title: Beyond the fixed setpoint of the hypothalamus-pituitary-thyroid axis.
abstract: The hypothalamus-pituitary-thyroid (HPT) axis represents a classical example of an endocrine feedback loop. This review discusses dynamic changes in HPT axis setpoint regulation, identifying their molecular and cellular determinants, and speculates about their functional role. Hypothalamic thyrotropin-releasing hormone neurons were identified as key components of thyroid hormone (TH) setpoint regulation already in the 1980s, and this was followed by the demonstration of a pivotal role for the thyroid hormone receptor beta in negative feedback of TH on the hypothalamic and pituitary level. Gradually, the concept emerged of the HPT axis setpoint as a fixed entity, aiming at a particular TH serum concentration. However, TH serum concentrations appear to be variable and highly responsive to physiological and pathophysiological environmental factors, including the availability or absence of food, inflammation and clock time. During food deprivation and inflammation, TH serum concentrations decrease without a concomitant rise in serum TSH, reflecting a deviation from negative feedback regulation in the HPT axis. Surprisingly, TH action in peripheral organs in these conditions cannot be simply predicted by decreased serum TH concentrations. Instead, diverse environmental stimuli have differential effects on local TH metabolism, e.g. in liver and muscle, occurring quite independently from decreased TH serum concentrations. The net effect of these differential local changes is probably a major determinant of TH action at the tissue level. In sum, hypothalamic HPT axis setpoint regulation as well as TH metabolism at the peripheral organ level is flexible and dynamic, and may adapt the organism in an optimal way to a range of environmental challenges.
authors.affiliation: Department of Endocrinology and MetabolismAcademic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsHypothalamic Integration MechanismsNetherlands Institute for Neuroscience, Amsterdam, The Netherlands e.fliers@amc.uva.nl.
authors.forename: Eric
authors.initials: E
authors.lastname: Fliers
authors.affiliation: Department of Endocrinology and MetabolismAcademic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsHypothalamic Integration MechanismsNetherlands Institute for Neuroscience, Amsterdam, The Netherlands Department of Endocrinology and MetabolismAcademic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsHypothalamic Integration MechanismsNetherlands Institute for Neuroscience, Amsterdam, The Netherlands.
authors.forename: Andries
authors.initials: A
authors.lastname: Kalsbeek
authors.affiliation: Department of Endocrinology and MetabolismAcademic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsHypothalamic Integration MechanismsNetherlands Institute for Neuroscience, Amsterdam, The Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Boelen
mesh_terms: D000818:Animals; D016638:Critical Illness; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007249:Inflammation / Q000150:complications / Q000378:metabolism; D009474:Neurons / Q000378:metabolism; D010902:Pituitary Gland / Q000502:physiology; D018805:Sepsis / Q000503:physiopathology; D013961:Thyroid Gland / Q000502:physiology*; D013963:Thyroid Hormones / Q000502:physiology; D013972:Thyrotropin / Q000378:metabolism
chemical_list: D013963:Thyroid Hormones; D013972:Thyrotropin