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Thyroid Function Test

This document summarizes various thyroid function tests: - Total T4, THBR (T3 Uptake test), and calculated Free T4 Index measure total T4 levels and binding proteins to assess hyperthyroidism, hypothyroidism, and binding protein abnormalities. - TSH is considered the best test to identify thyroid abnormalities and confirm primary hyper/hypothyroidism, even in borderline cases. - Additional tests include Free T4, TRH stimulation test, thyroid antibodies, radioactive iodine uptake, thyroglobulin, and thyroid scan to further evaluate thyroid conditions.

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21 views34 pages

Thyroid Function Test

This document summarizes various thyroid function tests: - Total T4, THBR (T3 Uptake test), and calculated Free T4 Index measure total T4 levels and binding proteins to assess hyperthyroidism, hypothyroidism, and binding protein abnormalities. - TSH is considered the best test to identify thyroid abnormalities and confirm primary hyper/hypothyroidism, even in borderline cases. - Additional tests include Free T4, TRH stimulation test, thyroid antibodies, radioactive iodine uptake, thyroglobulin, and thyroid scan to further evaluate thyroid conditions.

Uploaded by

Aisha
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THYROID FUNCTION TEST

Total Thyroxine (TT4)


- plasma T4 is more than 99% protein bound.
- Total T4 reflects free T4 concentration unless there are abnormalities of
binding proteins.
- Euthyroid – whatever the level of the binding protein, 1/3 of TBG
binding sites are occupied by T4 and 2/3 are unoccupied.
- Hyperthyroidism – both total and free T4 increased & number of
unoccupied binding sites on TBG decreased.
- Hypothyroidism – the opposite occurs.
- TT4 is routinely measured by RIA.
Thyroid Hormone Binding Ratio
( THBR )or T3 Uptake test ( T3 U) Test.
• The result is calculated by dividing the matrix-
bound product/counts by the residual serum
protein-bound product/counts.
Condition Total T4 THBR(T3U)
Euthyroid Normal Normal
Hyperthyroidism Increased Increased
Hypothyroidism Decreased Decreased
Increased TBP(TBG) Increased Decreased
- pregnancy
- oral contraceptives
- acute hepatitis
Decreased TBP(TBG) Decreased Increased
- anabolic steroid
- advanced liver disease
- advanced kidney disease
Competition for sites increased Decreased Increased
- Pheytoin
- Phenyl butazone
- Salicylates
Calculated Free Thyroxine Index ( FT4I)

• F T4 I = T T4 x THBR
• Normal value - F T4 I – 4.5 - 12
Free Thyroxine (F T4 ) Assay.
- A fully automated competitive immunoassay and
Electrochemiluminescence Immunoassay is currently available.
- Normal value- 1.2-2.5ng/dl.
TSH assay.
• TSH assay is considered to be the first and best
laboratory test for identification of thyroid
abnormalities
• It is extremely useful in the detection and
confirmation of suspected primary
hypothyroidism and hyperthyroidism.( even in
the borderline case)
• In subclinical hyper or hypothyroidism, TSH level
is abnormal and normal T T4 or F T4 in the
absence of overt symptoms.
• TSH level is increased in primary hypothyroidism
Thyroid-Releasing Hormone (TRH) Stimulation Test.
• detects residual TSH stores in the pituitary gland.
• confirmation of primary hyperthyroidism.
Thyroid-Binding Proteins/TBG.
• To confirm results of FT3 or FT4 or
abnormalities in the relationship of the TT4
and THBR test
Thyroglobulin
• The thyroglobulin assay is used as a
postoperative marker of thyroid cancer.
• Low levels may indicate the presence of
thyrotoxicosis.
Total or free T3
• they may be helpful for hyperthyroidism but
should not be used to diagnose
hypothyroidism.
Thyroid Antibodies.
• They include – thyrotropin receptor (TSHR)
antibodies, thyroperoxidase (TPO) and
antithyroglobulin antibodies.
Radioactive Iodine uptake (RAIU)
• The RAIU assay is used to measure the ability
of the thyroid gland to trap iodine.
• Normally 10% to 30% of ingested dose can be
detected within 24 hours.
• It is useful to determine the cause of
hyperthyroidism and not useful in the
diagnosis of hypothyroidism because there is
overlap of euthyroid and hypothyroid
response.
Thyroid scan
• used to determine the size, shape and
activity/inactivity of thyroid tissue/ nodules.

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