1;Foreword;4 2;Contents;5 3;Presentation of Contributors;13 4;List of Abbreviations and Definitions;14 5;1 Historical Background;20 5.1;1.1 Goitre and Iodine;20 5.2;1.2 Hypothyroidism;20 5.3;1.3 Hyperthyroidism;22 6;2 Anatomy and Physiology;24 6.1;2.1 The Embryologic Development and Anatomy of the Thyroid Gland;24 6.1.1;2.1.1 Embryology;24 6.1.2;2.1.2 Anatomy;24 6.1.3;2.1.3 Blood Supply;26 6.1.4;2.1.4 Lymph Drainage;27 6.1.5;2.1.5 Nerves;28 6.2;2.2 Iodine and the Thyroid;28 6.2.1;2.2.1 Transport of Iodine;28 6.2.2;2.2.2 The Iodine Pool;30 6.3;2.3 TSH and TSH Receptors;30 6.4;2.4 Synthesis and Secretion of Thyroid Hormones;31 6.4.1;2.4.1 Thyroglobulin;34 6.4.2;2.4.2 Regulation of Iodine Metabolism;35 6.4.3;2.4.3 Selenium;35 6.5;2.5 Hypothalamus-Pituitary-Thyroid Axis;36 6.6;2.6 Deiodinases;37 6.7;2.7 Mechanisms of Action of Thyroid Hormones;37 6.8;2.8 Biochemical Indicators of the Peripheral Effects of Thyroid Hormones;41 6.9;2.9 Factors Affecting Thyroid Hormone Homeostasis;43 6.9.1;2.9.1 Circadian and Seasonal Variation;43 6.9.2;2.9.2 Variation with Age;43 6.9.3;2.9.3 Effects of Stress and the Environment;43 6.10;2.10 Effects of General Illness and Pharmaceuticals (NTI);44 7;3 Biochemical Investigations;47 7.1;3.1 TSH;47 7.2;3.2 TRH-Stimulated TSH Secretion;50 7.3;3.3 Thyroid Hormones;50 7.4;3.4 Free Thyroid Hormones;51 7.5;3.5 Analytical Problems;52 7.6;3.6 Reference Ranges (Normal Values) for Thyroid-Associated Hormone Analyses;53 7.7;3.7 Antibodies Against Thyroperoxidase (TPOAb);54 7.8;3.8 Antibodies Against the TSH Receptor (TRAb);55 7.9;3.9 Thyroglobulin (Tg);56 7.10;3.10 Antibodies Against Thyroglobulin (TgAb);56 7.11;3.11 Thyroxine-Binding Globulin (TBG) and Transthyretin (Prealbumin);57 7.12;3.12 Calcitonin;57 7.13;3.13 Iodine in Urine;57 7.14;3.14 Genetic Diagnostics;57 7.15;3.15 Analytical Strategy;58 7.15.1;3.15.1 Hypothyroidism;58 7.15.2;3.15.2 Thyrotoxicosis;59 8;4 Other Investigations;64 8.1;4.1 Investigations Using Radionuclides;64 8.1.1;4.1.1 Gamma Camera Investigations (Scintigraphy);65 8.1.2;4.1.2 Radioiodine Uptake Investigation (Radioiodine Uptake Test);66 8.1.3;4.1.3 Uptake of Radioiodine by the Thyroid in Various Clinical Conditions;67 8.1.4;4.1.4 Perchlorate Test;69 8.1.5;4.1.5 Important Features of Radionuclide Investigations;69 8.2;4.2 Positron Emission Tomography (PET);71 8.3;4.3 X-ray, CT, and MR;71 8.4;4.4 Ultrasound;72 8.5;4.5 Fine-Needle Biopsy;75 8.5.1;4.5.1 Sampling Technique;75 8.5.2;4.5.2 Cytological Findings;76 8.5.3;4.5.3 Complications;77 8.5.4;4.5.4 Histological and Cytological Diagnostics;77 9;5 Clinical Investigation of the Thyroid;83 9.1;5.1 Medical History;83 9.2;5.2 Physical Examination;83 10;6 Iodine and the Thyroid Gland in Health and Sickness;87 10.1;6.1 Global Aspects of Iodine Intake;88 10.2;6.2 Thyroid Dysfunction Caused by Excessive Iodine Intake;89 10.3;6.3 Iodine in Foodstuffs and Medical Preparations;90 10.4;6.4 Iodine Blocking;91 10.4.1;6.4.1 Nuclear Accidents;91 10.4.2;6.4.2 Radionuclide Investigations and Treatments;92 11;7 Autoimmunity and the Thyroid Gland;94 11.1;7.1 Immunological Background;94 11.1.1;7.1.1 Antigen-Presenting Cells;94 11.1.2;7.1.2 MHC Molecules;95 11.1.3;7.1.3 T and B Lymphocytes;95 11.1.4;7.1.4 Interaction Between T Cells and APC (Simplified Model);95 11.1.5;7.1.5 Cytolytic T Lymphocyte-Associated Antigen 4 (CTLA-4);97 11.1.6;7.1.6 Fas/Fas-L and the Destruction of Cells;97 11.2;7.2 Autoimmunity;98 11.2.1;7.2.1 Hashimoto or Graves' Disease?;98 11.2.2;7.2.2 Antithyroid Drugs and the Immunological Process;99 11.3;7.3 Predisposing Factors;99 11.3.1;7.3.1 Genetic Predisposition;99 11.3.2;7.3.2 Other Endogenous Causes;101 11.4;7.4 Exogenous Factors;101 11.4.1;7.4.1 Iodine;101 11.4.2;7.4.2 Smoking;101 11.4.3;7.4.3 Stress;101 11.4.4;7.4.4 Infections/Cytokines;102 11.5;7.5 Autoimmune Polyglandular Syndrome;102 11.6;7.6 Immunological Markers in Clinical Work;102 11.6.1;7.6.1 TPO Antibodies;102 11.6.2;7.6.2 TSH Receptor Antibodies;103 11.6.3;7.6.3 Clinical Appl