Thyroid disease: pathophysiology and diagnosis

doi:10.1016/j.cll.2004.01.002

Clinics in Laboratory Medicine

Volume 24, Issue 1, March 2004, Pages 19-28

https://doi.org/10.1016/j.cll.2004.01.002 Get rights and content

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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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References (3)

P.R Larsen et al.
The thyroid gland

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Citation Excerpt :
These assays, because of their sensitivity and specificity, are acceptable for use in the diagnosis of thyroid disease from overt hypothyroidism to overt hyperthyroidism. In hospitalized patients, “third” generation assays help to distinguish sick hyperthyroid patients with very low values of TSH (< 0.05 m IU/l) from patients with mild temporal TSH reduction (0.05–0.1 m IU/l) consistent with non-thyroidal illness [2]. Clinical decisions may be guided or altered for patients with hyperthyroidism based on TSH results.
Serum thyroid stimulating hormone (TSH) measurements are useful for detecting clinical and subclinical primary hypo- and hyperthyroidism in ambulatory patients. For diagnosis of hyperthyroidism, the functional sensitivity (FS) is an important performance criterion, and current guidelines recommend an FS of ≤ 0.02 m IU/l for “third” generation performance.
We evaluated TSH FS for the Access 2, Advia Centaur, Architect i2000, Dimension ExL Modular Analytics E170, Immulite 2000 and Dimension Vista 1500 automated immunoassays using serum pools tested over a 6 week period using 2 reagent lots and 2 calibrations. FS was determined by fitting a power function to the imprecision data using KaleidaGraph software.
The FS (m IU/l) for Access 2, ADVIA Centaur, ARCHITECT i2000, Dimension ExL, Modular Analytics E170, Immulite 2000, and Dimension Vista 1500 systems were determined to be 0.039, 0.006, 0.007, 0.003, 0.008, 0.003, and 0.003, respectively. The lowest and next to lowest pools had overall mean TSH concentrations of 0.012 m IU/l and 0.020 m IU/l, respectively and a range of concentrations of 0.005 to 0.022 m IU/l and 0.007 to 0.077 m IU/l, respectively.
All assays showed excellent performance in FS consistent with a “third” generation claim except for the Access 2 system. Further harmonization of TSH immunoassays is required, especially at lower concentrations.
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Review articleThyroid disease: pathophysiology and diagnosis