Thyroid function tests ppt

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  • 1. Dr. Vijay Marakala, MBBS, MD. Senior Lecturer BIOCHEMISTRY IMS, MSU.
  • 2. Introduction Indications Assay of Hormones Radio Iodine Uptake Detection of Thyroid Antibodies
  • 3. THE THYROID GLAND IS A BUTTERFLY- SHAPED ENDOCRINE GLAND THAT IS NORMALLY LOCATED IN THE LOWER FRONT OF THE NECK
  • 4. Laboratory determinations of thyroid function are useful in distinguishing patients with euthyroidism (normal thyroid gland function) from those with hyperthyroidism (increased function) or hypothyroidism (decreased function)
  • 5. Hypothyroidism Hyperthyroidism
  • 6. Cold intolerance, Bradycardia Depression Fatigue, Goiter Hyperlipidemia Weight gain Dry skin and dry hair, Myxedema Menstrual irregularities
  • 7. Heat intolerance Fine resting tremor Tachycardia Palpitations Anxiety Sleep disturbance Irritability Fatigue Menstrual irregularities
  • 8. Suspicion of thyroid disease based on clinical signs and symptoms Screening for thyroid disease Evaluation of treatment for thyroid disease.
  • 9. Thyroid-stimulating hormoneTSH Serum total thyroxineT4 Serum total triiodothyronineT3 Free thyroxineFT4 Free T3FT3 Antithyroid peroxidase antibodies, Antithyroglobulin antibodiesThyroid antibodies
  • 10. Elevated TSH (>5 mU/L hypothyroidism Low TSH (<0.5 mU/L hyperthyroidism Normal range: 0.5 – 5mU/L One of the best thyroid function screening test
  • 11. Hypothyroidism • Decreased T4 Hyperthyroidism • Increased T4 Normal range: 65 – 150nmol/L
  • 12. Hypothyroidism • Decreased T3 Hyperthyroidism • Increased T3 Normal range: 1.8 – 3nmol/L
  • 13. Is the metabolically active thyroid hormone–not bound to protein Should be ordered when TSH is abnormal to determine thyroid hyperfunction or hypofunction Normal range: 10 - 23 pmol/L
  • 14. In nonthyroidal illness, a low FT3 level is a nonspecific finding. FT3 is done to rule out T3 toxicosis Normal Adults: 4.0–7.4 pmol/L
  • 15. The free thyroxine index (FTI) is a mathematical calculation used to correct the estimated total T 4 for the amount of TBG present. Make a calculation based on results of T 3 uptake and T 4 total, as follows: FTI= Total T4XT3 UPTAKE(%)/100 Normal Adults: 1.5–4.5 index
  • 16. • RadioimmunoassayRIA • Enzyme-linked immunosorbant assayELISA • Chemiluminescent immunoassayCLIA • Fluorescent immunoassayFIA
  • 17. Antithyroid peroxidase antibodies Used to diagnose suspected Hashimoto’s thyroiditis in hypothyroidism Antithyroglobulin antibodies Used to diagnose autoimmune thyroiditis or Graves’ disease in hyperthyroidism
  • 18. TRH administration stimulate production of TSH If hypothalamo-pituitary-thyroid axis is normal, T3 and T4 secretions will be increased
  • 19. In primary hyperthyroidism • little or no change in TSH levels In primary hypothyroidism • Prompt increase in TSH In secondary hypothyroidism • Does not produce an increase in TSH
  • 20. 131I used to detect functional derangements of thyroid gland. About 15 mci of 131I given intravenously After a few hours, the patient is monitored at the neck region by movable gamma-ray counter, which will pick up the radiation emitted by thyroid gland
  • 21. Normal response • About 25% uptake by thyroid within 2 hours • About 50% uptake by thyroid within 24 hours Abnormal response • Increased uptake in hyperthyroidism • Decreased uptake in hyporthyroidism