medigraphic.com
ISSN 2500-7106 (Electronic)
ISSN 0123-2576 (Print)
Medicina & Laboratorio

2020, Number 2

<< Back Next >>

Medicina & Laboratorio 2020; 24 (2)

Interpretation of thyroid function tests

Forero-Saldarriaga S, Puerta-Rojas JD, Correa-Parra L

Language: Spanish
References: 48
Page: 93-109
PDF size: 856.12 Kb.


ABSTRACT

Thyroid gland disorders are common and can affect up to 10% of the general population. In many cases the symptoms can be nonspecific, so the physician in search for a thyroid disorder should reach a functional and anatomical diagnosis. Serum measurements of thyroid hormones confirm if there is an excess, a deficit, or if concentrations are normal. For this, reference ranges of the local population, and specifically by age groups, are required for a correct interpretation of thyroid function tests. Thyroid hormones play a fundamental role in the endocrine system, control of the general metabolism of the body, neural development, normal growth and maturation of bones, as well as in cardiovascular and renal functions, among others. In this review, the most relevant thyroid tests will be described, starting with the biosynthesis and secretion of thyroid hormones, and continuing with an approach to reach an initial diagnosis. Finally, the most important aspects of the different thyroid patterns will be mentioned. It is beyond the scope of this review, to describe the treatment for thyroid disorders.


REFERENCES

  1. Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 2018;14:301-316. https://doi. org/10.1038/nrendo.2018.18.

  2. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017;390:1550-1562 https://doi.org/10.1016/S0140-6736(17)30703-1.

  3. Boucai L, Hollowell JG, Surks MI. An approach for development of age, gender, and ethnicity specific thyrotropin reference limits. Thyroid 2011;21:5-11. https://doi.org/10.1089/ thy.2010.0092.

  4. Builes-Barrera CA. Aspectos claves tiroides. Medellín; Fondo Editorial. 2016.

  5. Committee on Medicare Coverage of Routine Thyroid Screening, Board on Health Care Services. Prevalence and consequences of thyroid dysfunction. In: Stone MB, Wallace RB, eds. Medicare Coverage of Routine Screening for Thyroid Dysfunction. Washington: The National Academies Press; 2003. p. 21-31.

  6. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012;18:988-1028. https://doi.org/10.4158/ EP12280.GL.

  7. Maniakas A, Davies L, Zafereo ME. Thyroid disease around the world. Otolaryngol Clin North Am 2018;51:631-642. https://doi.org/10.1016/j. otc.2018.01.014.

  8. Abel MH, Korevaar TI, Erlund I, Villanger GD, Caspersen IH, Arohonka P, et al. Iodine intake is associated with thyroid function in mild to moderately iodine deficient pregnant women. Thyroid 2018;28:1359-1371. https://doi.org/10.1089/ thy.2018.0305.

  9. Jameson JL, Mandel SJ, Weetman AP. Disorders of the thyroid gland. In: Kasper DL, Fauci AS, Hauser ML, Longo DL, Loscalzo J, eds. 19th ed. New York: McGraw-Hill Education; 2015. p. 886- 894.

  10. Li M, Eastman CJ. Neonatal TSH screening: is it a sensitive and reliable tool for monitoring iodine status in populations? Best Pract Res Clin Endocrinol Metab 2010;24:63-75. https://doi. org/10.1016/j.beem.2009.08.007.

  11. Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiological reviews 2014;94:355-382. https://doi.org/10.1152/physrev. 00030.2013.

  12. Kopp P, Solis-S JC. Chapter 3 - Thyroid hormone synthesis. In: Wondisford FE, Radovick S, eds. Clinical management of thyroid disease. Philadelphia: W.B. Saunders; 2009. p. 19-41. https://doi. org/https://doi.org/10.1016/B978-1-4160-4745- 2.00003-1.

  13. Davies TF, Yin X, Latif R. The genetics of the thyroid stimulating hormone receptor: history and relevance. Thyroid 2010;20:727-736. https://doi. org/10.1089/thy.2010.1638.

  14. Smith BR, Sanders J, Furmaniak J. TSH receptor antibodies. Thyroid 2007;17:923-938. https://doi. org/10.1089/thy.2007.0239.

  15. Hall JE, Guyton AC. Guyton y Hall. Tratado de fisiología médica. 13 ed. Barcelona; Elsevier. 2016.

  16. Huhtaniemi I, Martini L. Encyclopedia of Endocrine Diseases. 2nd ed. Oxford; Elsevier. 2019.

  17. Stathatos N. Thyroid physiology. Med Clin North Am 2012;96:165-173. https://doi.org/10.1016/j. mcna.2012.01.007.

  18. Kundra P, Burman KD. The effect of medications on thyroid function tests. Med Clin North Am 2012;96:283-295. https://doi.org/10.1016/j. mcna.2012.02.001.

  19. Ross DS. Laboratory assessment of thyroid function. 2019. Acceso julio 22 de 2019. Disponible en https://www.uptodate.com/contents/ laboratory-assessment-of-thyroid-function.

  20. Esfandiari NH, Papaleontiou M. Biochemical testing in thyroid disorders. Endocrinol Metab Clin North Am 2017;46:631-648. https://doi. org/10.1016/j.ecl.2017.04.002.

  21. Pearce EN. The relationship between serum TSH and free T4 is not log-linear and varies by age and sex. J Clin Endocrinol Metab 2013; 25:156-157. [Epub ahead of print] 13 de mayo de 2013.

  22. Huang HL, Aw TC. Thyroid function testing-a review. Annals Thyroid Res 2014;1:17-22.

  23. Witherspoon LR. Clinical utility of sensitive TSH measurements. Laboratory Medicine 2005;36:711-715. https://doi. org/10.1309/60uvgc5u8q69ut1g.

  24. Caldwell G, Kellett HA, Gow SM, Beckett GJ, Sweeting VM, Seth J, et al. A new strategy for thyroid function testing. Lancet 1985;1:1117-1119. https://doi.org/10.1016/s0140-6736(85)92429-8.

  25. Nicoloff JT, Spencer CA. Clinical review 12: The use and misuse of the sensitive thyrotropin assays. J Clin Endocrinol Metab 1990;71:553-558. https://doi.org/10.1210/jcem-71-3-553.

  26. Ross DS, Ardisson LJ, Meskell MJ. Measurement of thyrotropin in clinical and subclinical hyperthyroidism using a new chemiluminescent assay. J Clin Endocrinol Metab 1989;69:684-688. https://doi.org/10.1210/jcem-69-3-684.

  27. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, 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. https:// doi.org/10.1210/jcem.87.2.8182.

  28. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526-534. https:// doi.org/10.1001/archinte.160.4.526.

  29. Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003;13:3-126. https:// doi.org/10.1089/105072503321086962.

  30. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997;18:404- 433. https://doi.org/10.1210/edrv.18.3.0300.

  31. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 2007;92:4575-4582. https://doi. org/10.1210/jc.2007-1499.

  32. Builes-Barrera CA, Márquez-Fernández JM, Gómez-Baena RM, Cárdenas-Gómez ML. Valores de pruebas tiroideas (TSH y T4 libre) en una población adulta de la ciudad de Medellín, Colombia. Rev Colomb Endocrinol Diab Metab 2015;2:19-23.

  33. Sapin R, Schlienger JL. [Thyroxine (T4) and tri-iodothyronine (T3) determinations: techniques and value in the assessment of thyroid function]. Ann Biol Clin (Paris) 2003;61:411-420.

  34. Larsen PR, Alexander NM, Chopra IJ, Hay ID, Hershman JM, Kaplan MM, et al. Revised nomenclature for tests of thyroid hormones and thyroid-related proteins in serum. J Clin Endocrinol Metab 1987;64:1089-1094. https://doi. org/10.1210/jcem-64-5-1089.

  35. Menconi F, Marcocci C, Marino M. Diagnosis and classification of Graves’ disease. Autoimmun Rev 2014;13:398-402. https://doi.org/10.1016/j. autrev.2014.01.013.

  36. Demers LM, Spencer CA. Guía de consenso para el diagnóstico y seguimiento de la enfermedad tiroidea. Med & Lab 2005;11:11-38.

  37. Dunlap DB. Thyroid function tests. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990. p.

  38. Christ ER, Burger AG. Thyroid Function Tests. In: Huhtaniemi I, Martini L, eds. Encyclopedia of Endocrine Diseases. 2nd ed. Oxford: Academic Press; 2015. p. 477-485. https://doi.org/10.1016/ B978-0-12-801238-3.04183-0.

  39. Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2015;162:35-45. https://doi. org/10.7326/M14-1456.

  40. Ross DS. Diagnosis of and screening for hypothyroidism in nonpregnant adults. Up to Date; 2017. Acceso 9 de agosto de 2019. Disponible en https://www.uptodate.com/contents/diagnosisof- and-screening-for-hypothyroidism-in-nonpregnant- adults.

  41. LaFranchi S. Clinical features and detection of congenital hypothyroidism. Up to Date; 2018. Acceso 9 de agosto de 2019. Disponible en https:// www.uptodate.com/contents/clinical-featuresand- detection-of-congenital-hypothyroidism.

  42. ARUP Consult. Thyroid disorders testing algorithm. 2006. Acceso 11 de agosto de 2019. Disponible en https://arupconsult.com/algorithm/ thyroid-disorders-testing-algorithm.

  43. Guimarães VC. Chapter 87-Subacute and Riedel’s Thyroiditis. In: Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, et al., eds. Endocrinology: adult and pediatric. 7th ed. Philadelphia: W.B. Saunders; 2016. p. 1528-1539.e1525. https://doi.org/10.1016/B978-0-323-18907- 1.00087-1.

  44. Sterling K, Refetoff S, Selenkow HA. T3 thyrotoxicosis. Thyrotoxicosis due to elevated serum triiodothyronine levels. JAMA 1970;213:571-575. https://doi.org/10.1001/jama.213.4.571.

  45. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016;26:1343- 1421. https://doi.org/10.1089/thy.2016.0229.

  46. Peeters RP. Subclinical hypothyroidism. N Engl J Med 2017;376:2556-2565. https://doi. org/10.1056/NEJMcp1611144.

  47. Dayan CM. Interpretation of thyroid function tests. Lancet 2001;357:619-624. https://doi. org/10.1016/S0140-6736(00)04060-5.

  48. Koulouri O, Gurnell M. How to interpret thyroid function tests. Clin Med 2013;13:282-286. https://doi.org/10.7861/ clinmedicine.13-3-282.




2020     |     www.medigraphic.com