THYROID FUNCTION
TESTS
DR MUNIR AHMED
Disorders of Thyroid Gland
A: Hyperthyroidism , B: hypothyroidism , C :Goiter
• HYPERTHYROIDISM (THYROTOXICOSIS ) is characterized By sustained high
plasma concentration of Thyroid hormones .
Causes : Grave’s Disease , Toxic multinodular Goiter , single functioning nodule
, adenoma , thyroid hormone administration , TSH secreting Tumor of Pituitary
gland .
Clinically there is tachycardia , fine tremors ,weight loss , Exophthalmos in Grave’s disease ,
Anxiety , diarrhea , cardiac arrhythmias , heat intolerance
HYPOTHYROIDISM
It is caused by suboptimal circulating thyroid hormones . May be of primary or Secondary types
Primary hypothyroidism
Causes : Hashimoto’s disease , de Quervain granulomatous thyroiditis , post thyroidectomy ,
Irradiation ,
Secondary hypothyroidism is caused by hypothalamic or pituitary deficiency .
clinically , there may be weight gain , puffy face, menstrual disturbances , cold intolerance
Goiter is enlargement of Thyroid gland , which may be diffuse or nodular
Objectives : Diagnosis
Assessment of treatment
First line tests : TSH
T4 (Thyroxin) total
Free T4 (FT4)
T3
Free T3 (FT3)
Special Tests : Thyroglobulin level
Thyroid Binding Globulins(TBG
Various antibodies
TSH (Thyroid Stimulating Hormone)
It is secreted by Anterior pituitary gland .Glycoprotein in nature . After secretion binds to specific
receptors on follicular cells of Thyroid gland and stimulates the thyroid hormones synthesis . TSH
secretion is high in the morning and low in the evening .
TSH is considered the single best indicator of thyroid disorders .
Ref. Range 0.5 –5.0 m IU /L
Test is done by ELISA , Fluorescence Immunoassay
TSH secretion is increased in Primary and secondary Hypothyroidism . While it is low in
Hyperthyroidism .
Thyroxine (T4 total )
• T4 is more than 99% protein bound therefore its level may be affected by protein abnormalities . It is increased in
Hyperthyroidism and decreased in Hypothyroidism . This test has disadvantage that total T4 is affected by changes
in Thyroid binding protein levels and displacement by drugs like salicylates and danazol . .Test is performed by
ELISA method and Fluorescence .
Ref . Range 5—12 ng /dl .
• Free T4 ( FT4) is the active form of the hormone . It is not effected by any change in binding proteins . it is increased in
Hyperthyroidism and decreased in Hypothyroidism . it remains normal in TBG excess and deficiency and displacement by drugs .
Test is performed by ELISA , Access free assay .
Ref Range 0.8 – 2.7 ng /dl
Thyroxine Binding Globulins (TBG)
• It is the principal carrier protein of T4 and T3 . its determination is help full when clinical features or other TFTs are not
compatable with T4 levels . Measured by Radio immunoassay , Electrophoresis .
Ref . Range : 12—30 microgram / ml
T3
T3 estimation is useful in hyperthyroidism because its concentration is increased greater and
earlier than T4 , but it not useful for hypothyroidism as its normal value is very low . sometimes
only T3 is increased called T3 thyrotoxicosis .
Ref. Range: 1.08 –3.14 nmol / L
Free T3 ( FT3) is not bound to proteins and therefore not affected by changes in
thyroid binding proteins .
Test is performed by Elisa . Ref .Range : 0,9 -2.8 nmol/ L
Serum Thyroglobulin
it is used as a tumor marker for thyroid tumors . Increased thyroglobulin in blood indicate occurrence or recurrence of thyroid
tumor after treatment .
REF .RANGE : 3- 42 ng / ml
• Thyrotropin Releasing Hormone (TRH) test
The normal pituitary gland responds to administration of TRH by increased secretion of TSH .
Response exaggerated in hypothyroidism
Response is reduced in hypopituitarism with hypothyroidism and hyperthyroidism .
• ANTIBODIES
• Thyroid receptor antibodies ( TRAbs ) are present in Grave’s disease .These are performed to
monitor the response to treatment in Grave’s disease
< 0.54 U/L present normally .
• Anti-thyroglobulin antibodies are present in 60% cases of Hashimoto’s disease
Normally undetectable or < 5 microgram /L.
• Thyroid microsomal antibodies(AMA) are done for Graves disease and Hashimoto’s disease .
Normally < 35 IU/ L present.
Thyroid peroxidase antibodies (TPO ab ) increase in grave’ diseases and Hashimoto’s disease .
Normally <9 IU /L may be present
Other Biochemical Findings in Thyroid
Disease
• Serum Cholesterol concentration is increased because in hypothyroidism clearance of plasma
LDL-c is impaired .
• Serum Creatine Kinase is raised in hypothyroidism
• There is hyponatremia because ADH secretion is increased which causes water retention
