Skip to main content
SpringerLink
Log in
Book cover

Thyroid Function Testing pp 155–171Cite as

Thyroid Function Testing in Ambulatory Practice

  • Chapter
  • First Online:

Part of the book series: Thyroid Function Testing ((ENDO,volume 28))

Abstract

Thyroid function tests are commonly obtained by both primary care physicians and various specialists in ambulatory practice for both the evaluation of symptomatic and screening assessment of asymptomatic thyroid disease. Abnormalities of thyroid function testing, including those which may not be clinically apparent, are common in the general population. Epidemiological studies have identified hypothyroidism (subclinical and overt) in 4.6–9.5% and hyperthyroidism (subclinical and overt) in 1.3–2.2% of individuals [1], while the incidence of mild/subclinical dysfunction in certain populations is much more common [2–4].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489-499.

    Google Scholar 

  2. Canaris GJ, Manowitz NR, Mayor R, et al. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160:526-534.

    Article  PubMed  CAS  Google Scholar 

  3. Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxford). 1977;7:481-493.

    Article  CAS  Google Scholar 

  4. Rosenthal MJ, Hunt WC, Garry PJ, Goodwin JS. Thyroid failure in the elderly. Microsomal antibodies as discriminant for therapy. JAMA. 1987;258:209-213.

    Article  PubMed  CAS  Google Scholar 

  5. Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160:1573-1575.

    Article  PubMed  CAS  Google Scholar 

  6. U.S. Preventive Services Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med. 2004;140:125-127.

    Google Scholar 

  7. Meyerovitch J, Rotman-Pikielny P, Sherf M, et al. Serum thyrotropin measurements in the community. Five year follow-up in a large network of primary care physicians. Arch Intern Med. 2007;167:1533-1538.

    Article  PubMed  CAS  Google Scholar 

  8. Grüning T, Zöphel K, Wunderlich G, et al. Influence of female sex hormones on thyroid parameters determined in a thyroid screening. Clin Lab. 2007;53:547-553.

    PubMed  Google Scholar 

  9. Toft AD, Beckett GJ. Measuring serum thyrotropin and thyroid hormone and assessing thyroid hormone transport. In: Braverman LE, Utiger RD, eds. Werner and Ingbar's The Thyroid. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:333.

    Google Scholar 

  10. Tunbridge WMG, Brewis M, French JM, et al. Natural history of autoimmune thyroiditis. Br Med J (Clin Res Ed). 1981(282):258-262.

    Google Scholar 

  11. Arvan P, Di Jeso B. Thyroglobulin structure, function, and biosynthesis. In: Braverman LE, Utiger RD, eds. Werner and Ingbar's The Thyroid. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:77.

    Google Scholar 

  12. van der Molen AJ, Thomsen HS, Morcos SK, et al. Effect of iodinated contrast media on thyroid function in adults. Eur Radiol. 2004;14:902-907.

    Article  PubMed  Google Scholar 

  13. Camacho PM, Dwarkanathan AA. Sick euthyroid syndrome. What to do when thyroid function tests are abnormal in critically ill patients. Postgrad Med. 1999;105:215-219.

    Article  PubMed  CAS  Google Scholar 

  14. Farwell AP. Sick euthyroid syndrome. J Intensive Care Med. 1997;12:249-260.

    Google Scholar 

  15. Petitpas I, Petersen CE, Ha CE, et al. Structural basis of albumin-thyroxine interactions and familial dysalbuminemic hyperthyroxinemia. Proc Natl Acad Sci U S A. 2003;100:6440-6445.

    Article  PubMed  CAS  Google Scholar 

  16. Ain KB, Mori Y, Refetoff S. Reduced clearance rate of thyroxine-binding globulin (TBG) with increased sialyation: a mechanism for estrogen-induced elevation of serum TBG concentration. J Clin Endocrinol Metab. 1987;65:689-696.

    Article  PubMed  CAS  Google Scholar 

  17. Pagliacci MC, Pelicci G, Francisci D, et al. Thyroid function tests in acute viral hepatitis: relative reduction in seru, thyroxine levels due to T4-TBG binding inhibitors in patients with severe liver cell necrosis. J Endocrinol Invest. 1989;12:149-153.

    PubMed  CAS  Google Scholar 

  18. Surks MI, Sievert R. Drugs and thyroid function. N Engl J Med. 1995;333:1688-1694.

    Article  PubMed  CAS  Google Scholar 

  19. Foppiani L, Del Monte P, Ruelle A, et al. TSH-secreting adenomas: rare pituitary tumors with multifaceted clinical and biological features. J Endocrinol Invest. 2007;30:603-609.

    PubMed  CAS  Google Scholar 

  20. Tonacchera M, Di Cosmo C, De Marco G, et al. Identification of TSH receptor mutations in three families with resistance to TSH. Clin Endocrinol (Oxford). 2007;67:712-718.

    Article  CAS  Google Scholar 

  21. Refetoff S. Resistance to thyroid hormone: one of several defects causing reduced sensitivity to thyroid hormone. Nat Clin Pract Endocrinol Metab. 2008;4:1.

    Article  PubMed  Google Scholar 

  22. Lazarus JH. Aspects of treatment of subclinical hypothyroidism. Thyroid. 2007;17:313-316.

    Article  PubMed  Google Scholar 

  23. Karmisholt J, Laurberg P. Serum TSH and serum thyroid peroxidase antibody fluctuate in parallel and high urinary iodine excretion predicts subsequent thyroid failure in a 1-year study of patients with untreated subclinical hypothyroidism. Eur J Endocrinol. 2008;158:209-215.

    Article  PubMed  CAS  Google Scholar 

  24. Seki K, Nagata I. Effects of a dopamine antagonist (metoclopramide) on the release of LH, FSH, TSH and PRL in normal women throughout the menstrual cycle. Acta Endocrinol (Copenhagen). 1990;122:211-216.

    CAS  Google Scholar 

  25. Gheri RG, Pucci P, Falsetti C, et al. Clinical, biochemical and therapeutic aspects of amiodarone-induced hypothyroidism (AIH) in geriatric patients with cardiac arrhythmias. Arch Gerontol Geriatr. 2004;38:27-36.

    Article  PubMed  CAS  Google Scholar 

  26. Mannavola D, Vannucchi G, Fugazzola L, et al. TBG deficiency: description of two novel mutations associated with complete TBG deficiency and review of the literature. J Mol Med. 2006;84:864-871.

    Article  PubMed  CAS  Google Scholar 

  27. Arafah BM. Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer. Ann Intern Med. 1994;121:247-251.

    PubMed  CAS  Google Scholar 

  28. Bános C, Takó J, Salamon F, et al. Effect of ACTH-stimulated glucocorticoid hypersecretion on the serum concentrations of thyroxine-binding globulin, thyroxine, triiodothyronine, reverse triiodothyronine and on the TSH-response to TRH. Acta Med Acad Sci Hung. 1979;36:381-394.

    PubMed  Google Scholar 

  29. Ito S, Kano K, Ando T, et al. Thyroid function in children with nephrotic syndrome. Pediatr Nephrol. 1994;8:412-425.

    Article  PubMed  CAS  Google Scholar 

  30. Wang R, Nelson JC, Wilcox RB. Salsalate and salicylate binding to and their displacement of thyroxine from thyroxine-binding globulin, transthyrin, and albumin. Thyroid. 1999;9:359-364.

    Article  PubMed  CAS  Google Scholar 

  31. Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines taskforce. Thyroid. 2006;16:109-142.

    Article  PubMed  Google Scholar 

  32. Hennessey JV. Levothyroxine dosage and the limitations of current bioequivalence standards. Nat Clin Pract Endocrinol Metab. 2006;2:474-475.

    Article  PubMed  CAS  Google Scholar 

  33. Burman K, Hennessey J, McDermott M, Wartofsky L, Emerson C. The FDA revises requirements for levothyroxine products. Thyroid. 2008;18:487-490.

    Article  PubMed  Google Scholar 

  34. Karmisholt J, Andersen S, Laurberg P. Interval between tests and thyroxine estimation method influence outcome of monitoring of subclinical hypothyroidism. J Clin Endocrinol Metab. 2008;93:1634-1640.

    Article  PubMed  CAS  Google Scholar 

  35. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;341:549-555.

    Article  PubMed  CAS  Google Scholar 

  36. Pop VJ, Brouwers EP, Vader HL, et al. Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study. Clin Endocrinol (Oxford). 2003;59:282-288.

    Article  Google Scholar 

  37. Alexander EK, Marqusee E, Lawrence J, et al. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. 2004;15:292-294.

    Google Scholar 

  38. Mandel SJ, Spencer CA, Hollowell JG. Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid. 2005;15:44-53.

    Article  PubMed  Google Scholar 

  39. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007;92:S1-S47.

    Article  PubMed  CAS  Google Scholar 

  40. Mandel SJ, Larsen PR, Seely EW, et al. Increased need for thyroxine during pregnancy in women with primary hypothyroidism. N Engl J Med. 1990;323:91-96.

    Article  PubMed  CAS  Google Scholar 

  41. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocinol (Oxf). 1995;43:55-68.

    Article  CAS  Google Scholar 

  42. Stockigt JR. Case finding and screening strategies for thyroid dysfunction. Clin Chim Acta. 2002;315:111-124.

    Article  PubMed  CAS  Google Scholar 

  43. Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med. 1998;129:141-143.

    Google Scholar 

  44. American Academy of Family Physicians. Summary of Policy Recommendations for Periodic Health Examinations. Reprint no. 510. Leawood, KS: American Academy of Family Physicians; 2002.

    Google Scholar 

  45. Helfand M; U.S. Preventive Services Task Force. Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:128-141.

    PubMed  Google Scholar 

  46. Committee on medicare coverage of routine thyroid screening. Medicare Coverage of Routine Screening for Thyroid Dysfunction. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

  47. Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association Guidelines for Detection of Thyroid Dysfunction. Arch Intern Med. 2000;160:1573-1575.

    Article  PubMed  CAS  Google Scholar 

  48. Manji N, Carr-Smith JD, Boelaert K, et al. Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab. 2006;91:4873-4880.

    Article  PubMed  CAS  Google Scholar 

  49. Stagnaro-Green A. Can a high-risk care-finding aproach identify all women with thyroid dysfunction during pregnancy? Nat Clin Pract Endocrinol Metab. 2007;2:216-217.

    Article  Google Scholar 

  50. Dosiou C, Sanders GD, Araki SS, et al. Screening pregnancy women for autoimmune thyroid disease: a cost-effectiveness analysis. Eur J Endocrinol. 2008;158:841-851.

    Article  PubMed  CAS  Google Scholar 

  51. Premawardhana LD, Parkes AB, John R, et al. Thyroid peroxidase antibodies in early pregnancy: utility for predictor of postpartum thyroid dysfunction and implications for screening. Thyroid. 2004;14:610-615.

    Article  PubMed  CAS  Google Scholar 

  52. Stagnaro-Green A. Postpartum thyroiditis. Best Pract Res Clin Endocrinol Metab. 2004;18:303-316.

    Article  PubMed  CAS  Google Scholar 

  53. Stagnaro-Green A, Chen X, Bogden JD, Davies TF, Scholl TO. The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid. 2005;15:351-357.

    Article  PubMed  CAS  Google Scholar 

  54. Stagnaro-Green A, Glinoer D. Thyroid autoimmunity and the risk of miscarriage. Best Pract Res Clin Endocrinol Metab. 2004;18:167-181.

    Article  PubMed  CAS  Google Scholar 

  55. Negro R, Formoso G, Mangieri T, et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91:2587-2591.

    Article  PubMed  CAS  Google Scholar 

  56. Negro R, Formoso G, Coppola L, et al. Euthyroid women with autoimmune disease undergoing assisted reproduction technologies: the role of autoimmunity and thyroid function. J Endocrinol Invest. 2007;30:3-8.

    PubMed  CAS  Google Scholar 

  57. AACE Thyroid Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8:457-469.

    Google Scholar 

  58. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin, Clinical management guidelines for obstetrician-gynecologists, Thyroid disease in pregnancy. Obstet Gynecol. 2002;100:387-396.

    Article  Google Scholar 

  59. Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007;92:203-207.

    Article  PubMed  CAS  Google Scholar 

  60. Haddow JE, McClain MR, Palomaki GE, et al. Screening for thyroid disorders during pregnancy: results of a survey in Maine. Am J Obstet Gynecol. 2006;194:471-474.

    Article  PubMed  Google Scholar 

  61. Weissel M. Disturbances of thyroid function in the elderly. Wien Klin Wochenschr. 2006;118:16-20.

    Article  PubMed  CAS  Google Scholar 

  62. Sawin CT. Thyroid dysfunction in older persons. Adv Intern Med. 1992;37:223-248.

    PubMed  CAS  Google Scholar 

  63. Morris MS. The association between serum thyroid-stimulating hormone in its reference range and bone status in postmenopausal American women. Bone. 2007;40:1128-1134.

    Article  PubMed  CAS  Google Scholar 

  64. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med. 2004;164:1675-1678.

    Article  PubMed  Google Scholar 

  65. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA. 2006;295:1033-1041.

    Article  PubMed  CAS  Google Scholar 

  66. Pearce EN. Hypothyroidism and dyslipidemia: modern concepts and approaches. Curr Cardiol Rep. 2004;6:451-456.

    Article  Google Scholar 

  67. Moulin de Moraes CM, Mancini MC, de Melo ME, et al. Prevalence of subclinical hypothyroidism in a morbidly obese population and improvement after weight loss induced by Roux-en-Y gastric bypass. Obes Surg. 2005;15:1287-1291.

    Article  Google Scholar 

  68. McGaffee J, Barnes MA, Lippmann S. Psychiatric presentations of hypothyroidism. Am Fam Physician. 1981;23:129-133.

    PubMed  CAS  Google Scholar 

  69. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med. 2005;165:2467-2472.

    Article  PubMed  Google Scholar 

  70. Pirich C, Müllner M, Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J Clin Epidemiol. 2000;53:623-629.

    Article  PubMed  CAS  Google Scholar 

  71. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease. Scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-238.

    Article  PubMed  CAS  Google Scholar 

  72. Ayala AR, Wartofsky L. The case for more aggressive screening and treatment of mild thyroid failure. Cleve Clin J Med. 2002;69:313-320.

    Article  PubMed  Google Scholar 

  73. Mantovani RM, Mantovani LM, Dias VM. Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus: prevalence and risk factors. J Pediatr Endocrinol Metab. 2007;20:669-675.

    PubMed  CAS  Google Scholar 

  74. Karagüzel G, Simşek S, Değer O, et al. Screening of diabetes, thyroid and celiac disease-related autoantibodies in a sample of Turkish children with type 1 diabetes and their siblings. Diabetes Res Clin Pract. 2008;80:238-243.

    Article  PubMed  CAS  Google Scholar 

  75. Warren RE, Perros P, Nyirenda MJ, et al. Serum thyrotropin is a better predictor of future dysfunction than thyroid antibody status in biochemically euthyroid patients with diabetes: implications for screening. Thyroid. 2004;14:853-857.

    Article  PubMed  CAS  Google Scholar 

  76. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005;118:706-714.

    Article  PubMed  CAS  Google Scholar 

  77. Gartner W, Weissel M. Do iodine-containing contrast media induce clinically relevant changes in thyroid function parameters of euthyroid patients within the first week? Thyroid. 2004;14:521-524.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center, 01583, Boston, MA, USA

    Angela M. Leung & Alan P. Farwell

Authors
  1. Angela M. Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alan P. Farwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alan P. Farwell .

Editor information

Editors and Affiliations

  1. VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, Los Angeles, 90095, USA

    Gregory A. Brent

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Leung, A., Farwell, A. (2010). Thyroid Function Testing in Ambulatory Practice. In: Brent, G. (eds) Thyroid Function Testing. Thyroid Function Testing, vol 28. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1485-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1485-9_8

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-1484-2

  • Online ISBN: 978-1-4419-1485-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation