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Laboratory Diagnosis of Thyroid Disease

  • Chapter
Thyroid Disorders with Cutaneous Manifestations

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From a dermatologist's vantage point, there are two major reasons to order thyroid function studies: to confirm a clinical suspicion of either hyperthyroidism or hypothyroidism. This is done by checking a thyroid-stimulating hormone (TSH) level with thyroxine (T4) level (or on occasion, triiodothyronine [T3]) or by screening for thyroid autoantibodies in an effort to ascertain if a patient is at risk for the development of autoimmune thyroid disease. For example, a 52-year-old woman presents with mild keratoderma and alopecia. A determination of TSH and T4 levels will rapidly determine if she is hypothyroid. In another typical case, an 8-year-old boy with alopecia areata is found to have elevated thyroper-oxidase antibodies and a normal TSH. This child may have the potential to develop autoimmune thyroid disease and should be followed periodically with a TSH level to be certain that neither Graves disease (GD) nor Hashimoto thyroiditis ensues. The appropriate use of thyroid function studies depends on a fundamental knowledge of thyroid hormone physiology. Many tests are now considered historical; however, their designs offer insights into thyroid physiology. On occasion, the dermatologist may order imaging studies of the thyroid gland, such as for the evaluation of thry-oglossal duct cysts or for assessing the gland for thyroid adenomas or carcinomas in patients with Cowden syndrome. In this chapter, the clinician reviews the utility and limitations of thyroid function tests and imaging studies so that they may be used appropriately in the diagnosis of thyroid disease, risk assessment for associated disorders, and as tools for monitoring response to treatment for those patients receiving thyroid hormone.

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References

  1. Kane L, Gharib H. Thyroid testing a clinical approach. In: Braverman L, ed. Contemporary Endocrinology: Diseases of the Thyroid. 2nd ed. Boston: Humana Press; 2003:39–52.

    Google Scholar 

  2. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988–1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489–499.

    Article  PubMed  CAS  Google Scholar 

  3. Caldwell G, Gow S, Sweeting, V. A new strategy for thyroid function testing. Lancet 1985;325:1117–1119.

    Article  Google Scholar 

  4. Nicoloff J, Spencer C. Clinical review 12: the use and misuse of the sensitive thyrotropin assays. J Clin Endocrinol Metab 1990;71:553–558.

    Article  PubMed  CAS  Google Scholar 

  5. Franklyn J, Black E, Betteridge J, et al. Comparison of second and third generation methods for measurement of serum thyrotropin in patients with overt hyperthyroidism, patients receiving thyroxine therapy, and those with nonthyroidal illness. J Clin Endocrinol Metab 1994;78:1368–1371.

    Article  PubMed  CAS  Google Scholar 

  6. Spencer C, Takeuchi M, Kazarosyan M, et al. Interlaboratory/Intermethod differences in functional sensitivity of immunometric assays of thyrotropin (TSH) and impact on reliability of measurement of subnormal concentrations of TSH. Clin Chem 1995;41:367–374.

    PubMed  CAS  Google Scholar 

  7. Spencer C, Eigen A, Shen D, et al. Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem 1987;33:1391–1396.

    PubMed  CAS  Google Scholar 

  8. Franklyn J, Black E, Wilson E, et al. Limitations of a sensitive assay for TSH in the management of thyroid disease. Clin Chem 1988;34:991.

    PubMed  CAS  Google Scholar 

  9. Ross D, Ardisson L, Meskell M. Measurement of thyrotropin in clinical and subclinical hyperthy-roidism using a chemiluminescent assay. J Clin Endocrinol Metab 1989;69:684–688.

    Article  PubMed  CAS  Google Scholar 

  10. Parle J, Franklyn J, Cross K, et al. Prevalence and follow-up of abnormal TSH concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 1991;34:77–85.

    Article  CAS  Google Scholar 

  11. Davies P, Franklyn J, Daykin J, et al. The significance of TSH values measured in a sensitive assay in the follow-up of hyperthyroid patients treated with radio-iodine. J Clin Endocrinol Metab 1992;74:1189–1194.

    Article  PubMed  CAS  Google Scholar 

  12. Spencer C, LoPresti J, Patel A, et al. Applications of a new chemiluminescent thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab 1990;70:453–460.

    Article  PubMed  CAS  Google Scholar 

  13. Spencer C, Takeuchi M, Kazarosyan M. Current status and performance goals for serum thyrotropin (TSH) assays. Clin Chem 1996;42:140–145.

    PubMed  CAS  Google Scholar 

  14. Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:1.

    Article  Google Scholar 

  15. Kratzsch J, Fiedler G, Leichtle A, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid. Clin Chem 2005;51:1480.

    Article  PubMed  CAS  Google Scholar 

  16. Elkins R. The free hormone hypothesis and measurement of free hormones. Clin Chem 1992;38:1289–1293.

    Google Scholar 

  17. Ekins R. Measurement of free hormones in blood [review]. Endocr Rev 1990;11:5–46.

    Article  PubMed  CAS  Google Scholar 

  18. Elkins R. The free hormone hypothesis and measurement of free hormones. Clin Chem 1993;39:1343–1344.

    Google Scholar 

  19. Midgley J. Direct and indirect free thyroxine assay methods: theory and practice. Clin Chem 2001;47:1353–1363.

    PubMed  CAS  Google Scholar 

  20. Soldin S, Soukhova N, Janicic N, et al. The measurement of free thyroxine by isotope dilution tandem mass spectrometry. Clin Chim Acta 2005;358:113–118.

    Article  PubMed  CAS  Google Scholar 

  21. Stockigt J. Free thyroid hormone measurement. A critical appraisal. Endocrinol Metab Clin North Am 2001;30:265–289.

    Article  PubMed  CAS  Google Scholar 

  22. Chopra I, Hershman J, Pardridge W, et al. Thyroid function in nonthyroidal illnesses. Ann Intern Med 1983;98:946–957.

    PubMed  CAS  Google Scholar 

  23. Hay I, Klee G. Thyroid dysfunction. Endocrinol Metab Clin North Am 1998;17:473–509.

    Google Scholar 

  24. Balock Z, Carayon P, Conte-Devolx B, et al. Guidelines Committee, National Academy of Clinical Biochemistry 2003 Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3–126.

    Article  Google Scholar 

  25. Spencer C, Nicoloff J. Serum TSH measurement—a 1990 status report. Thyroid Today 1990;13:1–4.

    Google Scholar 

  26. Klee G, Hay I. Biochemical thyroid function testing. Mayo Clin Proc 1994;69:469–470.

    Article  PubMed  CAS  Google Scholar 

  27. Stockigt J. Serum thyrotropin and thyroid hormone measurements and assessment of thyroid hormone transport. In: Braverman L, Utiger R, ed. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 7th ed. Philadelphia: Lippincott-Raven; 1996:377–396.

    Google Scholar 

  28. Kaptein E. Clinical application of free thyroxine determinations. Clin Lab Med 1993;13:653–672.

    PubMed  CAS  Google Scholar 

  29. Kaye T. Thyroid function tests. Application of newer methods. Postgrad Med 1993;94:81–82, 87–90.

    PubMed  CAS  Google Scholar 

  30. Braverman L, Dawber N, Ingbar S. Observations concerning the binding of thyroid hormones in sera of normal subjects of varying ages. J Clin Invest 1966;45:1273–1279.

    Article  PubMed  CAS  Google Scholar 

  31. Kaiser F. Variability of response to thyroid-releasing hormone in normal elderly. Age Ageing 1987;16:345–354.

    Article  PubMed  CAS  Google Scholar 

  32. Sawin C, Chopra D, Azizi F, et al. The aging thyroid. Increased prevalence of elevated serum thyrotropin levels in the elderly. JAMA 1979;242:247–250.

    Article  PubMed  CAS  Google Scholar 

  33. Hay I. Euthyroid hyperthyroxinemia. Mayo Clin Proc 1985;60:61–63.

    Article  PubMed  CAS  Google Scholar 

  34. Kaplan M. Interactions between drugs and thyroid hormone. Thyroid Today 1981;4:1–6.

    Google Scholar 

  35. Moses A, Lawlor J, Haddow J, et al. Familial euthy-roid hyperthyroxinemia resulting from increased thyroxine binding to thyroxine-binding prealbumin. N Engl J Med 1982;306:966–969.

    Article  PubMed  CAS  Google Scholar 

  36. Tibaldi J, Surks M. Effects of nonthyroidal illness on thyroid function. Med Clin North Am 1985;69:899–911.

    PubMed  CAS  Google Scholar 

  37. Chopra I. An assessment of daily turnover and significance of thyroidal secretion of reverse T3. J Clin Invest 1975;58:32–40.

    Article  Google Scholar 

  38. Kaptein E, Feinstein E, Nicoloff J, et al. Serum reverse triiodothyronine and thyroxine kinetics in patients with chronic renal failure. J Clin Endocrinol Metab 1983;57:181–189.

    Article  PubMed  CAS  Google Scholar 

  39. Kaptein E. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. Endocr Rev 1996;17:45–63.

    PubMed  CAS  Google Scholar 

  40. LoPresti J, Fried J, Spencer C, et al. Unique alterations of thyroid hormone indices in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1989;110:970–975.

    PubMed  CAS  Google Scholar 

  41. Ricart-Engel W, Fernandez-Real J, Gonzalez-Hulx F, et al. The relation between thyroid function and nutritional status in HIV-infected patients. Clin Endocrinol 1996;44:53–58.

    Article  CAS  Google Scholar 

  42. Torrens J, Burch H. Serum thyroglobulin measurement. Utility in clinical practice. Endocrinol Metab Clin North Am 2001;30:429–467.

    Article  PubMed  CAS  Google Scholar 

  43. Dralle H, Schwarzrock R, Lang W, et al. Comparison of histology and immunohistochemistry with thy-roglobulin serum levels and radioiodine uptake in recurrences and metastases of differentiated thyroid carcinomas. Acta Endocrinol (Copenh) 1985;108:504–510.

    CAS  Google Scholar 

  44. Pineada J, Lee T, Robbins J. Treating metastatic thyroid cancer. Endocrinologist 1993;5:433–442.

    Article  Google Scholar 

  45. Spencer C, Takeuchi M, Kazarosyna M. Current status and performance goals for serum thyroglobulin. Clin Chem 1996;42:164–173.

    PubMed  CAS  Google Scholar 

  46. Refetoff S, Lever E. The value of serum thy-roglobulin: measurement in clinical practice. JAMA 1983;250:2352–2357.

    Article  PubMed  CAS  Google Scholar 

  47. Spencer C, Wang C. Thyroglobulin measurement: techniques, clinical benefits and pitfalls. Endocrinol Metab Clin North Am 1996;24:841–864.

    Google Scholar 

  48. Schlumberger M, Van Herle A. Critical analysis of I–131 and I–125 thyroglobulin labels for radioimmunoassay use. J Clin Endocrinol Metab 1982;54:581–586.

    Article  PubMed  CAS  Google Scholar 

  49. Spencer C, Bergoglio L, Kazarosyan M, et al. Clinical impact of thyroglobulin (Tg) and Tg autoantibody method differences on the management of patients with differentiated thyroid carcinomas. J Clin Endocrinol Metab 2005;90:5566–5575.

    Article  PubMed  CAS  Google Scholar 

  50. Baloch Z, Carayon P, Conte-Devolx B, et al. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3–126.

    Article  PubMed  Google Scholar 

  51. Preissner C, O'Kane D, Singh R, et al. Phantoms in the assay tube: heterophile antibody interferences in serum thyroglobulin assays. J Clin Endocrinol Metab 2003;88:3069–3074.

    Article  PubMed  CAS  Google Scholar 

  52. Spencer C. Challenges of thyroglobulin (Tg) measurement in the presence of Tg autoantibodies (TgAb). J Clin Endocrinol Metab 2004;89:3702–3704.

    Article  PubMed  CAS  Google Scholar 

  53. Spencer C, Takeuchi M, Kazarosyan M, et al. Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement and prognostic significance in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 1998;83:1121–1127.

    Article  PubMed  CAS  Google Scholar 

  54. Hollowell J, Staehling N, Hannon W, et al. Serum thyrotropin, thyroxine, and thyroid antibodies in the United States population: NHANES III. J Clin Endocrinol Metab 2002;87:489–499.

    Article  PubMed  CAS  Google Scholar 

  55. Chung J, Park Y, Kim T, et al. Clinical significance of elevated level of serum antithyroglobulin antibody in patients with differentiated thyroid cancer after thyroid ablation. Clin Endocrinol (Oxf) 2002;57:215–221.

    Article  Google Scholar 

  56. Pacini F, Mariotti S, Formica N, et al. Thyroid autoantibodies in thyroid cancer: incidence and relationship with tumor outcome. Acta Endocrinol 1988;119:373–380.

    PubMed  CAS  Google Scholar 

  57. Amino N, Hagen S, Yamada N, et al. Measurement of circulating thyroid microsomal antibodies by the tanned red cell haemagglutination technique: its usefulness in the diagnosis of autoimmune thyroid diseases. Clin Endocrinol 1976;5:115–125.

    Article  CAS  Google Scholar 

  58. Cayzer I, Chalmers S, Doniach D, et al. An evaluation of two new haemagglutination tests for the rapid diagnosis of autoimmune thyroid diseases. J Clin Pathol 1978;31:1147–1151.

    Article  PubMed  CAS  Google Scholar 

  59. Chiovato L, Bassi P, Santini F, et al. Antibodies producing complement-mediated thyroid cytotoxicity in patients with atrophic or goitrous autoimmune thy-roiditis. J Clin Endocrinol Metab 1993;77:1700–1705.

    Article  PubMed  CAS  Google Scholar 

  60. Mariotti S, Caturegli P, Piccolo P, et al. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990;71:661–669.

    Article  PubMed  CAS  Google Scholar 

  61. Feldt-Rasmussen. Anti-thyroid peroxidase antibodies in thyroid disorders and non-thyroid autoimmune diseases. Autoimmunity 1991;9:245–251.

    Article  PubMed  CAS  Google Scholar 

  62. Nohr S, Jorgensen A, Pedersen K, et al. Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J Clin Endocrinol Metab 2000;85:3191–3198.

    Article  PubMed  CAS  Google Scholar 

  63. Martino E, Bartalena L, Bogazzi F, et al. The effects of amiodarone on the thyroid. Endocr Rev 2001;22:240–254.

    Article  PubMed  CAS  Google Scholar 

  64. Johnston A, Eagles J. Lithium-associated clinical hypothyroidism. Prevalence and risk factors. Br J Psychiatry 1999;175:336–339.

    Article  PubMed  CAS  Google Scholar 

  65. Bell T, Bansal A, Shorthouse C, et al. Low titre autoantibodies predict autoimmune disease during interferon alpha treatment of chronic hepatitis C. J Gastroenterol Hepatol 1999;14:419–422.

    Article  PubMed  CAS  Google Scholar 

  66. Ward D, Bing-You R. Autoimmune thyroid dysfunction induced by interferon-alfa treatment for chronic hepatitis C: screening and monitoring recommendations. Endocr Pract 2001;7:52–58.

    PubMed  CAS  Google Scholar 

  67. Phan G, Attia P, Steinberg S, et al. Factors associated with response to high-dose interleukin-2 in patients with metastatic melanoma. J Clin Oncol 2001;19:3477–3482.

    PubMed  CAS  Google Scholar 

  68. Zakarija M, McKenzie J, Banovac K. Clinical significance of assay of thyroid-stimulating antibody in Graves' disease. Ann Intern Med 1980;93:28–32.

    PubMed  CAS  Google Scholar 

  69. Laurberg P, Nygaard B, Glinoer D, et al. Guidelines for TSH-receptor antibody measurements in pregnancy: results of an evidence-based symposium organized by the European Thyroid Association. Eur J Endocrinol 1998;139:584–586.

    Article  PubMed  CAS  Google Scholar 

  70. Radetti G, Persani L, Cortelazzi D, et al. Transplacental passage of anti-thyroid autoantibodies in a pregnant woman with auto-immune thyroid disease. Prenat Diagn 1999;19:468–471.

    Article  PubMed  CAS  Google Scholar 

  71. Ladenson P, Singer P, Ain K, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med 2000;160:1573–1575.

    Article  PubMed  CAS  Google Scholar 

  72. Uy H, Reasner C, Samuels M. Pattern of recovery of the hypothalamic-pituitary thyroid axis following radioactive iodine therapy in patients with Graves' disease. Am J Med 1995;99:173–179.

    Article  PubMed  CAS  Google Scholar 

  73. Vanderpump M, Tunbridge W, French J, et al. The incidence of thyroid disorders in the community: a 20-year follow up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55–68.

    Article  CAS  Google Scholar 

  74. Fatourechi V. Subclinical thyroid disease. Mayo Clin Proc 2001;76:413–417.

    PubMed  CAS  Google Scholar 

  75. Glinoer D, De Nayer P, Bourdoux P, et al. Regulation of maternal thyroid function during pregnancy. J Clin Endocrinol Metab 1990;71:276–287.

    Article  PubMed  CAS  Google Scholar 

  76. Nissim M, Giorda G, Ballabio M, et al. Maternal thyroid function in early and late pregnancy. Horm Res 1991;36:196–202.

    Article  PubMed  CAS  Google Scholar 

  77. Pop V, De Vries E, Van Baar A, et al. Maternal thyroid peroxidase antibodies during pregnancy: a marker of impaired child development? J Clin Endocrinol Metab 1995;80:3561–3566.

    Article  PubMed  CAS  Google Scholar 

  78. Haddow J, Palomaki G, Allan W, 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 

  79. Marqusee E, Benson CB, Frates MC, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 2000;133:696–700.

    PubMed  CAS  Google Scholar 

  80. Tan, GH, Gharib H. Thyroid incidentalomas: management approaches to non-palpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126:226–231.

    PubMed  CAS  Google Scholar 

  81. Chen YK, Chen YL, Cheng RH, Yeh CL, Lee CC, Hsu CH. The significance of FDG uptake in bilateral thyroid glands. Nucl Med Commun 2007;28:117–122.

    Article  PubMed  CAS  Google Scholar 

  82. Karantanis D, Bogsrud TV, Wiseman GA, et al. Clinical significance of diffusely increased 18F-FDG uptake in the thyroid gland. J Nucl Med 2007;48:896–901.

    Article  PubMed  CAS  Google Scholar 

  83. Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK.18F-Fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 2005;115:1074–1078.

    Article  PubMed  Google Scholar 

  84. Higgins CB, Auffermann W. MR Imaging of thyroid and parathyroid glands: a review of current status. AJR Am J Roentgenol 1988;151:1095–1106.

    PubMed  CAS  Google Scholar 

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  1. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA

    Reagan Schiefer MD & Vahab Fatourechi

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  1. Reagan Schiefer MD
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  1. University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School at Camden, Marlton, NJ, USA

    Warren R. Heymann MD

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Schiefer, R., Fatourechi, V. (2008). Laboratory Diagnosis of Thyroid Disease. In: Heymann, W.R. (eds) Thyroid Disorders with Cutaneous Manifestations. Springer, London. https://doi.org/10.1007/978-1-84800-187-9_4

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