1. The serum TSH test is the best initial test for evaluating thyroid function, with a high TSH indicating hypothyroidism and a low TSH indicating hyperthyroidism.
2. Additional tests like T4, T3, thyroid antibodies, and radioactive iodine uptake can help diagnose specific thyroid disorders like Hashimoto's thyroiditis or Graves' disease.
3. Examining TSH, T4, T3 levels together can differentiate between primary thyroid disorders and secondary disorders originating from the pituitary or hypothalamus.
A presentation detailing how to read a Thyroid function test, when to do and when not to do specific tests.
Topics included
Hypo and hyperthyroidism
Subclinical hypothyroidism
subclinical hypothyroidism
thyroiditis
How to differentiate between each of these from thyroid profile is included
Sample cases included
The thyroid gland is an endocrine gland in the neck consisting of two connected lobes.
The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus.
The thyroid is located at the front of the neck, below the Adam's apple. Microscopically, the functional unit of the thyroid gland is the spherical thyroid follicle, lined with follicular cells (thyrocytes), and occasional parafollicular cells that surround a lumen containing colloid.
THYROID HORMONES:
The thyroid gland secretes three hormones: the two thyroid hormones – triiodothyronine (T3) and thyroxine (T4) – and a peptide hormone, calcitonin.
The thyroid hormones influence the metabolic rate and protein synthesis, and in children, growth and development.
Calcitonin plays a role in calcium homeostasis.
Secretion of the two thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is secreted from the anterior pituitary gland. TSH is regulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
The thyroid gland is located at the front of the neck just below the Adam’s apple (larynx).
It is butterfly-shaped and consists of two lobes located either side of the windpipe (trachea).
The thyroid gland is 2 inches (5 centimeters) wide and it weighs between 20 and 60 grams (0.7 to 2.1 ounces),
A complete presentation on hypothroidism endocrine disorder based on latest editon of harrison and reference books. this presentation will help to learn about this second most common endocrine disorder.
A presentation detailing how to read a Thyroid function test, when to do and when not to do specific tests.
Topics included
Hypo and hyperthyroidism
Subclinical hypothyroidism
subclinical hypothyroidism
thyroiditis
How to differentiate between each of these from thyroid profile is included
Sample cases included
The thyroid gland is an endocrine gland in the neck consisting of two connected lobes.
The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus.
The thyroid is located at the front of the neck, below the Adam's apple. Microscopically, the functional unit of the thyroid gland is the spherical thyroid follicle, lined with follicular cells (thyrocytes), and occasional parafollicular cells that surround a lumen containing colloid.
THYROID HORMONES:
The thyroid gland secretes three hormones: the two thyroid hormones – triiodothyronine (T3) and thyroxine (T4) – and a peptide hormone, calcitonin.
The thyroid hormones influence the metabolic rate and protein synthesis, and in children, growth and development.
Calcitonin plays a role in calcium homeostasis.
Secretion of the two thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is secreted from the anterior pituitary gland. TSH is regulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
The thyroid gland is located at the front of the neck just below the Adam’s apple (larynx).
It is butterfly-shaped and consists of two lobes located either side of the windpipe (trachea).
The thyroid gland is 2 inches (5 centimeters) wide and it weighs between 20 and 60 grams (0.7 to 2.1 ounces),
A complete presentation on hypothroidism endocrine disorder based on latest editon of harrison and reference books. this presentation will help to learn about this second most common endocrine disorder.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
3. Objectives of this lecture:
1. Hypothalamus- pituitary- thyroid axis
2. Common thyroid health problems
3. Tests performed for diagnosis of various
thyroid problems in labs
4. Normal values of different parameters
5. How to interpret the tests.
6. Differential diagnosis different thyroid
disorders.
4.
5.
6. T4
T4- Alb
T4- TTR T3
T4-TBG (70-75%)
T3-TBG (70-75%)
T3- TTR
T3- Alb
RT3
Thyroid Hormone Transport
TTR= transthyretin, TBG = thyroid binding globulin; RT3 = reverse T3
7. Given the protein levels, how does T4/T3
distribute across TBG,TTR, & Alb?
9. Thyroid function Tests performed in labs
• TRH
• Plasma FT4
• Total T4
• Plasma FT3
• Total T3
• RT3
• Free T4 index (FTI)
• TSH
• TBG
• TPO Ab (thyroid peroxidase
antibodies)
• TBG Ab (thyroglobulin antibodies)
• TSI (thyroid stimulating
immunoglobulins)
• TRAb (TSH receptor antibodies)
• Scintigraphy with radioactive iodine
Not all tests are useful in all situations
10. Approximate reference values
FT4 (0.9 − 2.5 ng/dL)
TT4 (5.0- 10.5 μg/dl)
FT3 (20- 45 pg/dL)
TT3 (70- 200 ng/dL)
TSH (0.4- 4.0 mIU/L)
FTI ( 1.1- 4.3 μg/dl)
TBG (1.5 to 3.4 mg/dl)
Urine Iodine (100-200mg/L)
Blood iodine (45-100 μg/l)
1. There are different reference values for children and pregnant
women
2. Reference range vary from lab to lab please check your local
guidelines.
12. The serum TSH is the best initial test of thyroid
function.
13. TSH; A high TSH level indicates that the
thyroid gland is not making enough thyroid
hormone (primary hypothyroidism).
The opposite situation, in which the TSH level
is low, usually indicates that the thyroid is
producing too much thyroid hormone
(hyperthyroidism).
Occasionally, a low TSH may result from an
abnormality in the pituitary gland adenoma,
which prevents it from making enough TSH to
stimulate the thyroid (secondary
hypothyroidism)
Then further tests are required
19. 1. A normal TSH and normal T4 show a Euthyroid.
2. A low TSH and high T4 generally means an Hyperthyroid.
3. A high TSH and low T4 means an Hypothyroid.
4. A high TSH and normal T4 means an subclinical Hypothyroid
5.The T3 usually ordered if T4 tests show elevation. confirmatory test.
6. TBG Lab Tesst: TBG binds T3 and T4/ hormone are inactive when
bound to TBG increased in hypothyroid, (false result increased in
Pregnancy, Oral Contraceptive Pills, hepatitis, Phenothiazine, opiates)
7. Thyroglobulin (Tg) Tg is not a primary measure of thyroid hormone
function. Levels can by elevated in thyroiditis, Graves’disease or
thyroid cancer. Used to monitor effectiveness of treatment
6. Iodine deficiency: The iodine in blood and urine is checked to
assess the iodine levels
Screening test or patch test for iodine deficiency is done on mass
level. PI2 on forearm disappears instantly in deficiency.
20. 7. FTI: Thyroxine (T4)/thyroid binding capacity.
Hyperthyroidism causes increased FTI, and hypothyroidism causes
decreased values.
8. Thyroid Peroxidase (TPO) antibodies, or Antithyroid
Peroxidase Antibodies (TPOAb).
Peroxidase enzyme that plays a part in the T4-to-T3
conversion and synthesis process.
TPO antibodies can be evidence of tissue destruction,
such as Hashimoto's thyroiditis and other thyroiditis such
as post-partum thyroiditis.
9,Testing for thyroglobulin antibodies (also called
antithyroglobulin antibodies) is common. Graves' disease, having
high levels of thyroglobulin antibodies means that you are more
likely to eventually become hypothyroid.
21. 10. Stimulatory TSH receptor antibody (TSI). This antibody
causes the thyroid to be overactive in Graves’ Disease.
TSH receptor antibody test (TSHR or TRAb), which detects
both stimulating and blocking antibodies.
levels in Graves’ patients may help to assess response to
treatment of hyperthyroidism, to determine when it is
appropriate to discontinue antithyroid medication, and to assess
the risk of passing antibodies to the fetus during pregnancy.
11.. Radioactive iodine uptake test (RAIU): Individual
swallow iodine pill or liquid, which is radioactive. Iodine is
taken up by thyroid. Radioactive I131 emits rays which is
recorded by gamma counter probe. High uptake in
thyrotoxicosis
22. Indirect Links to Other Systems
Give false results
Glucocorticoid
Excess ↓ TSH, TBG, TTR, T3, T4, ↑rT3
Deficiency ↑ TSH
Estrogens
TBG sialylation & serum t1/2
T4 requirement in hypothyroidism
↑ TSH in postmenopausal women
Androgens
TBG
↓ T4 turnover in women
T4 requirement in hypothyroidism
23. Differential Diagnosis of different thyroid disease
• Primary hypothyroidism: Low T4 and a raised TSH.
Autoimmune thyroiditis: TPO Ab and TBG Ab
Iodine deficiency Hypothyroid: Iodine deficiency
• Subclinical hypothyroidism: normal T4 and a raised TSH.
• Secondary hypothyroidism: Low T4 and T3 and low TSH
Decreased production or secretion of TRH and TSH results in
decreased stimulation of the thyroid gland cause decreased
thyroid hormones. Secondary to Pituitary or hypothalamic
disorders. Pituitary or hypothalamic tumors.
24. • Primary hyperthyroidism: Raised T3 and T4 and low TSH
• Causes of primary hyperthyroidism include:
• Graves’ disease (75% of all cases)
• Toxic multinodular goitre
• Toxic adenoma
Secondary hyperthyroidism :Raised T3/T4 and Raised TSH
Due to stimulation of the thyroid gland by excessive thyroid-
stimulating hormone (TSH)
Causes
• TSH-secreting tumours
• Chorionic-gonadotropin secreting tumours (hCG secreting)