Iodine- containing compounds mainly inhibit thyroid hormone release and transiently inhibit
organification. Lithium also inhibits thyroid hormone release and may inhibit thyroid hormone synthesis.
These include interference with enterohepatic circulation of thyroxine (17), competition with thyroid hormones for thyroid sulfotransferase enzymes (18), inhibition of thyroid peroxidase (19) and interference with thyroid hormone synthesis by inhibition of iodide uptake and
organification (8).
Because iodine uptake is low in this type of AIT, targeting the
organification process with a thionamide would not be expected to have a significant effect.
The process consists of the following five steps: iodine uptake by the cells of the follicle,
organification, coupling, storage, and secretion.
Iodide
organification defects are associated with mutations in the TPO or DUOX2 genes (22-25) and are characterized by a positive perchlorate discharge test.
Twelve patients (36%) were diagnosed with dyshormonogenesis, which consisted of an
organification defect in all but one patient.
Lin, "High prevalence of a novel mutation (2268 insT) of the thyroid peroxidase gene in Taiwanese patients with total iodide
organification defect, and evidence for a founder effect," The Journal of Clinical Endocrinology & Metabolism, vol.
Vulsma T, Gons MH, de Vijlder JJM, 1989, Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total
organification defect or thyroid agenesis, N Engl J Med 321(1):13-16, Wilber JF, Utiger RD, 1969, The effect of glucocorticoids on thyrotropin secretion, J Clin Invest 48(11):2096-2103.
Trapping,
organification, and storage of iodine are usually more prominent in functioning thyroid tissue than other organs.
However, high thyroglobulin levels and goiter may be also caused by iodine
organification defects, which have been detected in nearly 20% of the patients with transient CH (10).
It inhibits iodide transport and
organification as well as increasing the efflux of iodide from the gland.