THYROID FUNCTION TEST: DETAILED NOTES

Thyroid function tests (TFTs) are diagnostic tests used to assess how well the thyroid gland is
functioning. The thyroid gland, located in the neck, is responsible for producing hormones that
regulate metabolism, growth, and development. The thyroid hormones—primarily thyroxine
(T4) and triiodothyronine (T3)—influence almost every cell and organ in the body. Thyroid
function tests measure the levels of these hormones, as well as related hormones like thyroid-
stimulating hormone (TSH), which plays a key role in regulating thyroid hormone production.

Thyroid dysfunction is commonly associated with hypothyroidism (underactive thyroid) and

hyperthyroidism (overactive thyroid). TFTs are crucial in diagnosing these conditions and
guiding treatment.

1. Thyroid Stimulating Hormone (TSH) Test

 Function: TSH is a hormone produced by the pituitary gland in response to signals

from the hypothalamus. It stimulates the thyroid gland to produce thyroid hormones (T3
and T4). TSH levels reflect the feedback from thyroid hormones in the bloodstream—
high levels of TSH typically indicate low thyroid hormone levels (hypothyroidism), while
low levels of TSH suggest high thyroid hormone levels (hyperthyroidism).
 Clinical Significance:
o Hypothyroidism: High TSH levels with low T3 and T4 indicate an underactive
thyroid (primary hypothyroidism).
o Hyperthyroidism: Low TSH levels with high T3 and T4 suggest an overactive
thyroid (primary hyperthyroidism).
o Thyroid Disorders: Elevated TSH with normal T4 can indicate subclinical
hypothyroidism, while low TSH with normal T3 and T4 can indicate subclinical
hyperthyroidism.
 Normal Range: 0.4 - 4.0 mU/L (depending on laboratory and reference standards).

2. Free T4 (FT4) Test

 Function: T4 is the primary hormone secreted by the thyroid gland. It is converted into
the more active form (T3) in various tissues, especially the liver and kidneys. Free T4
(FT4) refers to the unbound or free fraction of T4, which is available to act on tissues.
Measuring FT4 is crucial for assessing thyroid function.
 Clinical Significance:
o Hypothyroidism: Low levels of FT4 are indicative of underactive thyroid
function (hypothyroidism).
o Hyperthyroidism: Elevated levels of FT4 suggest an overactive thyroid
(hyperthyroidism).
 o Thyroid Disease: Monitoring FT4 levels in combination with TSH can provide
insight into the severity and type of thyroid dysfunction.
 Normal Range: 0.8 - 2.0 ng/dL (depending on laboratory).

3. Free T3 (FT3) Test

 Function: T3 is the more biologically active form of thyroid hormone. It is derived from
T4 through the process of deiodination. Free T3 (FT3) measures the unbound T3 that is
available to act on cells.
 Clinical Significance:
o Hyperthyroidism: Elevated FT3 levels, often in the context of normal FT4
levels, are common in conditions like Graves' disease (an autoimmune form of
hyperthyroidism) and thyroid hormone resistance.
o Hypothyroidism: In cases of hypothyroidism, FT3 may be low, although the
TSH and FT4 levels are the primary markers.
o Subclinical Hyperthyroidism: In some cases, TSH may be suppressed while
FT3 and FT4 remain within the normal range.
 Normal Range: 2.3 - 4.2 pg/mL (depending on laboratory).

4. Total T4 and Total T3 Tests

 Function: These tests measure the total amount of T4 and T3 hormones, including both
the free and bound (protein-bound) fractions. The bound portion is attached to carrier
proteins (such as thyroxine-binding globulin or TBG), making it unavailable for
immediate use. However, total hormone levels can be affected by changes in protein
levels in the blood.
 Clinical Significance:
o Hypothyroidism: Decreased total T4 and T3 levels suggest an underactive
thyroid.
o Hyperthyroidism: Increased total T4 and T3 levels point to overactive thyroid
function.
o Conditions Affecting Protein Levels: Total hormone levels may be misleading if
protein levels (such as TBG) are abnormal, as this can alter the total amount of
hormone bound to proteins.
 Normal Range:
o Total T4: 4.5 - 12.5 μg/dL.
o Total T3: 80 - 220 ng/dL (depending on laboratory).

5. Thyroid Antibodies Tests

  Function: These tests measure the presence of antibodies that may indicate autoimmune
thyroid diseases, such as Hashimoto’s thyroiditis (hypothyroidism) and Graves’ disease
(hyperthyroidism). Common antibodies tested include:
o Anti-Thyroid Peroxidase Antibody (TPOAb): Targets thyroid peroxidase, an
enzyme involved in thyroid hormone production.
o Anti-Thyroglobulin Antibody (TgAb): Targets thyroglobulin, a protein
involved in the synthesis of thyroid hormones.
o TSH Receptor Antibody (TRAb): Involved in Graves' disease, where the
immune system stimulates the thyroid gland to produce excess hormones.
 Clinical Significance:
o Hashimoto’s Thyroiditis: Elevated TPOAb and/or TgAb levels are common in
autoimmune hypothyroidism (Hashimoto's disease).
o Graves' Disease: Positive TRAb is typically seen in Graves' disease, leading to
hyperthyroidism.
o Postpartum Thyroiditis: Autoantibodies may also be elevated in postpartum
thyroiditis, a condition that can occur after pregnancy.
 Normal Range:
o TPOAb: <35 IU/mL (depends on the lab).
o TgAb: <40 IU/mL (depending on lab standards).
o TRAb: Negative or very low levels.

6. Ultrasound of the Thyroid Gland

 Function: While not a direct thyroid function test, thyroid ultrasound is commonly
used to assess the structure of the thyroid gland, detect nodules, cysts, or tumors, and
guide biopsy if necessary.
 Clinical Significance:
o Thyroid Nodules: Helps detect nodules, which may require further testing (e.g.,
fine needle aspiration biopsy).
o Thyroid Cancer: Suspicious findings on ultrasound may lead to further
investigations to rule out malignancy.
o Enlarged Thyroid (Goiter): Can help diagnose and monitor the presence of a
goiter, which may indicate either hypothyroidism or hyperthyroidism.

7. Radioactive Iodine Uptake Test (RAIU)

 Function: This test measures how much radioactive iodine is taken up by the thyroid
gland. Iodine is essential for thyroid hormone production. The test involves a small
amount of radioactive iodine being given orally, followed by a scan to measure how
much iodine is absorbed.
 Clinical Significance:
 o Hyperthyroidism: High iodine uptake suggests conditions like Graves' disease
or toxic multinodular goiter, both of which lead to excessive hormone
production.
o Thyroiditis: Low uptake may be seen in thyroiditis (inflammation of the thyroid)
or in instances where the thyroid is unable to concentrate iodine.
o Thyroid Cancer: Helps evaluate thyroid tissue function after thyroidectomy,
especially in cancer patients.
 Normal Range: 10-35% of the iodine should be absorbed by the thyroid gland over a 24-
hour period.

8. Fine Needle Aspiration (FNA) of Thyroid Nodule

 Function: An invasive procedure in which a thin needle is used to remove a small sample
of thyroid tissue for examination under a microscope. This test is typically performed if a
thyroid nodule is detected on ultrasound.
 Clinical Significance:
o Thyroid Cancer: FNA is critical in distinguishing benign from malignant thyroid
nodules, providing a diagnosis for suspected thyroid cancer.
o Thyroid Disorders: Helps in the evaluation of nodules in both hyperthyroid and
hypothyroid patients.

Summary of Key Thyroid Function Tests:

Test What it Measures Used to Diagnose

Thyroid-stimulating hormone Hypothyroidism, hyperthyroidism,
TSH
level pituitary function
Hypothyroidism, hyperthyroidism,
Free T4 (FT4) Unbound thyroxine hormone
thyroid dysfunction
Unbound triiodothyronine Hyperthyroidism, thyroid hormone
Free T3 (FT3)
hormone resistance
Presence of autoimmune Hashimoto’s thyroiditis, Graves’
Thyroid Antibodies
antibodies (e.g., TPO, TRAb) disease, autoimmune thyroid disorders
Ultrasound of Size and structure of the thyroid
Thyroid nodules, goiter, thyroid cancer
Thyroid gland
Radioactive Iodine Hyperthyroidism, thyroid cancer,
Uptake of iodine by the thyroid
Uptake (RAIU) thyroid function monitoring
Fine Needle Cell sample from thyroid Thyroid cancer, evaluation of thyroid
Aspiration (FNA) nodule nodules

Conclusion:
Thyroid function tests provide valuable information for diagnosing thyroid disorders, whether
related to overactive (hyperthyroid) or underactive (hypothyroid) thyroid states. These tests
assess hormone levels (TSH, T3, T4), thyroid antibodies, and structural changes in the thyroid
gland, guiding clinicians in both diagnosing thyroid conditions and planning treatment. The
combination of clinical symptoms and test results helps to monitor thyroid health and prevent
complications.