Thyroid function tests

Clinical suspicion of hyperthyroidism should prompt laboratory testing. The tests

usually ordered are:

1. TSH test, which has the highest sensitivity and specificity for
hyperthyroidism
2. free thyroxine (T4)
3. free triiodothyronine (T3).

Although free T3 (fT3) is measured, it is less relevant than free T4 (fT4). This is
because the thyroid releases T4 and T3 at a ratio of about 20:1 respectively, with T3
mainly being produced by peripheral conversion of T4. As a result, T4 is a much
better marker of thyroid function

Condition TSH Free T4 Total T3

Primary Low High High
hyperthyroidism
ex: Graves’ disease (75% of
all cases), Toxic
multinodular goiter, Toxic
adenoma
Secondary High High High
hyperthyroidism
Ex: TSH-secreting tumour

Subclinical Low Normal Normal

hyperthyroidism
Radioactive iodine uptake and thyroid scan

A radioactive iodine uptake test and thyroid scan help determine the cause of
hyperthyroidism. Uptake is the percentage of an iodine 123 (I-123) tracer dose
taken up by the thyroid gland, ranging from 15% to 25% at 24 hours.

Condition Radioactive iodine Radiotracer distribution

uptake in the thyroid gland

Graves’ disease High Homogenous

Toxic adenoma High I-123 concentrated in one
spot
Toxic multinodular goiter High I-123 concentrated in
multiple spots
Thyroiditis Low -

The thyroid scan shows the distribution of radiotracer in the gland.

Ultrasonography is sometimes used as a cost-effective and safe alternative to

radioactive iodine uptake and scan. It is mainly used during pregnancy, lactation.

References:

 Notas, G., Kampa, M., Malliaraki, N., Petrodaskalaki, M., Papavasileiou, S., & Castanas,
E. (2018). Implementation of thyroid function tests algorithms by clinical laboratories: A
four-year experience of good clinical and diagnostic practice in a tertiary hospital in
Greece. European Journal of Internal Medicine, 54, 81–86.
https://doi.org/10.1016/j.ejim.2018.03.012
 Kravets, I. (2016, March 1). Hyperthyroidism: Diagnosis and Treatment. American
Family Physician. https://www.aafp.org/afp/2016/0301/p363.html
 Comprehensive Clinical Endocrinology 3rd ed., G.Besser, M. Thorner; 2002; 0-7234-
3185-X; Elsevier science limited