Thyroid Function Tests (TFTS)
Thyroid Function Tests (TFTS)
Thyroid Function Tests (TFTS)
tests(TFTs)
Yutapong Raruenrom
Introductions
Iodine balance
- Synthesis of thyroid hormones require
iodine
- Iodide is actively concentrated in the
thyroid gland, salivary glands, gastric
glands, lacrimal glands, mammary glands,
and choroid plexus
- The total iodide content of the thyroid
gland averages 7500 g, virtually all of
which is in the form of iodothyronines
-In the steady state, 70 to 80 g of iodide, or
about 1% of the total, is released from the
gland daily
Iodine balance
Thyroid hormone
synthesis
Thyroid hormones
- T4 and T3 in the bloodstream almost entirely
bind to proteins
- Protein binding of circulating T4 and T3:
70%
bound to thyroxine-binding
globulin(TBG)
10%-15% bound to transthyretin (TTR)
15%-20% bound to albumin
3%
bound to lipoproteins
- TBG is synthesized in the liver and binds one
molecule of T4 or T3
Thyroid hormones
Free hormone
- 0.03% of total plasma T4
- 0.3% of total plasma T3
Free T3 is biologically active and
mediates the effects of thyroid hormone
on peripheral tissues
: 3-4 times more potent than T4
Difference between T3
and T4
Interpretation of TFTs
TSH
TSH
TSH
FT3 or
FT4
TSH
Rare
Steroid therapy
Dopamine and dobutamine infusion
Non-thyroidal illness
TSH
Rare
Pituitary disease
(secondary hypothyroidism)
Congenital TSH or TRH deficiency
TSH FT3 or
FT4
TSH
Common
Chronic autoimmune thyroiditis
Post radioiodine
Post thyroidectomy
FT3 or FT4
Hypothyroid phase of transient thyroiditis
TSH
TSH
TSH
FT3
or FT4
Rare
Heterophile (interfering) antibody
Intermittent T4 therapy for hypothyroidism
Drugs: amiodarone, sertraline,
cholestyramine
Recovery phase after non-thyroidal illness
TSH
FT3
or FT4
FT3
or FT4
Rare
TSH
Intermittent T4 therapy
T4 overdose
Resistance to thyroid hormone
TSH secreting pituitary tumour
(hyperthyroid)
Acute psychiatric illness (first 13 weeks)
References
Colin M Dayan. Interpretation of thyroid
function tests. Lancet 2001; 357: 61924
Cooper, David S.Medical Management of
Thyroid Disease. 2nd. New York: Informa Hea
lthcare USA, 2008. 1-27. Print
Kronenberg, Henry, and Robert
Hardin.Williams textbook of endocrinology.
W.B. Saunders Company, 2008. eBook