Review articleThyroid disease: pathophysiology and diagnosis
Section snippets
Thyroid function testing
Serum-based tests are available by immunoassay for measuring the concentration of thyroid hormones in the circulation, including total T4 (TT4), total T3, free T4 (FT4), and free T3 (FT3) hormone. In addition, direct measurement of the thyroid hormone–binding plasma proteins, thyroxine binding globulin (TBG), transthyretin/prealbumin, and albumin also are available. The thyroid test measurement that has the greatest usefulness for evaluating patients who are suspected of having thyroid disease
Screening for and managing thyroid disease
Measuring the level of thyrotropin usually is selected for thyroid disease screening in an at-risk ambulatory population. Current third generation thyrotropin tests have sufficient sensitivity and specificity to cover the entire spectrum of thyroid disease, ranging from overt hypothyroidism to overt hyperthyroidism. A thyrotropin-alone first test strategy has been used by many primary care physicians and seems to work well in an outpatient, ambulatory population. A thyrotropin-centered strategy
Thyroid function testing in elderly patients
There is an increased prevalence of a low or high serum thyrotropin level (with normal FT4 results) in elderly patients compared with younger individuals. Age-adjusted reference intervals for thyroid hormones should be considered by clinical laboratories, particularly for the elderly. Some elderly patients can have mild thyroid disease with the symptoms masked by the normal aging process. Diseases, such as Hashimoto's thyroiditis, are encountered with increasing prevalence in the elderly and
Diagnosis of hypothyroidism
The most common cause of hypothyroidism is a disorder that is intrinsic to the thyroid gland itself and is known as primary hypothyroidism. Hypothyroidism leads to a hypometabolic state; generalized symptoms of thyroid hormone deficiency include fatigue, lethargy, cold intolerance, slowed speech and intellectual functions, slowed reflexes, periorbital edema, and a thickened, dry coarse skin. Primary hypothyroidism is more prevalent in women and is caused by the loss of functional thyroid tissue
Diagnosis of hyperthyroidism
A detailed history and physical examination often can suggest that a patient has hyperthyroidism, a hypermetabolic state that is associated with the increased availability and production of thyroid hormone. The term “thyrotoxicosis” has been used to denote the excess of thyroid hormone in this condition that causes a wide constellation of symptoms, including nervousness, heart palpitations, rapid pulse, fatigability, muscle weakness, weight loss, diarrhea, heat intolerance, sweating, variable
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The thyroid gland
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