Toxic Adenoma laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Measurement of serum TSH is considered as the initial test in the evaluation of thyroid disorders.^[1]^[2]^[3]^[4]
It should be measured in all patients with a thyroid nodule or goiter.
The serum free T 4 and free or total T 3 levels are elevated or in the upper part of the normal range.
Toxic adenomas can be associated with overt or subclinical hyperthyroidism.
- In overt hyperthyroidism, usually both serum (free) T4 and T3 are elevated.
- Isolated T 3 toxicosis, in which the serum T 3 concentration is elevated but free T 4 is normal, occurs in approximately 1% of patients with hyperthyroidism.
When the TSH is low, but both free T 4 and T 3 levels are normal, the patient has subclinical or mild hyperthyroidism, which is common in toxic multinodular goiter, especially in older patients.
Findings of routine laboratory tests include:
- elevated serum calcium
- elevated alkaline phosphataseh
- elevated ferritin levels
- low (LDL) cholesterol levels.

Tests	Findings
TSH	Low
Free T4	Elevated
Total T3	Elevated
CMP	Hypercalcemia Elevated aminotransferases Elevated alkaline phosphatase
TSH receptor antibodies	Negative
Thyroid peroxidase antibodies	Negative

↑ Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, LiVosli VA, Niccoli-Sire P, John R, Ruf J, Smyth PP, Spencer CA, Stockigt JR (2003). "Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease". Thyroid. 13 (1): 3–126. doi:10.1089/105072503321086962. PMID 12625976.
↑ Hegedüs L (2004). "Clinical practice. The thyroid nodule". N. Engl. J. Med. 351 (17): 1764–71. doi:10.1056/NEJMcp031436. PMID 15496625.
↑ Cattaneo F, Bürgi U, Mueller B (1999). "[Goiter and nodular thyroid disease: clinical guidelines for diagnosis and treatment. (Waiting? Hormone therapy? Surgery? radioiodine?)]". Ther Umsch (in German). 56 (7): 356–63. doi:10.1024/0040-5930.56.7.356. PMID 10434771.
↑ Hurley DL, Gharib H (1996). "Evaluation and management of multinodular goiter". Otolaryngol. Clin. North Am. 29 (4): 527–40. PMID 8844728.