Thyroid function tests: Difference between revisions
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==Overview== | ==Overview== | ||
'''Thyroid function tests''' ('''TFTs''') is a collective term for [[blood test]]s used to check the function of the [[thyroid]]. A TFT panel typically includes [[thyroid-stimulating hormone]] ([[TSH]], [[thyrotropin]]) and [[thyroxine]] ([[T4]]), and [[triiodothyronine]] ([[T3]]) depending on local laboratory policy.TFTs may be requested if a patient is thought to suffer from [[hyperthyroidism]] (overactive thyroid) or [[hypothyroidism]] (underactive thyroid) | '''Thyroid function tests''' ('''TFTs''') is a collective term for [[blood test]]s used to check the function of the [[thyroid]]. A TFT panel typically includes [[thyroid-stimulating hormone]] ([[TSH]], [[thyrotropin]]) and [[thyroxine]] ([[T4]]), and [[triiodothyronine]] ([[T3]]) depending on local laboratory policy.TFTs may be requested if a patient is thought to suffer from [[hyperthyroidism]] (overactive thyroid) or [[hypothyroidism]] (underactive thyroid) or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy. It is also requested routinely in conditions linked to thyroid disease, such as [[atrial fibrillation]]. The normal adult reference range for serum [[TSH]] is 0.4-4.5 mIU/L. The adult reference range of [[FT4]] using comparative direct methods is 0.7-1.8 ng/dL (9-23 pmol/L) and that for FT3 is 2.3-5.0 pg/mL (35-77 pmol/L). A high [[TSH]] level may indicate [[hypothyroidism]]. If the results indicate high [[TSH]] levels, a second confirmatory sample including [[TSH]] and free [[Thyroxine|T4]] levels should be tested prior to starting treatment. [[TSH]] should not be measured in isolation in patients with suspected hypothalamic-pituitary disease; the measurement of free [[T4]] is essential. Free [[T4]] testing, combined with TSH testing, is recommended for the routine assessment and diagnosis of thyroid function and following [[hyperthyroidism]] treatment and may or may not be used in cases of [[hypothyroidism]]. | ||
==Thyroid function tests== | ==Thyroid function tests== | ||
Thyroid function tests serve as an important diagnostic tool in the diagnosis and follow-up of various hyper and hypothyroid states:<ref name="urlUtilização dos testes de função tireoidiana na prática clínica">{{cite web |url=http://dx.doi.org/10.1590/S0004-27302013000300005+ |title=Utilização dos testes de função tireoidiana na prática clínica |format= |work= |accessdate=}}</ref> | Thyroid function tests serve as an important diagnostic tool in the diagnosis and follow-up of various [[Hyperthyroidism|hyper]] and [[Hypothyroidism|hypothyroid]] states:<ref name="urlUtilização dos testes de função tireoidiana na prática clínica">{{cite web |url=http://dx.doi.org/10.1590/S0004-27302013000300005+ |title=Utilização dos testes de função tireoidiana na prática clínica |format= |work= |accessdate=}}</ref> | ||
*The normal adult reference range for serum TSH is 0.4-4.5 mIU/L. A high TSH level may indicate hypothyroidism. If the results indicate high TSH levels, a second confirmatory sample including TSH and free T4 levels should be tested prior to starting treatment. | *The normal adult reference range for serum [[TSH]] is 0.4-4.5 mIU/L. A high [[TSH]] level may indicate hypothyroidism. If the results indicate high [[TSH]] levels, a second confirmatory sample including [[TSH]] and free T4 levels should be tested prior to starting treatment. | ||
*The adult reference range of FT4 using comparative direct methods is 0.7-1.8 ng/dL (9-23 pmol/L) and that for FT3 is 2.3-5.0 pg/mL (35-77 pmol/L). | *The adult reference range of FT4 using comparative direct methods is 0.7-1.8 ng/dL (9-23 pmol/L) and that for FT3 is 2.3-5.0 pg/mL (35-77 pmol/L). | ||
*TSH should not be measured in isolation in patients with suspected hypothalamic-pituitary disease; the measurement of free T4 is essential. Free T4 testing, combined with TSH testing, is recommended for the routine assessment and diagnosis of thyroid function and following hyperthyroidism treatment and may or may not be used in cases of hypothyroidism. | *[[TSH]] should not be measured in isolation in patients with suspected hypothalamic-pituitary disease; the measurement of free [[T4]] is essential. Free [[T4]] testing, combined with [[TSH]] testing, is recommended for the routine assessment and diagnosis of thyroid function and following [[hyperthyroidism]] treatment and may or may not be used in cases of [[hypothyroidism]]. | ||
*Serum T3 testing has a low sensitivity and specificity for diagnosing hypothyroidism. | *Serum [[T3]] testing has a low sensitivity and specificity for diagnosing [[hypothyroidism]]. | ||
*Abnormal levels of total T4 and T3 often result from changes in transport proteins, not thyroid function. Total hormone testing should only be performed when there are discrepancies in the free hormone levels. | *Abnormal levels of total [[T4]] and [[T3]] often result from changes in transport proteins, not thyroid function. Total hormone testing should only be performed when there are discrepancies in the free hormone levels. | ||
*Conditions other than thyroid disease should be considered when TSH levels are abnormal such as physiological changes associated with pregnancy, severe nonthyroidal illness, and medication use (including amiodarone, lithium, dopamine and glucocorticoids). | *Conditions other than thyroid disease should be considered when [[TSH]] levels are abnormal such as physiological changes associated with pregnancy, severe nonthyroidal illness, and medication use (including [[amiodarone]], [[lithium]], [[dopamine]], and [[glucocorticoids]]). | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===TSH levels | ===Increased TSH levels === | ||
*Hashimoto's thyroiditis | *[[Hashimoto's thyroiditis]] | ||
*Riedel's thyroiditis | *[[Riedel's thyroiditis]] | ||
*De Quervain's thyroiditis | *[[De Quervain's thyroiditis]] | ||
===TSH | ===Decreased TSH levels === | ||
*Graves disease | *[[Graves' disease|Graves disease]] | ||
*Thyrotoxicosis | *[[Thyrotoxicosis]] | ||
*Amiodarone | *[[Amiodarone]] | ||
==References== | ==References== | ||
Revision as of 17:00, 6 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Synonyms and keywords: TFTs
Overview
Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid. A TFT panel typically includes thyroid-stimulating hormone (TSH, thyrotropin) and thyroxine (T4), and triiodothyronine (T3) depending on local laboratory policy.TFTs may be requested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid) or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy. It is also requested routinely in conditions linked to thyroid disease, such as atrial fibrillation. The normal adult reference range for serum TSH is 0.4-4.5 mIU/L. The adult reference range of FT4 using comparative direct methods is 0.7-1.8 ng/dL (9-23 pmol/L) and that for FT3 is 2.3-5.0 pg/mL (35-77 pmol/L). A high TSH level may indicate hypothyroidism. If the results indicate high TSH levels, a second confirmatory sample including TSH and free T4 levels should be tested prior to starting treatment. TSH should not be measured in isolation in patients with suspected hypothalamic-pituitary disease; the measurement of free T4 is essential. Free T4 testing, combined with TSH testing, is recommended for the routine assessment and diagnosis of thyroid function and following hyperthyroidism treatment and may or may not be used in cases of hypothyroidism.
Thyroid function tests
Thyroid function tests serve as an important diagnostic tool in the diagnosis and follow-up of various hyper and hypothyroid states:[1]
- The normal adult reference range for serum TSH is 0.4-4.5 mIU/L. A high TSH level may indicate hypothyroidism. If the results indicate high TSH levels, a second confirmatory sample including TSH and free T4 levels should be tested prior to starting treatment.
- The adult reference range of FT4 using comparative direct methods is 0.7-1.8 ng/dL (9-23 pmol/L) and that for FT3 is 2.3-5.0 pg/mL (35-77 pmol/L).
- TSH should not be measured in isolation in patients with suspected hypothalamic-pituitary disease; the measurement of free T4 is essential. Free T4 testing, combined with TSH testing, is recommended for the routine assessment and diagnosis of thyroid function and following hyperthyroidism treatment and may or may not be used in cases of hypothyroidism.
- Serum T3 testing has a low sensitivity and specificity for diagnosing hypothyroidism.
- Abnormal levels of total T4 and T3 often result from changes in transport proteins, not thyroid function. Total hormone testing should only be performed when there are discrepancies in the free hormone levels.
- Conditions other than thyroid disease should be considered when TSH levels are abnormal such as physiological changes associated with pregnancy, severe nonthyroidal illness, and medication use (including amiodarone, lithium, dopamine, and glucocorticoids).