THYROID FUNCTION
TESTS
BY DR. KALINDI
(MBBS)
INTRODUCTION TO THYROID
HORMONE
• Two closely related iodine containing compound:- T3-
TRIIODOTHYRONINE
• T4-TETRAIODOTHYRONINE(THROXINE)
• These two are synthesized by follicular cells of
thyroid.
• Whereas CALCITONIN is synthesized by parafollicular
cells of Thyroid.
• Thyroid hormones act via nuclear receptor.
• Free form(1%)- responsible for all actions.
• Bound form(99%)- bound by protein
THYROID BINDING GLOBULIN- 70%
ALBUMIN- 20%
TRANSTHYRETIN (PREALBUMIN)- 10%
FUNCTION OF THYROID
HORMONE
Calorigenic effect or thermogenesis.
• Increases basal metabolic rate(BMR)
• Increases gluconeogenesis and cholesterol
degradation.
• Maturation of skeletal and nervous system.
• Stimulate lipolysis and proteolysis.
HORMONE RELEASE AND FEEDBACK
CONTROL
FREE T3 AND T4:-
• These are functionally active.
• Their values can be measured using
ELISA technique.
• Not bound to any plasma proteins.
PLASMA TSH:-
• In primary hypothyroidism, TSH is elevated due
to lack of feedback.
• In secondary hypothyroidism, TSH, T3 and T4 are
low due to hypothalamic and pituitary cause.
• Hyperthyroidism-> due to primary thyroid disease
T3 and T4 levels are high but suppressed TSH levels.
NORMAL VALUES:-
• TSH :-0.5-5.0 mU/L.
• T3 :- 1.8-3.0 nmol /L.
• rT3 :-10-25 ng/dL
• T4:- 5-12 microgram /dL
• TRH :-5- 60 ng /L.
DIFFERENCE B/W T3 & T4:-
• T3 • T4
• MoSt potent. • Less potent.
• More active-physiological • Less active
actions.
• Circulating levels more
• Circulating levels – less
short t1/2 • Long t1/2
• Rapid acting • Slow acting
FREE T3 T4 (ANY TIME), TSH(FASTING) ARE
IMPORTANT PART OF TFT. ALWAYS CHECK
TSH,T3,T4 TOGETHER.
THYROID ANTIBODIES
• Thyroid stimulating immunoglobulin(TSIg) also
called Long acting Thyroid Stimulator(LATS) is
seen in Grave’s disease. (Will have same
function as TSH).
• Antithyroglobulin antibodies are detected in
Hashimoto’s thyroiditis.
CONGENITAL HYPOTHYROIDISM
• Seen in iodine deficiency, absent or ectopic thyroid
gland , dyshormonogenesis and in TSH receptor
mutation.
• TSH assay used as screening in ANC to prevent
congenital hypothyroidism.
• In children, hypothyroidism produces mental and
physical retardation, known as CRETINISM.
SYMPTOMS OF HYPOTHYROIDISM
LAB FINDIINGS IN HYPOTHYROIDISM
SYMPTOMS OF HYPERTHYROIDISM
LAB FINDINGS IN HYPERTHYROIDISM
• Both hypothyroidism and hyperthyroidism
causes ANEMIA.
• Hypothyroidism- d/t decreased erythropoiesis
• Hyperthyroidism- relative anemia d/t
increase plasma volume.
CLINICAL CASE STUDY
• A30 year old female complained of weight
gain, irregular menstrual cycles & hair loss is
investigated for thyroid function test and has
fT3, fT4 normal and TSH elevated
(6.0mU/L)and anti thyroglobulin antibodies
positive. What is the probable diagnosis?
DIAGNOSIS-> HASHIMOTO’S THYROIDITIS
• Anti thyroglobulin antibodies-seen in 90% of
the cases.
• Anti TPO antibodies->seen in 90-100% cases
• Anti TSH receptor Antibodies ->seen in
<20%cases.
CLINICAL CASE STUDY-2
• A 40 year old female
presented to medicine opd
with features of
proptosis,eyelid retraction,
tremors ,weight loss and
increased appetite. On
examination following
findings can be seen
• What will be the TFT profile of the
patient?
• What is the probable diagnosis?How will
you confirm it?
• In this case fT3, fT4 will be raised.
• Next step-> check for TSH receptor
stimulating antibodies-> if positive->
Diagnosis-> GRAVE’S DISEASE.
Thank you