Goiter laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with goiter may be in a [[euthyroid]], [[hypothyroid]] or [[hyperthyroid]] state. Patients should be evaluated for free [[T4]], [[T3]], [[TSH]] levels and [[Thyroid peroxidase|TPO]] [[antibodies]]. | Patients with goiter may be in a [[euthyroid]], [[hypothyroid]] or [[hyperthyroid]] state. Patients should be evaluated for free [[tetraiodothyronine]] ([[T4]]), [[Triiodothyronine]] ([[T3]]), [[Thyroid-stimulating hormone|thyroid stimulating hormone]] ([[TSH]]) levels and [[thyroid peroxidase]] ([[Thyroid peroxidase|TPO]]) [[antibodies]]. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
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'''Thyroid function tests:''' | '''Thyroid function tests:''' | ||
*Patients with goiter may be in a [[euthyroid]], [[hypothyroid]] or [[hyperthyroid]] state. | *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 [[ | *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 [[Grave's disease]]. | ||
*When the [[TSH]] 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. | *When the [[TSH]] 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. | ||
Revision as of 18:57, 17 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients with goiter may be in a euthyroid, hypothyroid or hyperthyroid state. Patients should be evaluated for free tetraiodothyronine (T4), Triiodothyronine (T3), thyroid stimulating hormone (TSH) levels and thyroid peroxidase (TPO) antibodies.
Laboratory Findings
Thyroid function tests:
- 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 Grave's disease.
- When the TSH 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): [1]
- 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.
- The following laboratory testing should be carried out for:
- Serum TSH
- Serum T3
- Serum T4
- Serum thyroglobulin
- Serum cholesterol
- Thyroid scintigraphy
- Anti-TPO antibodies detected in most autoimmune thyroid disease (eg, Hashimoto's thyroiditis, idiopathic Myxedema, and Grave's disease)
- Urinary iodine levels less than 10 mcg/dL is suggestive of iodine deficiency
References
- ↑ Ris-Stalpers, Carrie; Bikker, Hennie (2010). "Genetics and phenomics of hypothyroidism and goiter due to TPO mutations". Molecular and Cellular Endocrinology. 322 (1–2): 38–43. doi:10.1016/j.mce.2010.02.008. ISSN 0303-7207.