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thyroidfunctiontests-130723113226-phpapp01

Uploaded by

Abinash Kumar Mandal
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Thyroid Function Tests

Introduction
Thyroid hormones:

tetra iodothyronine / thyroxine (T4)


tri iodothyronine (T3)

Binds to:

thyroxine binding globulin (TBG)


thyroxine binding pre albumin (TBPA)
albumin
apolipoproteins

Free fractions are metabolically active


Differences between T3 and T4
T3 T4

Secretion 30 microgram /day 80 microgram /day

Source 20 – 25% by gland Solely by gland


75 - 80% by
conversion
Half-life 1 day 7 days

Potency 3-4 times more potent Potent


than T4

Binding 0.2% in unbound 0.02% in unbound


Thyroid disorders

Hypothyroidism

 Primary
 Secondary
 Tertiary

Hyperthyroidism
Thyroid disorders
Symptoms of hypothyroidism
 Lethargy
 Constipation
 Dry and coarse skin and hair
 Facial puffiness
 Cold intolerance
 Decreased sweating
 Impaired memory
 Confusion
 Dementia
 Low speech and motor activity
 Anemia
Thyroid disorders
Causes of hypothyroidism
Primary Secondary Tertiary

Iodine deficiency Hypopituitarism Hypothalamic


Excess iodide intake - Adenoma dysfunction
Thyroid ablation - Ablative therapy
(Surgery) - Pituitary destruction
Hashimoto’s
thyroiditis
Sub acute thyroiditis
Genetic abnormalities
Goiterogenic food
(cabbage)
Drugs
– Lithium
– Amiodarone
– Anti thyroid agents
Thyroid disorders
Symptoms of hyperthyroidism

 Nervousness
 Fatigue
 Weight loss
 Heat intolerance
 Increased sweating
 Tachycardia
 Atrial fibrillation
 Warm and moist skin
 Exophthalmos
Thyroid disorders
Causes of hyperthyroidism
a) Overproduction of thyroid hormones
a) Grave’s disease
b) TSH secreting pituitary adenomas
c) Multi nodular goiter
b) Leaking thyroid hormone due to thyroid destruction
a) Lymphocytic thyroiditis
b) Sub acute thyroiditis
c) Radiation
c) Drugs
a) Thyroid replacement drugs
b) Amiodarone
c) Iodinated radio contrast agents
d) Metastatic thyroid carcinoma
Thyroid tests
Tests specific to thyroid status:

 Measure the concentration of products secreted


by the thyroid gland

 Evaluate the integrity of the hypothalamic–


pituitary- thyroid axis

 Assess inherent thyroid gland function

 Detect antibodies to thyroid tissue


Thyroid tests
Measure the concentration of products secreted by the
thyroid gland

 Free T4
 Total serum T4
 Serum T3 resin uptake
 Free T4 index
 Total serum T3
Thyroid tests
Free T4:
Reference range: 0.8 - 2.7 nanogram/dl

Measures unbound fraction of T4

Decreased direct equilibrium dialysis (method) T4


and increase TSH is suggestive of primary
hypothyroidism

Increase DED free T4 and TSH of less than 0.01


milliunits/L is suggestive of non-pituitary
hyperthyroidism
Thyroid tests
Total serum T4:
Reference range: 4 - 12 microgram/dl

Measures both bound and free T4

Increased total serum T4 – hyperthyroidism/


increase concentration of thyroid binding proteins

Decreased total serum T4 –


hypothyroidism/decrease concentration of thyroid
binding proteins/ non thyroid illness [DM, liver disease,
renal failure, prolonged infection and CV diseases]
Thyroid tests
Serum T3 resin uptake (thyroid hormone binding ratio):

Reference range: 25 – 35%

Indirectly estimates the number of binding sites on


thyroid binding proteins occupied by T3

The T3 resin uptake is high when thyroid –binding


protein is low and vice versa
Thyroid tests

Increase in T3 resin uptake - consistent with


hyperthyroidism

Decrease in T3 resin uptake - consistent with


hypothyroidism

This test is never used alone for diagnosis. In practice, the T3 resin
uptake test is used only to calculate the free T4 index
Thyroid tests
Free thyroxine (T4) index:

Reference range: 1.2 – 4.2

Free T4 index = Total serum T4 (mg/dl) X T3 resin uptake (%)

The index is high in hyperthyroidism

The index is low in hypothyroidism


Thyroid tests
Total serum T3:

Reference range: 78 - 195 nanogram/dl

Used to detect T3 toxicosis (increase T3 and normal T4)


Thyroid tests
Evaluate the integrity of the hypothalamic – pituitary -
thyroid axis:

Assessed by measuring TSH and TRH


Thyroid tests
TSH:

Ref range: 0.3 - 5 microunits /ml or milliunits /L

Symptomatic primary hypothyroidism: >20 mu/L

Mild symptomatic hypothyroidism: 10 to 20 mu/L

Primary hyperthyroidism: <0.05 mu/L


Thyroid tests
TRH:
Regulates the TSH secretion from pituitary

TRH test measure the ability of TRH to stimulate the


pituitary to secrete TSH

TSH rise of 5 micro units/ml over baseline - euthyroid state

A significant increase rules out – hyperthyroidism


Is performed by drawing baseline serum TSH concentration and then
administer approximately 200-400 microgram of TRH by iv over 30 – 60
seconds. Then TSH concentration drawn at 30 – 60 minutes
Thyroid tests
Assess inherent thyroid gland function

Radioactive iodine uptake test is used to assess


intrinsic function of the thyroid gland

This test is not specific and the reference range


should be adjusted based on local population

This test is indirect measure of thyroid activity


Thyroid tests
Subject with normal thyroid gland

 12 – 20% of radio active iodine is absorbed after 6


hours

 5 - 25% of radio active iodine is absorbed after 24


hours
Thyroid tests
Increased radio active iodine uptake noted in:
 Thyrotoxicosis
 Iodine deficiency
 Post thyroiditis
 Withdrawal rebound after thyroid hormone/ anti
thyroid drug therapy

Decreased radio active iodine uptake noted in:


 Acute thyroiditis
 Euthyroid patients
 Patients on exogenous thyroid hormone therapy
 Patients taking anti-thyroid drugs
 hypothyroidism
Thyroid tests
Detect antibodies to thyroid tissue (Anti thyroid antibodies)

Found in Hashimoto’s thyroiditis (95% of patients) and


Grave’s disease (55% of patients)

Adults without thyroid disease (10% of adults)

In Grave’s disease, hyperthyroidism is caused by


antibodies activating TSH receptors

In thyroiditis, hypothyroidism is caused by antibodies


competitively binding to TSH receptors thus blocking the
TSH from eliciting the response
Summary
Radioactiv
Total Total T3
Free T4 e iodine
Disease serum serum resin TSH
index uptake
T4 T3 uptake
test
10
Hypothyroidism
20, 3 0

Hyperthyroidism

No No No
T3 toxicosis
change change change No change

Euthyroid sick No No
variable No change
syndrome change change
Thank you

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