH is to increase the number and activity of osteoclast. The result is elevated bone resorption, which increases ionic calcium and phosphates into the blood. PTH also acts on the kidneys. First, it slows the rate which calcium and magnesium are lost in from blood into the urine. Second, it increases loss phosphate from blood into the urine. Because more phosphate is lost in the urine than is gained from the bones, PTH decreases blood phosphate level and increases calcium and magnesium blood levels. A third effect of PTH on the kidneys is to promote formation of the hormone CALCITRIOL, the active form of vitamin D. Calcitriol increases the rate of calcium, magnesium and phosphate absorption from the gastrointestinal tract to the blood. ADRENAL GLANDS The paired adrenal glands, one of which lies superior to each kidney in the retroperitoneal space, have a flattened pyramidal shape. In adult, each adrenal gland is 3-5 cm in height, 2-3 cm in width, and a little less than 1 cm thick, with a mass of 3.5-5 grams, only half in size in birth. ADRENAL CORTEX The adrenal cortex produces steroid hormones that are essential for life. Complete loss of adrenocortical hormones leads to death due to dehydration and electrolyte imbalances in a few days or a week, unless hormone replacement therapy begins promptly. The adrenal cortex is subdivided into three zones, each of which secretes different hormones: Zona Glomerulosa The outer zone, just deep to the connective tissue capsules, its cells, which are closely packed and arranged in spherical cluster and arched colums secretes hormones called MINERALOCORTICOIDS Mineralocorticoids affect mineral homeostasis Zona Fasciculata the middle zone, is the widest of the three zones and consists of cells arranged in long,vstraight columns. It secretes mainly GLUCOCORTICOIDS Glucocorticoids affect glucose homeostasis Zona Reticularis are arranged in branching cords. Synthesizes small amount of weak ANDROGENS Androgens steroid hormones that have masculinizing effects.

MINERALOCORTICOIDS ALDOSTERONE is the major mineralocorticoid. It regulates homeostasis of two mineral ions, namely sodium ions and potassium ions, and helps adjust blood pressure and blood volume. Aldosterone also promotes the excretion of H+ in the urine; this removal of acids from the body helps prevent acidosis (blood pH below 7.35). GLUCOCORTICOIDS The Glucocorticoids, which regulate metabolism and resistance to stress, these are the following effects: PROTEIN BREAKDOWN - glucocorticoids increases the rate of protein breakdown, mainly in muscle fibers, and thus, increases the liberationof amino acids into the bloodstream. The amino acids may be used by body cells for synthesis of new protein or for ATP production. GLUCOSE FORMATION upon stimulation of glucocorticoids, liver cells may convert certain amino acids or lactic acid to glucose, which neurons and other cells can use for ATP production. Such conversion of a substance other than glycogen or other than glycogen or another monosaccharides into glucose called GLUCONEOGENSIS. LIPOLYSIS glucocorticoids stimulates lipolysis, the breakdown of triglycerides and release of fatty acids from adipose tissue into the blood. RESISTANCE TO STRESS glucocorticoids work in many ways to provide resistance to stress. The additional glucose supplied by the liver cells provides tissues with the ready source of ATP to combat stress, including exercise, fasting, fright, temperature extremes, high altitude, bleeding and disease. Because glucocorticoids make blood vessels more sensitive to other hormones that causes vasoconstriction, they raise blood pressure. This effect would be an advantage in cases of severe blood loss, which causes blood pressure to drop. ANTI- INFLAMMATORY EFFECTS glucocorticosteroids inhibit white blood cells that participate in inflammatory responses. Unfortunately, glucocorticoids also retard tissue repair, and as a result, they slow wound healing. Glucocorticoids are very useful in the treatment of chronic inflammatory disorder such as rheumatoid arthritis. DEPRESSION OF IMMUNE RESPONSES high doses of glucocorticosteroids depresses immune responses. For this reason, glucocorticoids are prescribed for organ transplant recipients to retard tissue rejection by the immune system.

ANDROGEN IN BOTH MALES AND FEMALES, the adrenal cortex secretes small amounts of weak androgens. The major androgen secreted by the adrenal gland is dehydroepiandrosterone (DHEA). AFTER PUBERTY IN MALES, the androgen testosterone is also released in much greater quantity by the testes. Thus, the amount of androgens secreted by the adrenal gland in males is usually so low that their effects are insignificant. IN FEMALES, however, adrenal androgens play important roles. They promote libido (sex drive) and are converted into estrogens (feminizing sex steroids) by other body tissues. AFTER MENOPAUSE, when ovarian secretion of estrogens ceases, all female estrogens come from conversion of adrenal androgens. Adrenal androgens also stimulate growth of auxiliary and pubic hair in boys and girls and contribute to the prepubertal growth spurt. Although control of adrenal androgens secretion is not fully understood, the main hormone that stimulates its secretion is ACTH. ADRENAL MEDULLA The inner region of the adrenal gland is a modified sympathetic ganglion of the autonomic nervous system (ANS). It develops from the same embryonic tissue as all other sympathetic ganglia, but its cells, which lack axons, form cluster around large blood vessels. Rather than releasing a neurotransmitter. CHROMAFFIN CELLS - the cells of the adrenal medulla secrete hormones and hormone release can occur very quickly. EPINEPHRINE (adrenaline) and NOREPINEPHRINE (noradrenaline) - it gives the body sudden energy in times of stress, known as the "fight or flight" response Unlike the hormones of the adrenal cortex, the hormones of the adrenal medulla are not essential for life since they only intensify sympathetic responses in other parts of the body. PANCREAS The pancreas is both an endocrine gland and an exocrine gland and its a flattened organ that measure about 12.5 -15 cm (4.5 6 in.) in length, the pancreas is located in the curve of the duodenum, the first part of the small intestine, and consists of a head, a body, and a tail. Roughly 99% of the cells of the pancreas are arranged in clusters called acini. And acini produce digestive enzymes, which flow into the gastrointestinal tract through a network of ducts. Scattered among the exocrine acini are 1 2 million tiny clusters of endocrine of endocrine tissue called pancreatic islets or islet of Langerhans. Abundant capillaries serve both the exocrine and endocrine portion of the pancreatic.

CELLS TYPES IN THE PANCREATIC ISLET Each pancreatic islet includes four types of hormone secreting cells: Alpha or A cells - secrete glucagon. Beta or B cells - secrete insulin. Delta or D cells - secrete somatostatin. F Cells - secrete pancreatic polypeptide.

The interactions of the four pancreatic hormones are complex and not completely understood. We do know that glucagon raises blood glucose level, and insulin lowers it. Somatostatin acts in a paracrine manner to inhibit both insulin and glucagon release form neighboring beta and alpha cells. It may also act as a circulating hormone to slow absorption of nutrients from the gastrointestinal tract. Pancreatic polypeptide inhibits somatostatin secretion, gallbladder contraction, and secretion of digestive enzymes by the pancreas. GONADS: OVARIES The ovaries are the gonads or sex organs in females. The two almond-sized ovaries are located on each side of the pelvis, one at the end of each fallopian tube. The ovaries are attached to the uterus or womb by an ovarian ligament. ESTROGEN Govern development of oocytes, maintenance of female reproductive structures, and appearance of secondary sex characteristics. PROGESTERONE Helps prepare the endometrium of the uterus for implantation of fertilized ovum and the mammary glands for milk secretion. RELAXIN Increases flexibility of pubic symphysis during pregnancy and helps dilate uterine cervix during labor and delivery. INHIBIN Inhibits secretion of FSH from anterior pituitary gland. To stop stimulation of estrogen or progesterone

GONADS: TESTES The testes are the gonads in males. They are two small, egg-shaped structures suspended in the scrotum, a loose sac of skin that hangs outside the pelvic cavity between the upper thighs. TESTOSTERONE Stimulates descent of the testes before birth, regulates spermatogenesis, and promotes development and maintenance of male secondary sex characteristics. PINEAL GLAND A small endocrine gland attached to the roof of the third ventricle of the brain at the midline. Part of epithalamus, it is position between the two superior colliculi, has a mass of 0.1 0.2 grams, and is covered by a capsule pia mater. MELATONIN Appears to contribute to the setting of the bodys biological clock, which is controlled by the suprachiasmatic nucleus of the hypothalamus. A more melatonin is liberated during darkness than in light, this hormone thought to promote sleepiness. In response to visual input from the eyes (retina). THYMUS The thymus is a soft, flattened, pinkish-gray mass of lymphoid tissue located in the upper chest under the breastbone. In a fetus and newborn infant, the thymus is relatively large (about the size of an infant's fist). Up until about the age of puberty, the thymus continues to grow. After this point in life, it shrinks and gradually blends in with the surrounding tissue. Very little thymus tissue is found in adults. The thymus secretes several hormones that are known collectively as thymosins. Thymosins help change a certain group of white blood cells called lymphocytes into T cells, which are programmed to attack any foreign substance in the body. THYMOSIN PROMOTE the maturation of T-cells ( a type of white blood cell that destroys microbes and foreign substances ) and may retard aging.

THYROID SCAN The thyroid gland is the, is the main part of the body that takes up iodine. In a thyroid scan, iodine is labeled with a radioactive tracer, and a special camera is used to measure how much tracer is absorbed from the bloodstream by the thyroid gland. If a patient is allergic to iodine, technetium can be used as an alternative. HOW ITS PERFORMED A thyroid scan is an outpatient procedure usually done in the nuclear medicine section of a hospital. This is usually part of the radiology department. If you have a thyroid scan, you will be asked to take a drink, or swallow a pill containing the iodine. You will then wait for the iodine to be taken up by the thyroid - usually about 4 hours. At this time you lie under a scintography camera, and it will take pictures which correlate directly to the amount of iodine taken up by the thyroid. This is done by counting the intensity and location of the gamma rays emitted by the radioactively labeled iodine. You then leave the hospital, and return in 24 hours to have a second scan performed in the same manner. There are no limitations during this 24 hour interval except that you will be asked to take precautions when you urinate. This is because the radioactive iodine is removed from your body by the urine, and it is safer to have others avoid contact with your urine during this time. Be sure to let the doctor performing the test know if you have an iodine allergy, or if you have ingested a lot of iodinecontaining foods (like sushi) prior to the test. WHEN IS THYROID SCANNING HELPFUL A thyroid scan can provide information on the size and shape of the gland as well as the overall activity of the gland (is the whole thyroid gland overactive or underactive?). In addition, a thyroid scan can provide information on specific areas within the thyroid gland and can help to determine whether any localized areas are hyperfunctioning or under functioning compared to the rest of the gland. In these cases spots appear on the image corresponding to areas that take up iodine differently from the rest of the gland. Thyroid scanning is especially helpful in evaluating thyroid nodules, particularly after a fine needle aspiration biopsy has failed to provide a diagnosis. A scan will reveal whether a thyroid nodule is "functioning" or "nonfunctioning". Doctors refer to hyper functioning nodules of the thyroid (those that are actively taking up iodine to produce thyroid hormone more so than surrounding thyroid tissue) as "hot" nodules, and these hyperfunctioning areas are seen on the image of the thyroid gland. A nonfunctioning nodule does not take up iodine and produces a localized "cold" area on the image of the thyroid gland. HOT AND COLD IMAGING Functioning or "hot" nodules only rarely are from cancer. Nearly all thyroid cancers are nonfunctioning or "cold" nodules. Moreover, even among "cold" nodules, cancer is infrequent (less than 5 percent of cases).

THYROID ULTRASOUND Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in realtime, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels. Ultrasound imaging is a non-invasive medical test that helps physicians diagnose and treat medical conditions. An ultrasound of the thyroid produces a picture of the thyroid gland. The thyroid gland is located in front of the neck just below the Adam's apple and is shaped like a butterfly, with two lobes on either side of the neck connected by a narrow band of tissue. It is one of nine endocrine glands located throughout the body that make and send hormones into the bloodstream. What are some common uses of the procedure? An ultrasound of the thyroid is typically used to help diagnose: A lump in the thyroid. A thyroid that is not functioning properly. Because ultrasound provides real-time images, it also can be used to guide procedures such as needle biopsies, in which needles are used to extract sample cells from an abnormal area for laboratory testing. Ultrasound may also be used to guide the insertion of a catheter or drainage device and helps assure accurate placement. PREPARATION You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure. No other preparation is required. Ultrasound exams are very sensitive to motion and an active or crying child will slow the exam process. To ensure a smooth experience, it would be beneficial to explain the procedure to the child prior to the exam. You may bring a book to read to the child to ease anxiety. Ultrasound departments often have a television in the examination room and the child's favourite show may be played if there are no other available distractions. HOW IT WORK Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid or both). In medicine, ultrasound is used to detect changes in appearance of organs, tissues, and vessels or detect abnormal masses, such as tumors.

In an ultrasound examination, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off of internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. HOW ITS PERFORMED For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved. A pillow will be placed behind the neck to extend the area to be scanned for a thyroid study. This is especially important for a small child with very little space between the chin and the chest. A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern. When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or radiologist is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately. This ultrasound examination is usually completed within 30 minutes. LIMITATIONS OF AN ULTRASOUND OF THE THYROID If a lump is detected on ultrasound within the thyroid gland, it is common that the radiologist cannot distinguish between benign and malignant lumps with complete certainty. A fine needle biopsy and review of tissue under a microscope is often necessary, while in some cases surveillance and a repeat sonogram after a few months looking for stability may suffice. It is not possible to determine thyroid functionthat is, whether the thyroid gland is underactive, overactive, or normalwith ultrasound. For that determination, your doctor may order a blood test or a radioactive iodine uptake test.

THYROID BIOPSY

A thyroid biopsy is a procedure in which a small sample of tissue is removed from the thyroid gland and looked at under a microscope for cancer, infection, or other thyroid problems. The thyroid gland is found in front of the windpipe (trachea), just below the voice box (larynx). A sample of thyroid tissue can be taken by: Fine-needle biopsy. Your doctor puts a thin needle through the skin and into the thyroid gland. Many thyroid specialists like to use a needle biopsy method rather than surgery. Open biopsy. Your doctor makes a cut (incision) through the skin to see the thyroid gland. This method is done when other tests have not found the cause of your symptoms. A thyroid biopsy is done to: Find the cause of a lump (nodule) found in the thyroid gland. Lumps in the thyroid gland may be found during a physical examination or seen on a thyroid ultrasound test or radioactive thyroid scan. Find the cause of a goiter. Symptoms of a goiter include breathing and swallowing problems, paralyzed vocal cords, a feeling of fullness in the neck, and weight loss. PREPARATION You do not need to do anything before a needle biopsy. You will be asked to undress and put on a hospital gown. You will be awake during the biopsy. Do not eat or drink anything for 10 hours before an open biopsy. You will getgeneral anesthesia and be asleep during the biopsy. If you take medicines every day, ask your doctor whether you can take these medicines on the day of the biopsy. You can eat your normal diet after the biopsy. Just before the test, you will remove your dentures (if you wear them) and all jewelry or metal objects from around your neck and upper body. Before having a thyroid biopsy, you need to sign a consent form that says you understand the risks of the thyroid biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form. HOW IT IS DONE NEEDLE BIOPSY A needle biopsy is done in a hospital, clinic, or your doctor's office. During the test, you will lie on your back with a pillow under your shoulders, your head tipped backward, and your neck extended. This position pushes the thyroid gland forward, making it easier to do the biopsy. It is important to lie very still during the biopsy. Do not cough or swallow when the needle is in place. A needle biopsy takes about 5 to 10 minutes.

Before the biopsy, you may be given a medicine (sedative) to help you relax. Your doctor cleans the skin over your thyroid gland with a special soap. Your doctor may use an ultrasound to guide the placement of the needle. He or she will put a thin needle into your thyroid gland and take out a small amount of thyroid tissue and fluid. The tissue is looked at under a microscope. A small bandage is placed over the area where the needle was inserted. OPEN BIOPSY An open biopsy of the thyroid gland is done in an operating room by a surgeon. It is done when other tests have not found the cause of your symptoms. An open biopsy takes about an hour. You may be given a sedative to help you relax. An intravenous (IV) line is inserted in a vein in your arm for medicine and fluids. You will be asleep for the biopsy. The skin over your thyroid gland is cleaned with a special soap. A small cut (incision) is made in your neck. A sample of thyroid tissue is taken or your doctor can take out a lump if one is present. Some thyroid tissue may be sent to the laboratory during the biopsy to see whether it has cancer cells. If cancer cells are present, your doctor may take out more or all of the thyroid gland. The incision is closed with stitches. A bandage is put over the stitches. Keep the biopsy site covered and dry for 48 hours. A small amount of bleeding from the biopsy site can be expected. Ask your doctor how much drainage to expect. Some people may need to stay in the hospital for one night. Open biopsy is not as commonly done as needle biopsy. A thyroid biopsy is a procedure in which a small sample of tissue is removed from the thyroid gland and looked at under a microscope for cancer, infection, or other thyroid problems. Results from a thyroid biopsy are usually available in a few days.

DMMA COLLEGE OF SOUTHERN PHILIPPINES COLLEGE OF NURSING

A REPORT OF ANATOMY AND PHYSIOLOGY OF ENDOCRINE SYTEM

SUBMITTED TO: MR. ALBERTO S. ALEJANDRE III, RN CLINICAL INSTRUCTOR

SUBMITTED BY:

ASHER FLORES PULGO, JUNIOR BSN III