Thyroid Testing

A Clinical Approach
  • Laurie A. Kane
  • Hossein Gharib
Part of the Contemporary Endocrinology book series (COE, volume 2)

Abstract

Diseases of the thyroid are among the most common endocrine disorders in clinical practice. These diseases are typically detected and managed based on results of thyroid function tests, the diversity and multiplicity of which can be confusing to some clinicians. Ongoing changes and laboratory pitfalls in thyroid related testing add to this complexity. Moreover, the recent introduction of sensitive laboratory tests have led to the detection of mild and early thyroid disorders. For these reasons, expertise is often needed to determine what tests to order and how to interpret them, bearing in mind that results can often be affected by concomitant diseases or medications. Finally, in 1996, cost considerations dictate that physicians be selective, ordering specific laboratory tests for specific disorders.

Keywords

Thyroid Nodule Subclinical Hypothyroidism Autoimmune Thyroid Disease Subclinical Hyperthyroidism Struma Ovarii 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Spencer CA, Nicoloff JT. Serum TSH measurement-A 1990 status report. Thyroid Today 1990; 13: 1–4.Google Scholar
  2. 2.
    Nicoloff JT, Spencer CA. The use and misuse of the sensitive TSH assays. J Clin Endocrinol Metab 1990; 71: 553–558.PubMedCrossRefGoogle Scholar
  3. 3.
    Spencer CA, LoPresti JA, Patel A, Guttler RB, Eigen A, Shen D, Gray D, Nicoloff JT. Applications of a new chemiluminometric thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab 1990; 70: 453–460.PubMedCrossRefGoogle Scholar
  4. 4.
    Klee GG, Hay ID. Biochemical thyroid function testing. Mayo Clin Proc 1994; 69: 469–470.PubMedCrossRefGoogle Scholar
  5. 5.
    Spencer CA, et al. Interlaboratory/intermethod differences in functional sensitivity of immunometric assays for thyrotropin (TSH): Impact on reliability of measurement of subnormal concentration. Clin Chem 1995; 41 (3): 367–374.PubMedGoogle Scholar
  6. 6.
    Ekins R. Measurement of free hormones in blood. Endocr Rev 1990; 11: 5–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Stockigt JR. Serum thyrotropin and thyroid hormone measurements and assessment of thyroid hormone transport. In: Braverman LE, Utiger R eds. Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text. 7th ed. JB Lippincott, 1996, pp. 377–396.Google Scholar
  8. 8.
    Kaptein EM. Clincial Application of free thyroxine determinations. Clin Lab Med 1993; 13: 653–672.PubMedGoogle Scholar
  9. 9.
    Kaye TB. Thyroid function tests. Application of newer methods. Postgrad Med 1993; 13: 653–672.Google Scholar
  10. 10.
    Braverman LE, Dawber NA, Ingbar SH. Observations concerning the binding of thyroid hormones in sera in normal subjects of varying ages. J Clin Invest 1966; 45: 1273–1279.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaiser FE. Variability of response to thyroid releasing hormone in normal elderly. Age Aging 1987; 16: 345–354.CrossRefGoogle Scholar
  12. 12.
    Sawin CT, Chopra D, Azizi F, et al. The aging thyroid: Increased prevalence of elevated serum thyrotropin in the elderrly. JAMA 1979; 242: 247–250.PubMedCrossRefGoogle Scholar
  13. 13.
    Chopra IJ, Hershman JM, Pardridge MD, Nicoloff JT. Thyroid function in nonthyroidal illnesses. Ann Intern Med 1983; 98: 946–957.PubMedGoogle Scholar
  14. 14.
    Hay ID. Euthyroid hyperthyroxinemia. Mayo Clin Proc 1985; 61: 61–63.CrossRefGoogle Scholar
  15. 15.
    Kaplan MM. Interactions between drugs and thyroid hormone. Thyroid Today 1981; 4: 1–6.Google Scholar
  16. 16.
    Moses AC, Lawlor J, Haddow R, Jackson IMD. Familial euthyroid hyperthyroxinemia resulting from increased thyroxine binding to thyroxine binding prealbumin N Engl J Med 1982; 360: 966–969.Google Scholar
  17. 17.
    Tibaldi JM, Surks MI. Effects of nonthyroidal illness on thyroid function. Med Clin N Am 1985; 69: 899–911.PubMedGoogle Scholar
  18. 18.
    Olsen T, Laurberg P, Weeke J. Low serum triiodothyronine and high serum reverse triiodothyronine in old age: An effect of disease, not age. J Clin Endocrinol Metab 1978; 47: 1111–1115.PubMedCrossRefGoogle Scholar
  19. 19.
    Amino N, Hagan SR, Yamada N, Refetoff HS. Measurement of circulating thyroid microsomal antibodies by the tanned red cell haemagglutination technique: its usefulness in the diagnosis of autoimmune thyroid disease. Clin Endocrinol 1976; 5: 115–125.CrossRefGoogle Scholar
  20. 20.
    Cayzer I, Chalmers SR, Doniach D, Swana G. An evaluation of two new haemagglutination tests for the rapid diagnosis of autoimmune thyroid disease. J Clin Pathol 1978; 31: 1147–1151.PubMedCrossRefGoogle Scholar
  21. 21.
    Chiovato L, Bassi P, Santini F, et al. Antibodies producing complement-mediated thyroid cytotoxicity in patients with atrophic or goitrous autoimmune thyroiditis. J Clin Endocrinol Metab 1993; 77: 1700–1705.PubMedCrossRefGoogle Scholar
  22. 22.
    Czarnocka B, Ruf J, Ferrand M, Carayon P. Lissitzky S. Purification of the human thyroid peroxidase and its identification as the microsomal antigen involved in the autoimmune thyroid disease. FEBS Lett 1985; 190: 147–148.PubMedCrossRefGoogle Scholar
  23. 23.
    Ekholm R. Biosynthesis of thyroid hormones. Int Rev Cytol 1990; 120: 243–288.PubMedCrossRefGoogle Scholar
  24. 24.
    Seto P, Hirayu H, Magnusson RP, et al. Isolation of a complimentary DNA clone for thyroid microsomal antigen. Homology with the gene for the thyroid peroxidase. J Clin Invest 1987; 80: 1205–1208.PubMedCrossRefGoogle Scholar
  25. 25.
    Salvi M, Fukazawa H, Bernard N, Hiromatsu Y, How J, Wall JR. Role of autoantibodies in the pathogenesis and association of endocrine autoimmune disorders. Endocr Rev 1988; 9: 450–466.PubMedCrossRefGoogle Scholar
  26. 26.
    Beever K, Bradbury J, Phillips D, McLachlan SM, Pegg C, Goral A, Overbeck W, Felfel G, Rees Smith B. Highly sensitive assay of autoantibodies to thyroglobulin and to thyroid peroxidase. Clin Chem 1989; 35: 1949–1954.PubMedGoogle Scholar
  27. 27.
    Amino N, Iwatani Y, Tamaki H, et al. Post-partum autoimmune thyroid syndromes. In: Walfish PG, Wall JR, Volpe R, eds. Autoimmunity and the thyroid. Academic, Orlando, 1985, pp. 289–304.Google Scholar
  28. 28.
    Kraiem Z, Glaser B, Pauker J, Sadeh O, Sheinfeld M. Bioassay of thyroid-stimulating immunoglobulin in cryopreserved human thyroid cells: optimization and clinical evaluation. Clin Chem 1988; 34: 244–249.PubMedGoogle Scholar
  29. 29.
    Zakarija M, McKenzie JM, Banovac K. Clinical significance of assay of thyroid-stimulating antibody in Graves’ disease. Ann Intern Med 1980; 93: 28–32.PubMedGoogle Scholar
  30. 30.
    Zakarija M, McKenzie JM, Hoffman WH. Prediction and therapy of intrauterine and late-onset neonatal hyperthyroidism. J Clin Endocrinol Metab 1986; 62: 368–371.PubMedCrossRefGoogle Scholar
  31. 31.
    Van Herle AJ, Rich P, RJung BE, Ashcroft MW, Solomon DH, Keeler EB. The thyroid nodule. Ann Int Med 1982; 96: 221–232.Google Scholar
  32. 32.
    Rojeski MT, Gharib H. Nodular thyroid disease. N Engl J Med 1985; 313: 428–435.PubMedCrossRefGoogle Scholar
  33. 33.
    Gharib H. Current evaluation of thyroid nodules. TEM 1994; 5: 365–369.PubMedGoogle Scholar
  34. 34.
    Ashcraft MW, Van Herle AJ. Management of thyroid nodules I. history and physical examination, blood tests, x-ray tests, and ultrasonography. Head Neck 1981; 3: 216–230.CrossRefGoogle Scholar
  35. 35.
    Reading CC, Gorman CA. Thyroid imaging techniques. Clin Lab Med 1993; 13: 711–724.PubMedGoogle Scholar
  36. 36.
    Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies. Clin Lab Med 1993; 13: 699–709.PubMedGoogle Scholar
  37. 37.
    Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118: 282–289.PubMedGoogle Scholar
  38. 38.
    Gharib H, Goellner JR, Zinsmeister AR, Grant CS, van Heerden JA. Fine-needle aspiration biopsy of the thyroid: The problem of suspicious cytologic findings. Ann Intern Med 1984; 101: 25–28.PubMedGoogle Scholar
  39. 39.
    Cersosimo E, Gharib H, Suman VJ, Goellner JR. “Suspicious” thyroid cytologic findings: Outcome in patients without immediate surgical treatment. Mayo Clin Proc 1993; 68: 343–348.PubMedCrossRefGoogle Scholar
  40. 40.
    Tunbridge WMG, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Grimley Evans J, Young E, Bird T, Smith PA. The spectrum of thyroid disease in a community: the Wickham Survey. Clin Endocrinol 1977; 7: 481–493.CrossRefGoogle Scholar
  41. 41.
    Nystrom E, Bengtsson C, Lindquist O, Noppa H, Lindstedt G, Lundberg P. Thyroid disease and high concentration of serum thyrotropin in a population sample of women. Acta Med Scand 1981; 210: 39–46.PubMedCrossRefGoogle Scholar
  42. 42.
    Rosenthal MJ, Hunt WC, Garry PJ, Goodwin JS. Thyroid failure in the elderly-microsomal antibodies as discriminant for therapy. JAMA 1987; 258 (2): 209–213.PubMedCrossRefGoogle Scholar
  43. 43.
    Spencer C, Eigen A, Shen D, Duda M, Qualls S, Weiss S, Nicoloff J. Specificity of sensitive assays thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem 1987; 33: 1391–1396.PubMedGoogle Scholar
  44. 44.
    Glinoer D, DeWayer P, Bourdoux P. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab 1990; 71: 276–287.PubMedCrossRefGoogle Scholar
  45. 45.
    Lazarus JH. Silent thyroiditis and subacute thyroiditis. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text. 7th ed. JB Lippincott, Philadelphia, 1991, pp. 577–591.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Laurie A. Kane
  • Hossein Gharib

There are no affiliations available

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