Goiter laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Laboratory Findings

Thyroid function tests:

• In Goiter, serum TSH levels evaluation is advised.
• Patients with Goiter may be in a euthyroid, hypothyroid or hyperthyroid state.
• When the serum TSH is below normal levels, then the serum free T4 and T3 should should be evaluated. The most likely diagnosis in patients with overt or subclinical hyperthyroidism and goiter is either multinodular goiter (MNG) or Graves' disease.
• When theTSH is above normal levels, then the free T4 should be evaluated. Hashimoto's thyroiditis is the most probable diagnosis in patients presenting with overt or subclinical hypothyroidism, except for patients for those in the areas of iodine deficiency leading to endemic goiter.

• Thyroid peroxidase antibodies (TPO): In patients with goiter, serum TPO antibodies have to be evaluated. In patients with goiter and and normal TSH levels, TPO antibodies are measured to rule out Hashimoto's thyroiditis.
• In the United States, TPO antibodies are mostly elevated in patients with elevated TSH (hypothyroidism) and goiter, and the most likely diagnosis is Hashimoto's thyroiditis.

• Laboratory testing for the following:
  • Serum TSH
  • Serum T3
  • Serum T4

Condition	T3	T4	TSH
Thyrotoxicosis	Increased	Increased	Supressed
T3 Toxicosis	2X (Increased Twice)	Normal	Supressed
Hypothyroidism	Lo/Normal	Low	Increased

• Serum thyroglobulin
• Serum cholesterol
• Thyroid scintigraphy
• Anti-TPO Antibodies detected in most autoimmune thyroid disease (eg, Hashimoto thyroiditis, idiopathic myxedema, and Graves disease)
• Urinary Iodine levels less than 10 mcg/dL is suggestive of Iodine deficiency