work shop of thyroid1393 -...
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IntroduceIntroduceR. GholamnezhadR. Gholamnezhad
Lecturer of school of nursing & midwifery of IranLecturer of school of nursing & midwifery of Iran university
Ph D t d t f I l S h l f di lPh.D student of Immunology, School of medical sciences of Isfahan university
E-Mail: Gholami278@gmail. Com
InterpretingInterpretingof of
thyroid function teststhyroid function tests
ScopeScope
• The detection of thyroid dysfunction in adults (individuals 19 years of age and over)
• Monitoring adult patients treated for thyroidMonitoring adult patients treated for thyroid function disorders.
ScopeScope• Routine thyroid function testing is notRoutine thyroid function testing is notrecommended in asymptomatic adults.However testing may be indicated when non‐However, testing may be indicated when nonspecific signs and symptoms are present inpatients at risk for thyroid diseasepatients at risk for thyroid disease
Risk factors for thyroid diseaseRisk factors for thyroid disease
personal history of thyroid disease
strong family history of thyroid disease
diagnosis of autoimmune disease
past history of neck irradiation
drug therapies such as lithium and amiodarone
women over age 50
elderly patientsy p
women 6 weeks to 6 months post‐partum
Diagnosis/Investigation
Hypothyroidism Hyperthyroidism
•Weight gain•Hair loss•LethargyM t l i l iti ( h i )
•Weight loss•Hair loss•Palpitations / Tachycardia / Atrial fib ill ti•Menstrual irregularities (menorrhagia)
•Cognitive impairment•Depression•Constipation
fibrillation•Menstrual irregularities (amenorrhea / oligomenorrhea)•Widened pulse pressurep
•Goitre•Dry skin•Cold intolerance
p p•Nervousness and tremor•Muscular weakness•Goitre•Heat intolerance diaphoresis clammy•Heat intolerance, diaphoresis, clammy hands•Hypertension
pointpoint• Measurement of TSH has become theMeasurement of TSH has become theprincipal test for the evaluation of thyroidfunction in most circumstances A TSH valuefunction in most circumstances. A TSH valuewithin the reference interval excludesmajority of cases of primary overt thyroidmajority of cases of primary overt thyroiddisease. If TSH is abnormal, confirm thediagnosis with free T4 (fT4)diagnosis with free T4 (fT4)
InterpretingInterpretingofof
thyroidfunctionteststhyroidfunctiontests
HPT AxisHPT Axis
NormalNormal
TSH = 5 mu/LTSH = 0/4 – 4/5 mu/LT3 = 87‐ 180 ng/dl
T4 = 5/6 13/7 mcg/dl
T3 T4 TSH
T4 = 5/6 – 13/7 mcg/dlFT3= 230 – 420 Pg /dlFT4 = 0/8 – 1/5 ng/dl
HyperthyroidismHyperthyroidism
T3T4
TSH
HypothyroidismHypothyroidism
TSH
T3T4
Please before sampling NOTE:Please before sampling NOTE:You do not have to fast but because of the influence ofYou do not have to fast, but because of the influence ofturbidity caused by eating fat on the test results, at least3 hours before the test, do not eat food.
Up to 2 weeks after surgery to avoid these tests.
Use of contraceptive pills can increase the hormones.
Concentration of thyroid hormones in the summer is20% lower than winter.Sampling is not done between 16‐18 hours.
1•Common causes:Primary hyperthyroidism ‐ Graves' disease, multinodular goitre, toxic nodule.
Relatively common causes with low radio‐iodine uptake:Transient thyroiditis (postpartum, post‐viral, De Quervain'sthyroiditis).
Rare with a low radio‐iodine uptake:Thyroxine ingestion.•Ectopic thyroid tissue.
Low TSH Raised FT3 or FT4
p y•Iodine‐induced.•Amiodarone therapy.
Rare with a positive pregnancy test:Rare with a positive pregnancy test:Gestational thyrotoxicosis with hyperemesis gravidarum.•Hydatiform mole.
Rare:Familial TSH receptor mutation.
22•Common causes:•Common causes:Subclinical hyperthyroidism.•Thyroxine ingestion.
•Rare causes:Low TSH Normal FT3
or FT4
Rare causes:Steroid therapy.•Dopamine and dobutamine infusion.•Non‐thyroidal illness.
33C•Common causes:Non‐thyroidal illness.•Recent treatment for hyperthyroidism.
Rare causes:Low TSH Low FT3 or
FT4
Rare causes:Pituitary disease.•Congenital TSH or TRH deficiencies
4Common causes:Chronic autoimmune thyroiditis.•Following radio‐iodine.g•Following thyroidectomy.•Transient thyroiditis ‐ hypothyroid phase.
Rare causes (anti‐TPO negative):Following external beam radiotherapy to the neck.•Drugs ‐ amiodarone, lithium, interferons, interleukin‐2.
Raised TSH
Low FT4 or FT3
•Iodine deficiency.
Congenital causes:Congenital causes:Thyroid dysgenesis.•Iodine transport defects.•TSH‐receptor defects.•TSH resistance.
55Common causes:Subclinical autoimmune hypothyroidism.
Rare causes:Drugs ‐ amiodarone, sertraline, colestyramine.•Recovery phase after non‐thyroidal illness.
Raised TSH
Normal FT3 or FT4
y p y•Heterophile (interfering) antibody.
Congenital causes:Congenital causes:TSH‐receptor defects.•TSH resistance
66• Rare causes:
Amiodarone.• Interfering antibodies.
F ili l• Familial.• TSH‐secreting pituitary tumour.• Acute psychiatric illness
Normal or Raised TSH
Raised FT3 or FT4
T k ☺Thank you ☺y