Thyroid Disorders Testing

Click here for topics associated with this algorithm

INDICATIONS FOR TESTING

 Increased or decreased metabolism (heat or cold intolerance, weight loss or gain,
depression, anxiety, etc)
 Family history of autoimmune thyroiditis
 Goiter on physical exam

ORDER
Thyroid Stimulating Hormone with Reflex
to Free Thyroxine
Low TSH – High TSH –
suggests suggests
hyperthyroidism hypothyroidism
Normal TSH and free T4

Thyroid disease
unlikely

Low free T4  Primary hypothyroidism

 Thyroid ablation removal Low free
 Central hypothyroidism  Euthyroid sick syndrome T4
 Severe illness  Transient thyroiditis

 Euthyroid sick If still concerned with

syndrome hyperthyroidism,
Normal  Thyroid hormone
free T4  Subclinical ORDER
hyperthyroidism Triiodothyronine, Total resistance High
 Drug interference (Total T3)  TSH resistance free T4
 TSH secreting adenoma

Normal High

 Subclinical hypothyroidism
High Hyperthyroidism Hyperthyroidism T3  Euthyroid sick syndrome Normal
free T4 unlikely hyperthyroidism  Transient thyroiditis free T4
 Autoimmune thyroiditis

ORDER
Thyroid Stimulating Immunoglobulin (TSI)
Thyroid Peroxidase (TPO) Antibody
Thyroid Stimulating Hormone Receptor Antibody (TRAb) CONSIDER
 Thyroid Antibodies
 Triiodothyronine, Total (Total T3)
 T3 by dialysis
TSI Ab+
TPO+
TRAb+
Clinical indications of
Graves ophthalmologic
disease present TPO Ab- Normal T3 Low T3 Positive Negative
Diffuse thyroid gland TSI Ab- antibodies antibodies
enlargement

Probable Hypothyroidism T3 Automimmune Thyroid disease

Graves disease
toxic nodule/s unlikely hypothyroidism thyroid disease unlikely

Facilitate treatment decisions

CONSIDER
Radioiodine thyroid scan and % uptake

© 2006 ARUP Laboratories. All Rights Reserved. www.arupconsult.com Last updated: November 2018