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Thyroid Disorders Testing Algorithm

The document provides guidelines for testing thyroid disorders based on a patient's symptoms and test results. It recommends ordering a thyroid stimulating hormone test with reflex to free thyroxine first to determine if levels are low, normal, or high. Follow up tests may include total triiodothyronine, thyroid antibodies, and radioactive iodine uptake scan depending on initial results to diagnose conditions like Graves' disease, hypothyroidism, or determine if thyroid disease is unlikely.

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Muhamad Suriansyah
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© © All Rights Reserved
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28 views

Thyroid Disorders Testing Algorithm

The document provides guidelines for testing thyroid disorders based on a patient's symptoms and test results. It recommends ordering a thyroid stimulating hormone test with reflex to free thyroxine first to determine if levels are low, normal, or high. Follow up tests may include total triiodothyronine, thyroid antibodies, and radioactive iodine uptake scan depending on initial results to diagnose conditions like Graves' disease, hypothyroidism, or determine if thyroid disease is unlikely.

Uploaded by

Muhamad Suriansyah
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Thyroid Disorders Testing

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INDICATIONS FOR TESTING


 Increased or decreased metabolism (heat or cold intolerance, weight loss or gain,
depression, anxiety, etc)
 Family history of autoimmune thyroiditis
 Goiter on physical exam

ORDER
Thyroid Stimulating Hormone with Reflex
to Free Thyroxine
Low TSH – High TSH –
suggests suggests
hyperthyroidism hypothyroidism
Normal TSH and free T4

Thyroid disease
unlikely

Low free T4  Primary hypothyroidism


 Thyroid ablation removal Low free
 Central hypothyroidism  Euthyroid sick syndrome T4
 Severe illness  Transient thyroiditis

 Euthyroid sick If still concerned with


syndrome hyperthyroidism,
Normal  Thyroid hormone
free T4  Subclinical ORDER
hyperthyroidism Triiodothyronine, Total resistance High
 Drug interference (Total T3)  TSH resistance free T4
 TSH secreting adenoma

Normal High

 Subclinical hypothyroidism
High Hyperthyroidism Hyperthyroidism T3  Euthyroid sick syndrome Normal
free T4 unlikely hyperthyroidism  Transient thyroiditis free T4
 Autoimmune thyroiditis

ORDER
Thyroid Stimulating Immunoglobulin (TSI)
Thyroid Peroxidase (TPO) Antibody
Thyroid Stimulating Hormone Receptor Antibody (TRAb) CONSIDER
 Thyroid Antibodies
 Triiodothyronine, Total (Total T3)
 T3 by dialysis
TSI Ab+
TPO+
TRAb+
Clinical indications of
Graves ophthalmologic
disease present TPO Ab- Normal T3 Low T3 Positive Negative
Diffuse thyroid gland TSI Ab- antibodies antibodies
enlargement

Probable Hypothyroidism T3 Automimmune Thyroid disease


Graves disease
toxic nodule/s unlikely hypothyroidism thyroid disease unlikely

Facilitate treatment decisions


CONSIDER
Radioiodine thyroid scan and % uptake

© 2006 ARUP Laboratories. All Rights Reserved. www.arupconsult.com Last updated: November 2018

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