Causes and Lab diagnosis of

Hypothyroidism and Hyperthyroidism

Presented to:
Pro. Dr Riffat Yasmin

Presented By:
Muhammad Rashid
Qadeer Nazir
M Muteeb Ullah
 Today’s Agenda

Laboratory
Introduction Causes of Diagnosis of
Hormone Causes of
to thyroids Hyperthyroidis Hypothyroidism Summary
functions Hypothyroidism
Glands m and
Hyperthyroidism

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Introduction to thyroids Glands?

The thyroid gland is a vital

endocrine organ located in the
front of the neck, just below the
Adam’s apple (larynx).

Shaped like a butterfly, it

consists of two lobes connected
by a narrow isthmus.

Despite its small size, the

thyroid gland plays a crucial
role in regulating the body’s 3

metabolism, energy production,

and overall hormonal balance.
Hormone Functions?

Produces and secretes Hormones

• Thyroxine (T4): Contains four iodine atoms; converted to T3 in target

tissues.
• Triiodothyronine (T3): Active form, regulates metabolic processes.
• Calcitonin: Produced by parafollicular cells (C cells), helps regulate calcium
levels.

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Regulation of the Thyroid Gland?

The thyroid gland operates under the hypothalamic-pituitary-thyroid axis:

Hypothalamus: Secretes Thyrotropin-Releasing Hormone (TRH).

Pituitary Gland: TRH stimulates the anterior pituitary to release Thyroid-

Stimulating Hormone (TSH).

Thyroid Gland: TSH stimulates the thyroid to produce T3 and [Link]

hormones exert negative feedback on the hypothalamus and pituitary to
maintain balance.

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Regulation of the Thyroid Gland?

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 Causes of Hypothyroidism

Primary Hypothyroidism: Thyroid gland itself fails to produce T3 and T4

Hashimoto’s Thyroiditis: Autoimmune destruction of the thyroid gland.

Iodine Deficiency: Most common cause worldwide.

Congenital Hypothyroidism: Absence or malformation of the thyroid gland.

Thyroidectomy or Radioactive Iodine Therapy: Surgical or therapeutic removal of thyroid tissue.

Medications: Lithium, amiodarone, and anti-thyroid drugs.

Thyroiditis: Inflammatory conditions affecting the thyroid. 7

Secondary Hypothyroidism: That occurs due to insufficient
stimulation of the thyroid gland

Pituitary Dysfunction: Inadequate TSH production.

Hypothalamic Dysfunction: Insufficient TRH production.

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Hyperthyroidism

• also called overactive thyroid, is a condition where

your thyroid makes and releases high levels of
thyroid hormone. It has multiple possible causes.
Primary Causes of Hyperthyroidism
• Graves’ Disease
• Autoimmune condition
• Most common cause (70-80%)
• Associated with goiter and exophthalmos

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Cause of hyperthyroidism

Other Causes
• 1. Toxic Multinodular Goiter (Plummer’s Disease)
• - Hyperfunctioning thyroid nodules
• - Common in older adults
• 2. Thyroiditis
• - Inflammation of the thyroid gland
• - Subacute, painless, or postpartum types
• 3. Excessive Iodine Intake
• - Overuse of iodine supplements or contrast dyes

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Cause of hyperthyroidism

Rare Causes
• Thyroid Adenoma
• - Benign tumor causing overproduction of hormones
• TSH-Secreting Pituitary Adenoma
• - Unregulated TSH production
• Ectopic Thyroid Tissue
• - Hormone production from non-thyroid sites (e.g., ovarian
teratomas)
Risk Factors
• - Family history
• - Autoimmune conditions
• - High iodine intake
• - Age and gender (more common in women)
• ---
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Lab Diagnosis

• Tests specific to thyroid status: • Thyroxine (T4)

• Measure the concentration of products secreted by • Triiodothyronine(T3)
the thyroid gland
• TSH (Thyroid-Stimulating Hormone)
• Evaluate the integrity of the hypothalamic-pituitary-
thyroid axis • T 3 resin uptake

• Assess in herent thyroid gland function • Free T 4

• Detect antibodies to thyroid tissue • Free T 4 index

• Thyroid Antibodies:
• TSH receptor antibodies (TRAb):
• Anti-thyroid peroxidase (Anti-TPO)

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Triiodothyronine (T3) test

Hyperthyroidism Hypothyroidism
• T3 is elevated. • T3 is usually normal or low.
• In hyperthyroidism, the thyroid gland overproduces • In hypothyroidism, the production of T3 decreases
thyroid hormones, particularly T3. It is often as thyroid function declines. However, T3 levels may
disproportionately elevated compared to T4, a remain normal in the early stages of hypothyroidism
phenomenon called T3 toxicosis. due to peripheral conversion of T4 to T3
compensating for reduced thyroid function.
Clinical Importance:
• Reference range: 80-220 ng/dL
• T3 levels are more diagnostic for hyperthyroidism
than hypothyroidism. In hypothyroidism, TSH and T4
are more reliable markers for assessment.

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Thyroxine (T4)

Hyperthyroidism Hypothyroidism
• Measures both bound and free T4 • Decreased total serumT4
• Reference range:4-12 microgram/dl • hypothyroidism/decrease concentration of thyroid
• Increased total serum T4 - hyperthyroidism/increase • binding proteins/ non thyroid illness
concentration of thyroid binding proteins
•

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TSH (Thyroid-Stimulating
Hormone)
Hypothyroidism Hyperthyroidism
• TSH Levels :Suppressed/Low
• TSH Levels: Elevated • TSH < 0.4 mIU/L
• TSH > 4.5 mIU/L (common cutoff) • -Severe cases: Undetectable TSH levels (< 0.01
mIU/L)
• - Severe cases: TSH > 10 mIU/L
Mechanism
Mechanism
• - Excess thyroid hormone (T3, T4) negatively
• Low thyroid hormone production (T3, T4) triggers feedbacks, reducing pituitary TSH secretion.
the pituitary to secrete more TSH to stimulate the
thyroid. TSH as a Diagnostic Marker
• - High TSH = Hypothyroidism
• - Low TSH = Hyperthyroidism

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Serum T3 resin uptake (thyroid
hormone binding ratio)

• Reference range:25-35%
• Indirectly estimates the number of binding sites on thyroid binding proteins occupied by T3
• The T3 resin uptake is high when thyroid-binding protein is low and vice versa
• Increase in T3 resin uptake - consistent with hyperthyroidism
• Decrease in T3 resin uptake - consistent with hypothyroidism
• This test is never used alone for diagnosis. In practice, the T3 resin up take test is used only to calculate the free
T4 index

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Free thyroxine T4

Free. T 4 Free thyroxine (T4) index:

• :Reference range:0.8-2.7 nanogram/dl
• Measures unbound fraction of T4 • Reference range:1.2-4.2
• Decreased free T4 and increase TSH is suggestive • Free T4 index = Total serum T4 (mg/dl) X T3 resin
of primary hypothyroidism uptake(%)
• Increase free T4 and TSH of less than • The index is high in hyperthyroidism
0.01milliunits/L issuggestive of non-pituitary
hyperthyroidism • The index is low in hypothyroidism

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Thyroid Antibodies Test

Hyperthyroidism Hypothyroidism
• Thyroid Stimulating Hormone Receptor Antibodies • TPO-Ab and Tg-Ab* are elevated in Hashimoto's
(TSHR-Ab) or Thyroid-Stimulating Immunoglobulin thyroiditis, the most common cause of autoimmune
(TSI). hypothyroidism.
• - Indicative of Graves' disease. Pathophysiology
• Other Possible Antibodies • Antibodies damage thyroid tissue, leading to
reduced hormone production.
• Thyroid Peroxidase Antibodies (TPO-Ab) and
Thyroglobulin Antibodies (Tg-Ab) may be present if Clinical Implications:
Hashimoto's thyroiditis progresses to transient
hyperthyroidism (Hashitoxicosis). • -Presence of antibodies confirms **autoimmune
thyroid disease.
• Helps differentiate between autoimmune and non-
autoimmune thyroid disorders.

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Summary

Disease T3 T4 TSH Free T4 T3 resin up T 4 index

take

Hypothyroidi Normal or Low High Low Low Low

sm Low

Hyperthyroi High High Normal or High High High

dism Low

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THANK YOU!

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