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Thyroid Function Tests (TFT'S) : Roll No 04

The document discusses thyroid function tests and their interpretation. It outlines the different tests involved in thyroid function testing including TSH, free T3, free T4, thyroid antibodies, and others. It provides the normal ranges for these tests and discusses how to interpret various patterns of test results in relation to conditions like hypothyroidism, hyperthyroidism, and non-thyroidal illness.

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Ajay YA
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47 views

Thyroid Function Tests (TFT'S) : Roll No 04

The document discusses thyroid function tests and their interpretation. It outlines the different tests involved in thyroid function testing including TSH, free T3, free T4, thyroid antibodies, and others. It provides the normal ranges for these tests and discusses how to interpret various patterns of test results in relation to conditions like hypothyroidism, hyperthyroidism, and non-thyroidal illness.

Uploaded by

Ajay YA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Thyroid function tests(TFT’s)

Roll no 04
They include:
1. Serum TSH / thyrotropin
2. Serum free T3
3. Serum free T4
4. Reverse T3 (rT3)
5. Thyroglobulin( Tg)
6. Uptake of radioactive iodine (RAIU) or technetium
7. USG of the gland
8. Thyroid auto-antibody tests
9. Tests to determine etiology : calcitonin, FNAC / excision biopsy
10. Thyrotropin releasing hormone(TRH) test
11. Total serum thyroxine (tT4 )
12. Total serum tri-iodothyronine (tT3)
13. T3 resin uptake , free T4 index and effective T4 Ratio
Normal levels
Reference interval

0.4 - 4.2 mcIU/ml

0.80 - 2.70 ng/dl

2.10 - 4.40 pg/ml


Serum thyroid stimulating hormone
⬢ Measured by chemiluminometric assays
⬢ Normal Range- 0.4- 4.2 mcIU/ml
⬢ Interpretation :

Thyroid diseases
● Helps differentiate Non thyroid diseases
hypothyroidism, ● TSH secreting tumors of
hyperthyroidism and pituitary
euthyroidism ● Sick euthyroid syndrome
● Elevated levels indicate ● Low TSH in pregnancy -
primary hypothyroidism first trimester with high
● Suppressed levels indicate doses of corticosteroids
thyrotoxicosis
Reverse T3
⬢ Inactive metabolite of T4
⬢ For assessing rare conditions like MCT8 mutations
Thyroglobulin
⬢ Synthesised by follicular cells
⬢ Used to know outcome of therapy
⬢ Increased in medullary ca of thyroid, hyperthyroidism
⬢ Decreased in total thyroid thyroidectomy & destruction of thyroid by
radiation
Thyroid auto-antibody tests
1. Anti-microsomal antibody
a. Anti thyroid peroxidase antibody ( Hashimoto's and atrophic thyroiditis)
2. Antithyroglobulin antibody ( may be in hashimoto’s)
3. TSH receptor antibody
a. Stimulating antibodies (grave’s)
b. Receptor blocking antibodies
c. Neutral antibodies

Thyrotropin releasing hormone stimulation test


⬢ Used in investigating hypothalamic- pituitary dysfunction
⬢ Serum TSH is measured before and after IV administration of TRH
⬢ Not used now a days as sensitive TSH assays are available
Key points
⬢ The results of thyroid function tests (TFTs) must always be interpreted in
light of the clinical status of the patient: hypothyroid, euthyroid or
hyperthyroid
⬢ Confounding factors that may might influence thyroid status (eg:
intercurrent non-thyroidal illness or medications) should be excluded
before proceeding on further biochemical, radiological or genetic testing
⬢ Although thyroid disease in its most florid form is easily recognised,
patients often manifest symptoms and/or signs that are non-specific, and
present to clinicians in many different specialties.
⬢ Accordingly, a high clinical index of suspicion is required, and
confirmation of diagnosis usually depends on accurate measurement and
interpretation of thyroid function tests (TFTs).
General considerations
● In any given individual, TH (thyroxine, T4; triiodothyronine, T3) levels
remain relatively constant and reflect the ‘set-point’ of the
hypothalamic–pituitary–thyroid (HPT) axis in that individual.

● Changes in thyroid status are typically associated with concordant


changes in TH and TSH levels (eg raised T4 and T3 with suppressed
TSH in thyrotoxicosis; low T4 and T3 with elevated TSH in
hypothyroidism)

● TSH has traditionally been recommended as a frontline screening


test for thyroid dysfunction, because relatively slight changes in
TH levels are associated with marked changes in TSH.

● screening exclusively with TSH means that some patients will be


misdiagnosed, whereas other conditions might be missed altogether
● It is also important to consider whether total (TT4 and TT3) or free (FT4 and FT3)
TH levels are being measured.
● If the former, then changes in binding proteins can confound interpretation of
results
● T4 and T3 are heavily protein bound
● THUS total, but not free, hormone measurements are affected by alterations
in binding protein status (eg exogenous oestrogen therapy and pregnancy
increase TT4 levels through elevation of T4-binding globulin (TBG)).
⬢ In all patients in whom thyroid function testing is being considered, it is
important to keep the following in mind.
⬡ Thyroid status. Ideally, results of TFTs should confirm one’s clinical
suspicion, namely that the patient is euthyroid, hypothyroid or
hyperthyroid.

⬡ Levothyroxine therapy. Anomalous and/or discordant TFTs are


frequently seen in patients being treated with levothyroxine (LT4)

⬡ Medications. Several commonly prescribed drugs can cause thyroid


dysfunction as an adverse effect and a careful medication history should
be taken in all patients with thyroid disease
⬢ Non-thyroidal illness (‘sick euthyroid syndrome’). Intercurrent illness can
affect thyroid function in several different ways. Commonly, TSH is low
normal or partially suppressed, with low or normal free TH

⬢ Pregnancy. Physiological alterations during pregnancy lead to changes in


TH and TSH levels. Accordingly, trimester-specific reference ranges for TH
and TSH should be used whenever possible.

⬢ Assay interference. In any patient in whom anomalous or discordant TFTs


are not readily explained by the above, consideration must be given to
whether one or other laboratory result could be erroneous.
TFT patterns
1. Low TSH and high FT4 (and FT3)
a. This combination of TFTs suggests primary hyperthyroidism
b. Graves’ disease (GD) and toxic multinodular goitre (MNG) are the two
most common causes

2. High TSH and low FT4 (and FT3)


a. This combination of TFTs suggests primary hypothyroidism
b. most usually the result of autoimmune thyroiditis (Hashimoto’s disease or
atrophic thyroiditis) or follows radioiodine or thyroidectomy
3. Low TSH and normal FT4 and/or FT3
a. Subclinical hyperthyroidism (eg owing to a ‘low-grade’ toxic
multinodular goitre or adenoma) is characterised by apparently ‘normal’
TH levels, but low TSH.
i. As described above, although within the reference range, TH levels
in these individuals are higher than the normal set-point of the HPT
axis, resulting in TSH suppression.

b. Non-thyroidal illness (NTI) is another common cause of transiently low


(but not fully suppressed) TSH, with resolution following recovery and
emphasises the importance of not acting on a single TSH result.
4. High TSH and normal FT4 (and FT3)

⬢ This pattern of results can signify ‘subclinical


hypothyroidism’.
⬢ Measurement of antithyroid peroxidase (TPO) antibody
titres is a useful adjunct to help decision-making because
positivity predicts a higher risk of subsequent progression
to overt hypothyroidism.
5. Low FT4 (and/or low FT3) with inappropriately normal or low TSH
⬢ This combination of TFTs is also seen in NTI and resolves with recovery.
⬢ However, in the absence of a clear alternative diagnosis, central
hypothyroidism must be considered and a full pituitary hormone profile is
mandatory. .

6. High FT4 (±FT3) with inappropriately normal or high TSH


⬢ This unusual pattern of TFTs is most commonly accounted for by
⬡ assay interference
⬡ confounding effects of drugs (eg amiodarone or heparin)
⬡ T4 replacement therapy (including non-compliance)
⬡ Once these have been excluded, two rare but important conditions must be
distinguished: resistance to TH (RTH) and a TSH-secreting pituitary adenoma
(TSHoma)
Primary hyperthyroid Non thyroid illness Secondary hyperthyroid

High

Subclinical hyperthyroid Euthyroid Subclinical hyperthyroid


Free T4
Normal

Secondary hypothyroid Non thyroid illness Primary hypothyroid


Low

Low Normal High

TSH
Algorithm for Hypothyroidism
Algorithm for Hyperthyroidism
Thank you

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