Laboratory Medicine: The Diagnosis of Disease in the Clinical Laboratory > The Endocrine System

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Table 221

Laboratory Evaluation of Patients for Thyroid Disease

Disorder

Laboratory Test Results Suggestive of Diagnosis in the Appropriate Clinical Setting

Hyperthyroidism
Graves disease

TSH low free T4 high in some cases, T3 is elevated and free T4 is normal TRAbs or TSI elevated

Toxic multinodular
goiter

TSH low free T4 and T3 normal or high normal or increased radioactive iodine uptake thyroid scan with multiple areas of increased uptake surrounded by suppressed uptake

Toxic adenoma

TSH low free T4 and T3 normal or high normal or increased radioactive iodine uptake thyroid scan with focal increased uptake in tumor surrounded by suppressed uptake in
nontumor tissue

Subacute thyroiditis

TSH low free T4 and T3 high increased decreased radioactive iodine uptake

Painless thyroiditis

TSH low free T4 and T3 high erythrocyte sedimentation rate normal decreased radioactive iodine uptake

Hypothyroidism
Hashimoto thyroiditis

TSH high T4 normal and then low, preceding a decline in T3 anti-TPO and/or antithyroglobulin antibody positive

Ablative
hypothyroidism

TSH high free T4 and T3 low following procedure that ablates thyroid

Infantile
hypothyroidism

TSH high free T4 low in a newborn or infant

Euthyroid sick
syndrome

TSH normal to high free T4 normal T3 low rT3 high concentrations of TSH and thyroid hormones vary throughout disease course

rT3, reverse triiodothyronine T3, triiodothyronine free T4, free thyroxine TSH, thyroid-stimulating hormone TRAbs, TSH receptor autoantibodies TSI, thyroid-stimulating immunoglobulins.