Extensions, validation, and clinical applications of a feedback control system simulator of the hypothalamo-pituitary-thyroid axis.
BACKGROUND
We upgraded our recent feedback control system (FBCS) simulation model of human thyroid hormone (TH) regulation to include explicit representation of hypothalamic and pituitary dynamics, and updated TH distribution and elimination (D&E) parameters. This new model greatly expands the range of clinical and basic science scenarios explorable by computer simulation.


METHODS
We quantified the model from pharmacokinetic (PK) and physiological human data and validated it comparatively against several independent clinical data sets. We then explored three contemporary clinical issues with the new model: combined triiodothyronine (T(3))/thyroxine (T(4)) versus T(4)-only treatment, parenteral levothyroxine (L-T(4)) administration, and central hypothyroidism.


RESULTS
Combined T(3)/T(4) therapy--In thyroidectomized patients, the L-T(4)-only replacement doses needed to normalize plasma T(3) or average tissue T(3) were 145 microg L-T(4)/day or 165 microg L-T(4)/day, respectively. The combined T(4) + T(3) dosing needed to normalize both plasma and tissue T(3) levels was 105 microg L-T(4) + 9 microg T(3) per day. For all three regimens, simulated mean steady-state plasma thyroid-stimulating hormone (TSH), T(3), and T(4) was within normal ranges (TSH: 0.5-5 mU/L; T(4): 5-12 microg/dL; T(3): 0.8-1.9 ng/mL). Parenteral T(4) administration--800 microg weekly or 400 microg twice weekly normalized average tissue T(3) levels both for subcutaneous (SC) and intramuscular (IM) routes of administration. TSH, T(3), and T(4) levels were maintained within normal ranges for all four of these dosing schemes (1x vs. 2x weekly, SC vs. IM). Central hypothyroidism--We simulated steady-state plasma T(3), T(4), and TSH concentrations in response to varying degrees of central hypothyroidism, reducing TSH secretion from 50% down to 0.1% of normal. Surprisingly, TSH, T(3), and T(4) plasma concentrations remained within normal ranges for TSH secretion as low as 25% of normal.


CONCLUSIONS
Combined T(3)/T(4) treatment--Simulated standard L-T(4)-only therapy was sufficient to renormalize average tissue T(3) levels and maintain normal TSH, T(3), and T(4) plasma levels, supporting adequacy of standard L-T(4)-only treatment. Parenteral T(4) administration-TSH, T(3), and T(4) levels were maintained within normal ranges for all four of these dosing schemes (1x vs. 2x weekly, SC vs. IM), supporting these therapeutic alternatives for patients with compromised L-T(4) gut absorption. Central hypothyroidism--These results highlight how highly nonlinear feedback in the hypothalamic-pituitary-thyroid axis acts to maintain normal hormone levels, even with severely reduced TSH secretion.
Eisenberg
Marisa
M
Biocybernetics Laboratory, Departments of Computer Science, Medicine, and Biomedical Engineering, UCLA, Los Angeles, California 90095-1596, USA. marisa@cs.ucla.edu
Samuels
Mary
M
DiStefano
Joseph J
JJ
D001921:Brain / Q000502:physiology; D003198:Computer Simulation; D005246:Feedback; D020249:Hormone Replacement Therapy; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007037:Hypothyroidism / Q000188:drug therapy; D007453:Iodide Peroxidase / Q000502:physiology; D007700:Kinetics; D008954:Models, Biological; D013961:Thyroid Gland / Q000502:physiology*; D013965:Thyroidectomy; D013974:Thyroxine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D014284:Triiodothyronine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use
D014284:Triiodothyronine; D007453:Iodide Peroxidase; D013974:Thyroxine