Thyroid Disorders

Thyroid Factor

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nostic Studies in Thyroid Disorders

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Thyroid-stimulating hormone (TSH)

Most sensitive test to detect 1° hypo- and hyperthyroidism May be inappropriately normal in central etiologies I'd by dopamine, steroids, severe illness

Tj and T* immunoassays

Measure total serum concentrations (. . influenced by TBG)

Free T4 immunoassay (FT,)

Free T4, not influenced by TBG. increasingly popular

Thyroxine-binding globulin (TBG)

t TBG (.. T Ji): estrogens. OCR pregnancy, hepatitis iTBG (. . i T<): androgens, glucocorticoids, nephrotic syndrome, cirrhosis, acromegaly, phenytoin

Reverse Tj

Inactive. I'd in sick euthyroid syndrome

Thyroid antibodies

Antithyroid peroxidase (TPO) — Hashimoto's Thyroid-stimulating Ig (TSI) Graves' disease

Thyroglobuiin

i'd in thyroid injury, inflammation, and cancer (.. useful marker of recurrence of papillary and follicular cancer)

Radioactive iodine uptake (RAIU) scan

Useful to differentiate causes of hyperthyroidism t uptake homogeneous Graves' disease heterogeneous multinodular goiter 1 focus of uptake w suppression of rest of gland = hot nodule no uptake subacute painful or silent thyroiditis, exogenous thyroid hormone, struma ovarii, recent iodine load, or antithyroid drugs

Figure 7-1 Approach to thyroid d»tor»iert

Figure 7-1 Approach to thyroid d»tor»iert

Free Tt

¡f normal \ Secondary I incfi hvpolhyroidism ▼

Subclinical hyperthyroidism

Primary

| increased normal ^

decreased I Secondary

▼ hyperthyroidism Subclinical or hypothyroidism Thyroid hormone

Primary hyperthyroidism hypothyroidism resistance

homogeneous heterogeneous * *

Graves' Toxic disease multinodular goiter

Functioning adenoma serum thyroglobuiin

Thyrotoxicosis Thyroiditis factitia Struma ovarii or Iodine load

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