Thyroid Function Test

No Routine Lab Test Test Measurement of T4 and T3 - free hormones (free T4, free T3) - total hormones (Total T4, Total T3) Measurement Thyroid Stimulating Hormone (Thyrotrophin, TSH) Comments -Free assays are preferred bcoz not affected by conditions which give misleading to total T4 and T3 levels -Eg : estrogens (OCP, pregnancy) can increase TBG and total T4 -High : primary hypothyroidism, secondary hyperthyroidism -Low : primary hyperthyroidism, secondary hypothyroidism -inactive metabolite of T4 -elevated levels in : newborn, severe acute non-thyroidal illness, starvation -no major routine diagnostic use -administer 100-200 uCi of radioactive iodine orally measure uptake at thyroid area using camera after 4-6hours and 24 hours -useful for hyperthyroid state and to assess residual thyroid tissue after thyrodectomy or determine recurrence of thyroid cancer -high RAIU : hyperthyroidism due to Graves disease or toxic nodular goiter -low RAIU : hypothyroidism, thyroiditis, thyrotoxicosis factitia, iodine excess -antibodies against thyroid tissue : Thyroglobulin auto-antibodies (TGA) Thyroid Microsomal auto-antibodies (TMA) Thyroperoxidase auto-antibodies (TPO) TSH receptor antibodies (TSHr) -useful to assess autoimmune thyroid disease -to confirm commonest disease of hypothyroidism (Hashimotos disease destruction of thyroid tissue by autoantibodies, high TSH, hypothyroid, high thyroid antibodies) -to determine amount of thyroid tissue after throdectomy (should be no thyroglobulin after complete thyrodectomy)

Reverse Tri-iodothyronine (rT3)

Test for Iodine Metabolism Radioactive Iodine Uptake (RAIU)

Thyroid Auto-antibodies

Thyroglobulin Assay

-to monitor the recurrence of common thyroid cancer -measured by immunoassay Calcitonin Assay -medullary thyroid cancer : C-cell cancer, secretes calcitonin -to detect and monitor the recurrence of medullary thyroid cancer -administer iv 500 ug TRH draw samples at 0,30,60,90,120 min - TSH not rise : pituitary insufficiency or suppression -hypersensitivity on TRH : primary hypothyroidism -impaired response : high circulating TH levels -exaggerated response : primary hypothyroid -now rarely use, so replaced by high sensitivity TSH assays measure TSH each points

TRH Stimulation Test

Primary Thyroid Failure Secondary Thyroid Failure Excess hormone by primary gland Excess hormone by pituitary gland

End organ hormone (T4) low low high high

Pituitary hormone (TSH) high low low high

Part of organ Thyroid gland not normal Hypothalamus or pituitary gland not normal Excess T4 by thyroid gland Excess TSH