THYROID FUNCTION TESTS

A. BASED ON METABOLIC EFFECTS OF T4

1. BMR i.e. O2 consumption of the subject under physical and mental rest.

Normal: + 20%

Causes of increase: Hyperthyroidism (increase upto +100%); exercise, fever, pregnancy, anxiety,
congestive cardiac failure, etc.

Causes of decrease: Hyperthyroidism (decreases to -30 to -40%); nephritic syndrome, etc.

2. Blood sugar. Normal (fasting) 70-90 mg%, increases in hyperthyroidism and decreases in
hypothyroidism.
3. S. Cholesterol. Normal: 150-240 mg% increases in hyperthyroidism and decreases in
hypothyroidism.
4. S. Creatinine. Normal: 0.6 mg%, increases in hyperthyroidism and decreases in hypothyroidism.
B. BASED ON HANDLING OF IODINE
I. Protein Bound Iodine (PBI)
Normal: 3.5-7.5 ugm%
1. It reflects the index of circulating level of T4 and T3. Amount of T3 is so low as compared to
T4 that T3 does not contribute practically to PBI.
2. It is the only single reliable test to diagnose thyroid functions if done under full precautions.
3. Disadvantage: It also measures I2 containing dyes which do not bind to TBG, therefore,
(a) False low values are due to mercurial diuretics which block the catalytic reaction of
estimation; and
(b) False high values are seen in I2 contamination e.g. I2 containing expectorants or creams,
drugs (enterovioform) and radiotherapy.
4. PBI decreases in hypothyroidism, pregnancy and acute thyroiditis and increases in
hyperthyroidism and patients on oral contraceptives.
II. Butanol Extractable Iodine (BEI)

Normal : 3-5 ugm%; same basis as of PBI; increases in hyperthyroidism and decreases in
hypothyroidism.

III. Radioactive Iodine Uptake

Radioactive studies

1. Normal thyroid can concentrate I2 10,000 times more than the other tissues. Half life of
123I, 125I,131I and 132I is 12 hours, 60 days, 8 days and 2-3 hours respectively.
2. Radioactive iodine uptake values must be interpreted with the physiology of I2 metabolism.
Therfore,
 A . On diet high in I2 content, 123I uptake is low, even though thyroid functions may e normal,
because I- pool is so large that the traces of radioactivity are excessively diluted. Conversely,

B . 123I uptake is high without hyperthyroidism, in individuals whose daily I2 intake is adequate
to prevent I2 deficiency goiter but chronically lower than the average intake.
3. Patient should not be given any I2 medication for one month, then 25 u curies of radioactive
iodine (123I) is given orally in 100 ml water; thyroid uptake is determined by placing a
gamma ray counter over the neck. An area over the thigh is also counted and count in this
region is substracted from the neck count to correct for non-thyroidal radio-activity in the
neck.
4. Normal radioactive iodine (RAI2) uptake by thyroid is 20-40% and rest is excreted.
a. In hyperthyroidism I- Is rapidly incorporated into T4 and T3 and these are released at an
accelerated rate, therefore, amount of RAI2 in thyroid gland rises rapidly, >60%, but it then
levels off and may start to decrease within 24 hours (at a time when the I2 uptake in normal
subject is still rising). RAI2 uptake at 3 hours is more likely to be abnormal than the 24 hours
uptake in hyperthyroid patients.
b. In hypothyroidism – RAI2 uptake is low, <20%. Large amounts of RAI2 destroy thyroid tissue,
because the radiation kills the thyroid cells; therefore, useful in some cases of thyroid
cancer.
IV. T3 Suppression Test
It is useful in suspected cases of thyrotoxicosis. Thyroxine (T4) is given orally for two days; in
euthyroids (normal functioning thyroid) radioactive iodine uptake should decrease because
of T3 suppression, while in thyrotoxicosis it does not decrease.
V. Serum Thyroid Hormone and TSH Levels There are regarded as one of he best tests to assess
thyroid functions and can be accurately measured by radioimmunoassays. Noramally, there
is marked inverse relationship between serum free thyroid hormone and TSH levels.
C. OTHER INVESTIGATIONS
1. Radiography. It is done for:
i. Determining position of the trachea;
ii. Diagnosis of retro-sternal goiter, and
iii. Any evidence of bony metastasis of thyroid cancer.
2. Indirect Laryngoscopy. It is done to:
i. Confirm diagnosis of involvement of recurrent laryngeal nerve;
ii. Confirm whether vocal cords are paralysed or not.
3. Biopsy from thyroid gland for histocytological examination.
4. Urinary Calcium Loss – Normal: 100 mg/day, decreases in hypothyroidism and increases in
hyperthyroidism.
 Pulmonary (Lung) Function Tests
Pulmonary function tests (PET) provide a quantitative and objective assessment of the
physiological derangement associated with pulmonary diseases. While these tests do not
give a specific etiological or pathological diagnosis, the reasons for pulmonary function
testing are.
1. Identification of cause of respiratory sysmptoms.
2. Diagnosis of functional abnormalities such as
i. Obstructive, restrictive or reactive diseases;
ii. Ventilation-perfusion mismatching;
iii. Abnormalities in the control of ventilation; and
iv. Occupational-related pulmonary disabilities.
3. Diagnosis of severity of dysfunction, including subclinical abnormalities.
4. Identification of and screening of unsuspected diseases.
5. Assessment of reversibility of airway obstruction.
6. Assessment of airway sensitivity.
7. Evaluation of effectiveness of short-term and long-term therapy.
8. Long-term follow-up

On the basis of these requirements the various PFT can be broadly classified into three
groups:

i. Tests to assess ventilator functions of lungs;

ii. Tests to assess gaseous exchange across the lungs,and
iii. Tests to assess transport of gases in the body.
I. TESTS TO ASSESS VENTILATORY FUNCTIONS OF LUNGS
A. Assessment of the expansion of lungs and chest wall
1. Measurement of pressure changes during ventilation. For example:
i. Intra-pulmonary (intra-alveolar) pressure; and
ii. Intra-pleural (intra-thoracic) pressure.
2. Measurment of compliance
i. Compliance of lungs and chest wall;
ii. Compliance of lungs along.
B. Assessment of restrictive and obstructive ventilatory defects
1. Measurement of static and dynamic lung volumes and capacities by ‘spiromentry’
2. Measurement of airways resistance

These provide a fairly good idea of the physical fitness in normal and the type and extent of
derangement of lung function in patients.
II. TESTS TO ASSESS GASEOUS EXCHANGE ACROSS THE LUNGS
1. Measurement of ‘functional residual capacity’-FRC
2. Measurement of ‘dead space’ (DS) and uniformity of ‘alveolar ventilation.
3. Measurement of diffusion capacity of lungs.
III. TESTS TO ASSESS TRANSPORT OF GASES IN THE BODY
1. Measurement of gas tension, for example, pO2 and pCO2 in inspired, expired and alveolar
air.
2. Measurement of gas tension and acid-base status of the blood.