Thyroid Disorders Testing

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INDICATIONS FOR TESTING

Increased or decreased metabolism (heat or cold intolerance, weight loss or gain,
depression, anxiety, etc)
Family history of autoimmune thyroiditis
Goiter on physical exam

ORDER
Thyroid Stimulating Hormone with Reflex
to Free Thyroxine
Low TSH High TSH
suggests suggests
hyperthyroidism hypothyroidism
Normal TSH and free T4

Thyroid disease
unlikely

Low free T4 Primary hypothyroidism

Thyroid ablation removal Low free
Central hypothyroidism Euthyroid sick syndrome T4
Severe illness Transient thyroiditis

If still concerned with

Euthyroid sick
hyperthyroidism,
syndrome
Normal ORDER Thyroid hormone
free T4 Subclinical
Triiodothyronine, Total resistance High
hyperthyroidism
(Total T3) OR Free T3 by TSH resistance free T4
Drug interference
dialysis TSH secreting adenoma

Normal High

Subclinical hypothyroidism
High Hyperthyroidism Hyperthyroidism T3 Euthyroid sick syndrome Normal
free T4 unlikely hyperthyroidism Transient thyroiditis free T4
Autoimmune thyroiditis

ORDER
Thyroid Stimulating Immunoglobulin (TSI)
Thyroid Peroxidase (TPO) Antibody
Thyroid Stimulating Hormone Receptor Antibody (TRAb) CONSIDER
Thyroid Antibodies
Triiodothyronine, Total (Total T3)
T3 by dialysis
TSI Ab+
TPO+
TRAb+
Clinical indications of
Graves ophthalmologic
disease present TPO Ab- Normal T3 Low T3 Positive Negative
Diffuse thyroid gland TSI Ab- antibodies antibodies
enlargement

Probable Hypothyroidism T3 Automimmune Thyroid disease

Graves disease
toxic nodule/s unlikely hypothyroidism thyroid disease unlikely

Facilitate treatment decisions

CONSIDER
Radioiodine thyroid scan and % uptake

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