Laboratory Assessment

of Thyroid Function
What are Thyroid Function tests?
 Thyroid function tests (TFTs) is a collective term for blood
tests used to check the function of the thyroid.
 TFTs may be requested if a patient is thought to suffer from
hyperthyroidism (overactive thyroid) or hypothyroidism
(underactive thyroid), or to monitor the effectiveness of either
thyroid-suppression or hormone replacement therapy.
 It is also requested routinely in conditions linked to thyroid
disease, such as atrial fibrillation and anxiety disorder.
 A TFT panel typically includes thyroid hormones such as thyroid-
stimulating hormone (TSH, thyrotropin) and thyroxine (T4), and
triiodothyronine (T3)
Production of Thyroid Hormes

 Hipotalamus
 PituitaryGland
 Thyroid Gland
The Hypothalamus
What is the Hypothalamus
 The Hypothalamus is a portion of the brain that contains a
number of small nuclei with a variety of functions. The
hypothalamus is responsible for certain metabolic
processes and other activities of the autonomic nervous
system. It synthesizes and secretes certain
neurohormones, called releasing hormones or
hypothalamic hormones, and these in turn stimulate or
inhibit the secretion of pituitary hormones.
 The Releasing hormones- Thyrotropin-Releasing Hormone
(TRH)
 The pituitary hormones- Thyroid Stimulating hormones
(TSH)
The pituitary gland
What is the pituitary gland
 The pituitary gland, in humans, is a pea-sized gland that sits in
a protective bony enclosure called the sella turcica. It is
composed of three lobes: anterior, intermediate, and posterior.
The intermediate is avascular and almost absent in human
beings.
 The anterior pituitary (or adenohypophysis) is a lobe of the
gland that regulates several physiological processes (including
stress, growth, reproduction, and lactation).
 The posterior pituitary (or neurohypophysis) is a lobe of the
gland that is functionally connected to the hypothalamus by the
median eminence via a small tube called the pituitary stalk
(also called the infundibular stalk or the infundibulum).
 Its is responsible for the production of the Thyroid stimulating
Hormone
The Thyroid Gland
The Thyroid Gland “The Body’s
Thermostat”
 A butterfly-shaped gland wrapped around the windpipe -
behind and below the Adam's apple. It is the largest
endocrine gland in the body and the master gland of
metabolism.

 Produces thyroid hormones Thyroxine (T4) and

Triiodothyronine (T3)
•✔ T4 – Storage form
•✔ T3 – Metabolically active form

 These hormones are necessary for all cells in your body to

work normally
Triiodothyronine (T3)
 T3 has three primary functions:
 Enhance protein synthesis and growth
 Help oxygen get into cells – determines how quickly the body uses energy (the basal
metabolic rate (BMR)). Increasing cellular oxygen consumption increases production of
cellular ATP (cell's energy currency)
 Control body's sensitivity to other hormones

 Thus, they basically influence all body functions, including:

 ✔Nerve and bone formation
✔Reproduction
✔Condition of the skin, hair, nails and teeth
✔Connective tissue strength and our speech/mental state

 All the thyroid hormone metabolic activity comes from T3 -

T4 is in the body just to be converted to T3 (Except during
pregnancy, when T4 is needed for the fetus to develop
properly).
Thyroid Stimulating Hormone

 Thyroid-stimulating is a pituitary hormone that stimulates

the thyroid gland to produce thyroxine (T4), and which is
then converted to triiodothyronine (T3) which stimulates
the metabolism of almost every tissue in the body. .
 About 80% of this conversion is in the liver and other
organs, and 20% in the thyroid itself.
Normal Ranges for Thyroid function tests

Test From To Units

mU/L (milliunits per
TSH 0.4 4.0
litre)
FT4 pmol/L (picomoles
9.0 25.0
per litre)
FT3 pmol/L (picomoles
3.5 7.8
per litre)
 Hyperthyroidism
 Hyperthyroidism is a condition in which the thyroid gland is
overactive and makes excessive amounts of thyroid hormone.
 When the thyroid gland is overactive (hyperthyroidism) the body’s
processes speed up and you may experience
 Nervousness

 Mood Swings
 anxiety,

 rapid heartbeat,
 hand tremor,
 excessive sweating,
 weight loss
 Heart palpitations or irregular heartbeat
 sleep problems, among other symptoms.
Cuases of Hyperthyroidism
1. The most common cause of hyperthyroidism is the autoimmune
disorder Graves’ disease.
 Production of an antibody- TSI Thyroid Stimulating
Immunoglobulin
2. Hyperthyroidism also may be caused by a toxic nodular or
multinodular goiter, which are lumps or nodules in the thyroid
gland that cause the thyroid to produce excessive amounts of
thyroid hormones.
3. people who consume too much iodine (either from foods or
supplements) or who take medications containing iodine (such
as amiodarone) may cause the thyroid gland to overproduce
thyroid hormones.
4. some women may develop hyperthyroidism during pregnancy or
in the first year after giving birth.
Testing
 Laboratory tests that evaluate thyroid function:
 Serum TSH is usually decreased
 T3 and free T4 are usually elevated
 This disease may also decrease the results of the following
tests:
 Triglycerides
 Cholesterol
Low results can be a sign of an elevated metabolic rate,
in which your body is burning through cholesterol and
Triglycerides quickly.
Hypothyroidism

 Hypothyroidism is a condition in which the body lacks

sufficient thyroid hormone.
 Since the main purpose of thyroid hormone is to "run the
body's metabolism," it is understandable that people with
this condition will have symptoms associated with a slow
metabolism.
 There are three types of hypothyroidism: primary,
secondary, and tertiary.
Primary Hypothyroidism
 In primary hypothyroidism, your thyroid is being stimulated
properly. However, it isn’t able to produce enough thyroid
hormones for your body to function properly.
At first, you may notice general symptoms including:
 fatigue
 lethargy
 sensitivity to cold
 depression
 muscle weakness
 Weight gain
 Pain in the joints
 Constipation

 Ifyour hypothyroidism is extremely severe, you might fall into

a coma, known as a myxedema coma. This is a life-threatening
condition.
Secondary & Tertiary Hypothyroidism
 Secondary hypothyroidism involves decreased activity of the
thyroid caused by failure of the pituitary gland.
 Hypothyroidism may cause a variety of symptoms and can affect
all body functions. The body's normal rate of functioning slows,
causing mental and physical sluggishness.
 Symptoms:
 Early symptoms:
 Weakness
 Fatigue
 Cold intolerance
 Constipation
 Weight gain
 Depression
 Joint or muscle pain
 Brittle fingernails
 Coarseness, thinning of hair
Secondary Hypothyroidism
 Additional laboratory abnormalities may include:
 Increased cholesterol levels
 Low serum sodium
 Low blood glucose
 Increased liver enzymes
 Increased serum prolactin
 A CBC that shows anemia
 Deficiency or excess of other pituitary hormones
 Imaging will include an MRI of the pituitary to look for a
tumor.
THANK YOU!