A

Seminar On
Thyroid Function Tests

Presented by:

Abiori, Akwesa A
 Outline
• Introduction
• The Anatomy of the Thyroid Gland
• Thyroid Regulation
• Thyroid Hormones
• Thyroid Disorders
• Thyroid Assays
• Reference ranges/Interpretation
• Conclusion
 Introduction
• Thyroid Function tests(TFTs) is a collective
term used for blood tests used to check the
function of the thyroid.
 The Thyroid Gland
• A butterfly-shaped organ positioned just below
the larynx
• One of the Largest of endocrine glands ( 20-25 g )
• Consists of 2 lobes, one on each side of the
trachea, connected anteriorly by a broad isthmus
• Secretes (a) Thyroxine ( T₄ )
• (b) Triiodothyronine ( T₃ )
• (c) Thyrocalcitonin ( Calcitonin )
 Thyroid regulation
• Hypothalamus secretes neurohormones that
stimulate the Anterior Pituitary gland
• The Anterior Pituitary secretes pituitary
hormones that regulate peripheral endocrine
glands ( thyroid, adrenals and gonads )
• (*The posterior pituitary regulates water
balance, lactation & uterine contraction )
 Thyroid regulation(contd)
• The Hypothalamus secretes Thyrotropin
Releasing Hormone ( TRH ), a neurohormone
• TRH stimulates the Pituitary gland to secrete
the thyroid stimulating hormone (TSH )
• TSH stimulates the thyroid gland to produce
T₄ & T₃
• T₃ & T₄ circulate, mostly bound to serum
proteins
 Hypothalamic – Thyroid Axis
• Hypothalamus
• ↓Neurohormones
• (TRH )
• Pituitary Gland ↖
• ↓ ( TSH )
• Thyroid Gland
• ( T₃ & T₄ )
• ↘Circulation
 Thyroid hormones
 T₃ and T₄
Stored in thyroid follicles & released as needed,
to regulate metabolic functions:
• - protein synthesis
• - energy release from carbohydrates
• - Rate of growth in young people
• - Sexual maturity
• - Maturity of the nervous system
 Disorders of the Thyroid gland

i. Hyperthyroidism

ii. Hypothyroidism
 Hyperthyroidism
• Increased activity: nervousness, tachcardia, tremor,
frequent bowel movements
• Hypersensitivity to heat
• Exophthalmos (due to incr. retroorbital tissue )
• Goiter
• Fine, moist skin
• Increased appetite with wt. loss
 Causes:
• Graves disease
• Toxic mt goitre
• Amiodarone
 Hypothyroidism
• A reaction to thyroid hormone deficiency
• Two types: Primary & Secondary
• Primary: most common
• -Probably an autoimmune Dz
• - can be a sequel of radiation therapy
• - can be a sequel of Hashimoto’s
• thyroiditis
 Hypothyroidism ( contd )
• Secondary: Failure of the hypothalamic -
• pituitary axis
• Decreased secretion of TRH from the
hypothalamus OR lack of secretion of TSH by
the Pituitary
• Dull facial expression, hoarse voice, slow
speech, cold intolerance, dry hair, wt gain,
contipation> Mexedema Madness( psychosis)
 Thyroid Assays

i. Hormonal assays

ii. Antibodies assay

• Also used to monitor thyroid therapy

• ↑ in primary hypoth

• ↓ in hyperth
 b.) Total thyroxine & T₄
• T₄ more than 99% protein-bound
• ↑ in hyperTH
• ↓ in hypoth
 c.) Total or free T₃
• Total T₃ or free T₃(f T₃) concentrations helps
in diagnosis of hyperTH
• Not normally used in diagnosis of hypoTH due
to very low plasma concentrations
• ↑ in hyperTH
• ↓ in hypoTH
 d.) TRH test
• For confirmation of secondary hypothyroidism
• Differential diagnosis of thyroid resistance
syndrome
 Thyroid Assay
B. Antibody Assay
• Anti-thyroid peroxidase autoantibodies(anti-TPO)
• Anti-thyroglobulin autoantibodies(anti-Tg)
• Antibodies against TSH receptors (Anti-TSH)
• Antibody assays done in autoimmune diseases
like Graves disease & Hashimoto’s thyroiditis
• NB: anti-TPO is commoner in Hashimoto’s while
anti-TSH is commoner in Graves disease
 Effect of drugs on TFTs
T₄ fT₄ T₃ fT₃
Carbimazole ↓ ↓ ↓ ↓

Propyl- ↓ ↓ ↓ ↓
thiouracil
Amiodarone ↑ Normal Normal Normal

Propanolol Normal Normal ↓ ↓

Phenytoin ↓ ↓ Normal Normal

&

INTERPRETATION OF RESULTS
 Normal Reference Ranges
Thyroid

T₃-total 60-181 ng/mL

T₄ -free 0.8-1.5 ng/dL

T₄ -total 5.5-12.3 ng/mL

Thyroxine-Binding Globulin
12-30 mg/L
(TBG)

Tyroid-Stimulating Hormone
0.4-4.5 µU/mL
(TSH)
 TFTs
Serum Serum T₃ Serum T₃ Free T₄ Serum TSH
Primary Total T₄ ↓ Uptake Index
↓ ↑
Hypothyr ↓ ↓ ↓ ↓ ↑
oidism
Secondary ↓ ↓ ↓ ↓ ↓
Hypothyro
idism
Hyperthyr ↑ ↑ ↑ ↑ ↓
oidism
 Conclusion
• TSH (anterior pituitary) acts on TG to release
two iodine containing hormones, T₄ and T₃
• TFTs are tests done to assess the function of
the TG
• Hormonal and antibody TFTs
• Assay of hormones helps to assess the state of
thyroid gland function, confirm diagnosis or
monitor treatment
THANK YOU