Laboratorium tes

1. TSH test
The best way to initially test thyroid function is to measure the TSH level in a blood sample.
This type of examination is really sensitive, using an immunospesific monoclonal antibody. The
normal level of this examination is 0,5 – 0,6 μU/ml. A high TSH level indicates that the thyroid
gland is failing because of a problem that is directly affecting the thyroid (primary hypothyroidism).
The opposite situation, in which the TSH level is low, usually indicates that the person has an
overactive thyroid that is producing too much thyroid hormone (hyperthyroidism). Occasionally, a
low TSH may result from an abnormality in the pituitary gland, which prevents it from making
enough TSH to stimulate the thyroid (secondary hypothyroidism). In most healthy individuals, a
normal TSH value means that the thyroid is functioning normally. If the TSH result is low and and
clinically suspected hyperthyroidism, a diagnosis can be made. This means that no need to do TRH
stimulation test to establish Graves’ disease.

2. T4 tests
T4 circulates in the blood in two forms:
 T4 bound to proteins that prevent the T4 from entering the various tissues that need thyroid
hormone.
 Free T4, which does enter the various target tissues to exert its effects. The free T4 fraction
is the most important to determine how the thyroid is functioning, and tests to measure this
are called the Free T4 (FT4) and the Free T4 Index (FT4I or FTI). Individuals who have
hyperthyroidism will have an elevated FT4 or FTI, whereas patients with hypothyroidism
will have a low level of FT4 or FTI.
The type of this examination is radioimmunoassay. Free T4 or FTI will be measured in this
examination. Combining the TSH test with the FT4 or FTI accurately determines how the thyroid
gland is functioning. The normal result from this examination is 5 – 12 μg/dl.
The finding of an elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to
disease in the thyroid gland. A low TSH and low FT4 or FTI indicates hypothyroidism due to a
problem involving the pituitary gland. A low TSH with an elevated FT4 or FTI is found in
individuals who have hyperthyroidism.
Another interpretation is when the result of FT4 is increased accompanied by increasing TBG,
these conditions can be caused by using oral contraceptive pill, estrogen, pregnancy, familial,
hepatitis, cirrhosis hepatis, or using tamoxifen. When the result of FT4 is decreased accompanied by
increasing TBG, these conditions can be caused in patient with nephrosis, glucocorticoid
consumption, familial, and androgen conditions.
 In some cases, high or low T4 levels doesn’t indicates a thyroid problem. Thyroid hormone levels
will be higher in pregnency or are taking oral contraceptives. Severe illness or using corticosteroids
medicines to treat asthma, arthritis, skin conditions, and other health problems can lower T4 levels.
These conditions and medicines change the amount of proteins in your blood that “bind,” or attach,
to T4. Bound T4 is kept in reserve in the blood until it’s needed. “Free” T4 is not bound to these
proteins and is available to enter body tissues. Because changes in binding protein levels don’t affect
free T4 levels.

3. T3 test
This test is to measure biologically active hormone. T3 tests are often useful to diagnosis
hyperthyroidism or to determine the severity of the hyperthyroidism. The normal level of this test is
80 – 200 ng/dl. Patients who are hyperthyroid will have an elevated T3 level. In some individuals
with a low TSH, only the T3 is elevated and the FT4 or FTI is normal. T3 testing rarely is helpful in
the hypothyroid patient, since it is the last test to become abnormal. Patients can be severely
hypothyroid with a high TSH and low FT4 or FTI, but have a normal T3. In some situations, such as
during pregnancy or while taking birth control pills, high levels of total T4 and T3 can exist. This is
because the estrogens increase the level of the binding proteins. In these situations, it is better to ask
both for TSH and free T4 for thyroid evaluation.

4. Thyroid antibody tests.

Measuring levels of thyroid antibodies may help diagnose an autoimmune thyroid disorder
such as Graves’ disease, the most common cause of hyperthyroidism and Hashimoto’s disease, the
most common cause of hypothyroidism. Thyroid antibodies are made when immune system attacks
the thyroid gland by mistake.

5. Thyroglobulin

Thyroglobulin (Tg) is a protein produced by normal thyroid cells and also thyroid cancer
cells. It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid
gland is still present. It is used most often in patients who have had surgery for thyroid cancer in
order to monitor them after treatment. Tg is included in this brochure of thyroid function tests to
communicate that, although measured frequently in certain scenarios and individuals, Tg is not a
primary measure of thyroid hormone function.

6. Radioactive Iodine Uptake Test

 Because T4 contains much iodine, the thyroid gland must pull a large amount of iodine out
from the blood stream in order for the gland to make an appropriate amount of T4. The thyroid has
developed a very active mechanism for doing this. Therefore, this activity can be measured by
having an individual swallow a small amount of iodine, which is radioactive. The radioactivity
allows the doctor to track where the iodine molecules go. By measuring the amount of radioactivity
that is taken up by the thyroid gland (radioactive iodine uptake, RAIU), doctors may determine
131
whether the gland is functioning normally. I given orally. After 6 and 24 hours, the interpretation
of the uptake, be careful with Tc99m scanning. The normal level of this test is 30 – 40% uptake
within 24 hours. A very high RAIU (>60%) is seen in individuals whose thyroid gland is overactive
(hyperthyroidism, hashimoto initial phase, endemic goitre, postpartum), while a low RAIU (<10%)
is seen when the thyroid gland is underactive (hypothyroidism, further hashimoto’s disease, jod-
basedowi, de Quervain disease, and post thyroid ablation).

7. T3RU (T3 Resin Uptake Results)

This examination is a blood test that measures the binding capacity of a hormone called
thyroxin-binding globulin (TBG). If the T3 level is elevated, the TBG binding capacity should be
low. The normal level of this test is 25 – 35%. If the result is >35%, it means hyperthyroidism
conditions occur. And if accompanied with decreasing TBG, maybe it happens in patient with
nephrosis. If the result is <25%, it means hypothyroidism conditions occur. And if accompanied with
increasing TBG, maybe it happens in patient using oral contraceptive pills.

8. Thyroglobulin Antibody (Anti-Tg)

This antibody detects the presence and quantity of spesific thyroid autoantibodies. These
develop when a person’s immune system mistakenly recognizes components of the thyroid as
foreign and can lead to chronic thyroiditis, tissue damage, and disruption of thyroid function. Often
associated with thyroid cancer or Hashimoto’s thyroiditis. Positive anti-Tg occurs in thyroid cancer
patients. In Graves’ disease patients, found an antibody that can effect TSH receptor from thyroid
cells and stimulate thyroid hormone secretion. The antibody called TSI (thyroid stimulating
immunoglobulins). Beside TSI, there is another immunglobulin that can stimulate thyroid hormone
growth without affecting thyroid hormone secretion. The antibody called TGI (thyroid growth
immunoglobulins). The normal level of anti-Tg is 3 – 42 ng/ml. If the anti-Tg is elevated, maybe that
can occur because of hyperthyroidism, subacute thyroiditis, untreated thyroid cancer, Graves’
disease, benign tumour, thyroid cyst. If the anti-Tg is decreased, maybe that can occur because of
congenital hypothyroidism.
9. Thyroid Peroxidase Antibody (Anti-TPO)/Microsomal Antibody
In normal people, the test result is negative. Positive microsomal antibody can occur in
patient with thyroid autoimmune, sometimes thyroid carcinoma. In patient with thyroxin treatment
 failure, if there is positive antibody, indicates thyroid function failure. 95% Hashimoto’s thyroiditis
patients and about 85% Graves’ disease patients have positive anti-TPO.
10. Thyroid Stimulating Antibodies (TSAb)
In normal people, the test result is negative. 70 – 80% Graves’ disease patients that left
untreated, 15% Hashimoto diseases patients, 60% Graves Ophthalmic Patients, and some patients
with thyroid cancer, the thyroid stimulating antibodies (TSAb) can be positive.

Imaging

1. Ultrasound
If there is a lump that moves up, the USG should be performed in patient. Ultrasound of the
thyroid is most often used to look for, or more closely at, thyroid nodules. Thyroid nodules are lumps
in neck. Ultrasound can help to tell if the nodules are more likely to be cancerous. For further
examinations are thyroid scan, CT scan, or PET scan, depends on the indications.

2. Thyroid scan
Thyroid scan may help to look at the size, shape, and position of the thyroid gland. This test
uses a small amount of radioactive iodine to help find the cause of hyperthyroidism and check for
thyroid nodules. A week before the test the patient may avoid foods high in iodine, such as kelp, or
medicines containing iodine.