July 30, 2022

1400H - 1500H
Via Zoom

Empowerment
objective - for
Health Issue
laypeople to have an
Course –
understanding of the
THYROID
importance of
Tests & Results
reading and
-
interpreting
Reading &
THYROID test results
Interpretation
in their health
management.
 Empowerment
objective - for ROJoson PEP Talk
Health Issue
laypeople to have an
Course –
understanding of the I have a Patient
THYROID Empowerment
importance of
Tests & Results Program in which I
reading and
- like to empower the
interpreting lay people or
Reading &
THYROID test results patients to take
Interpretation
in their health control in the
management. management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 Empowerment My PEP TALK today
objective - for is entitled: THYROID
Health Issue Test Results -
laypeople to have an
Course – Reading and
understanding of the
THYROID Interpretation.
importance of
Tests & Results
reading and
- This is part of the
interpreting
Reading & Health Issue Course.
THYROID test results
Interpretation
in their health
management.
 Health Issue Contents of PEP TALK on THYROID Test Results -
Course – Reading and Interpretation
THYROID • General recommendations on reading and interpreting
Tests & Results - lab tests with numeric values and narrative descriptions
and conclusions
Reading & • How I read and interpret thyroid test results – thyroid
Interpretation function tests and thyroid ultrasound
• Idiosyncrasies of radiologists in reading and writing
thyroid ultrasound results
• Examples of challenges in reading and interpretation of
thyroid function tests and thyroid ultrasound
• ROJoson’s advice in reading and interpreting thyroid
function test and thyroid ultrasound
 Health Issue Thyroid function tests and ultrasound of the
Course – thyroid are commonly done as laboratory
THYROID diagnostic tests for patients with possible thyroid
Tests & Results - disorders.
Reading &
Interpretation
A lot of Filipino patients have these tests done for
one reason or another, usually resulting from
screening fad or ordered by physicians who are
ritualistic and maximalist.

Then, they ask me to read and interpret the

results.
 Health Issue I am a minimalist physician. 
Course –
THYROID I don’t subscribe to the screening fad of laypeople
Tests & Results - as well as physicians who are usually ritualistic
Reading & and maximalist and who outrightly want to please
Interpretation their patients with their desire for screening
laboratory tests.
 Health Issue I do laboratory tests only when indicated
Course – (patients with symptoms and signs in which I am
THYROID not very definite with my clinical diagnosis that I
Tests & Results - need help from laboratory tests; patients without
Reading & symptoms and signs but with a high risk for a
Interpretation particular disease).
 Health Issue In my practice, I cannot avoid or refuse patients I like to empower the
Course – coming to me for interpretation of the results of patients to know the
THYROID their laboratory tests requested by themselves principles and
Tests & Results - and other physicians.  processes and
Reading & caveats of reading
Interpretation Because of the prevalence of these events, I have and interpreting lab
decided to try to write something about them, test results.
particularly to advise the laypeople on how to
read and interpret the results of the laboratory Along the way,
tests. hopefully, I can
convince them to
For today, I will focus on THYROID tests. have lab tests done
only when indicated.
 Health Issue But before I go to the THYROID tests, allow me to
Course – give you some important relevant introduction.
THYROID
Tests & Results - The thyroid gland is a butterfly-shaped organ
Reading & located in the base and central part of the neck.
Interpretation
 Health Issue The thyroid gland is a vital organ (vital organ –
Course – one that is needed to survive) that regulates
THYROID metabolism, growth and development of the
Tests & Results - human body. The thyroid gland makes, releases,
Reading & and controls thyroid hormones that control
Interpretation metabolism. Metabolism is a process where the
food taken into body is transformed into energy.
This energy is used throughout the entire body to
keep many of the body's systems working
correctly.
 Health Issue If there is an abnormality in the thyroid gland, the
Course – commonly used term is GOITER.
THYROID
Thus, there is a GOITER when there is an
Tests & Results -
abnormality in the thyroid gland.
Reading &
Interpretation
 Health Issue It can have abnormality in both structure and Thyroid function tests
Course – function, singly or in combination. – diagnostic tests for
THYROID thyroid function
Tests & Results - (euthyroid,
Reading & • Abnormality in function (hyperthyroidism or hyperthyroid,
Interpretation hypothyroidism – normal: euthyroidism) hypothyroid)
• Abnormality in structure (either enlargement
or nodule formation) Thyroid ultrasound –
• Abnormality in both structure and function diagnostic test for
(combined or simultaneous) structure
(enlargement, nodule
formation – benign vs
malignant)
 Health Issue Usual thyroid function tests being done Thyroid function tests
Course – nowadays: – diagnostic tests for
THYROID thyroid function
• FT3 (free triiodothyronine)
Tests & Results - (euthyroid,
Reading & • FT4 (free thyroxine) hyperthyroid,
Interpretation • TSH (thyroid stimulating hormones) hypothyroid)
 Thyroid function tests
Health Issue Usual interpretations of thyroid function test – diagnostic tests for
Course – results: thyroid function
THYROID
Normal Thyroid Function (euthyroid,
Tests & Results -
(EUTHYROID) hyperthyroid,
Reading &
• Normal FT3 hypothyroid)
Interpretation
• Normal FT4 There are reference
• Normal TSH ranges (normal
HYPERTHYROID HYPOTHYROID values) for the
• Elevated FT3 • Depressed FT3 different types of
• Elevated FT4 • Depressed FT4 thyroid function test.
• Depressed TSH • Elevated TSH These reference
ranges have numeric
Must be correlated clinically! (symptoms & signs) values.
 Health Issue Usual interpretations of thyroid function test Thyroid function tests
Course – results: – diagnostic tests for
THYROID thyroid function
Tests & Results - Normal Thyroid Function (euthyroid,
Reading & (EUTHYROID) hyperthyroid,
Interpretation • Normal FT3 hypothyroid)
• Normal FT4
• Normal TSH
HYPERTHYROID HYPOTHYROID If there are
• Elevated FT3 • Depressed FT3 incongruencies and
• Elevated FT4 • Depressed FT4 doubts, REPEAT
• Depressed TSH • Elevated TSH tests.

Must be correlated clinically! (symptoms & signs)

 Health Issue CHALLENGES in interpretations of thyroid function Thyroid function tests
Course – test results: – diagnostic tests for
THYROID thyroid function
Tests & Results - Normal Thyroid Function (euthyroid,
Reading & (EUTHYROID) hyperthyroid,
Interpretation • Normal FT3 hypothyroid)
• Normal FT4
• Normal TSH
HYPERTHYROID HYPOTHYROID If there are
• Normal FT3 • Normal FT3 incongruencies and
• Normal FT4 • Normal FT4 doubts, REPEAT
• Depressed TSH • Elevated TSH tests.

Must be correlated clinically! (symptoms & signs)

 Health Issue CHALLENGES in interpretations of thyroid function
Course – test results:
THYROID ZG, 66-year-old female, had thyroid function tests done as
Tests & Results - screening (not ordered by me). NO symptoms of
Reading & hyperthyroidism or hypothyroidism.
Interpretation FT3 low; FT4 normal; TSH elevated. I asked for a repeat.
 Health Issue CHALLENGES in interpretations of thyroid function
Course – test results:
THYROID
Repeat tests – normal FT3; normal FT4; and
Tests & Results -
normal TSH.
Reading &
Interpretation
 Health Issue CHALLENGES in interpretations of thyroid function
Course – test results:
THYROID
Tests & Results -
If there were NO repeat tests, patient could have been
Reading & treated unnecessarily with medications, which can be
Interpretation lifetime. She has normal thyroid function tests afterall.
She will have the unwanted lifetime anxiety of thinking she
has a thyroid disease.
Also, she may have a cascade of other unnecessary tests
like ultrasound and biopsy that may be needed to do
further investigations.
Fortunately, for her, a repeat test has prevented these
errors and other possible negative consequences.
 Health Issue CHALLENGES in interpretations of thyroid function
Course – test results:
THYROID
Tests & Results - Another type of error:
Reading &
Interpretation Error in interpretation of hyperthyroidism based
on decreased TSH but without symptoms.

Repeat tests showed normal.

If not re-checked, patient could have been treated

erroneously for hyperthyroidism.
 Health Issue Ultrasound of the Thyroid Thyroid ultrasound –
Course – diagnostic test for
(contains narrative descriptions of findings and
THYROID structure
conclusions)
Tests & Results - (enlargement, nodule
Reading & • Enlargement without nodules formation – benign vs
Interpretation • Enlargement with nodule/s malignant)
• Nodule/s (how many, location, size, nature –
cystic / solid / complex; border – distinct /
indistinct; tall vs wide ratio; calcifications; etc.)
• Presence or absence of enlarged neck nodes
 Health Issue Ultrasound of the Thyroid - Conclusions Indications for needle
Course – biopsy
TIRADS = Thyroid Imaging Reporting and Data
THYROID
System (For thyroid nodules seen)
Tests & Results -
Reading & • TIRADS 1
Interpretation • TIRADS 2
• TIRADS 3
• TIRADS 4
• TIRADS 5
• TIRADS 6
 Health Issue TIRADS = Thyroid Imaging Reporting and Data System (For
Course – thyroid nodules seen)
THYROID Tirads Definition Ultrasound features
Tests & Results - 1 Negative Normal thyroid
Reading & 2 Benign Benign features
Interpretation 3 Probably benign Without suspicious features

4A Low suspicion One suspicion feature Indications for

needle biopsy
4B Intermediate suspicion Two suspicion feature

4C Moderate suspicion Three or four suspicion feature

5 High suspicion Five suspicion feature

6 Known proved malignancy Confirmed malignancy

 Health Issue TIRADS = Thyroid Imaging Reporting and Data System (For
Course – thyroid nodules seen)
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue TIRADS = Thyroid Imaging Reporting and Data System (For
Course – thyroid nodules seen)
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue Clinical Diagnosis (without ultrasound and thyroid Sharing with you
Course – function tests): my experience with
THYROID clinical diagnosis
• Enlarged thyroid without symptoms of
Tests & Results - (without ultrasound
hypothyroidism / hyperthyroidism – DIFFUSE
Reading & and thyroid
Interpretation COLLOID ADENOMATOUS GOITER function tests) –
• Enlarged thyroid with symptoms of batting average –
hyperthyroidism – HYPERTHYROIDISM more than 90%
• Enlarged thyroid with symptoms of accurate.
hypothyroidism - HYPOTHYROIDISM

Must be correlated clinically! (symptoms & signs)

 Health Issue Clinical Diagnosis (without ultrasound): Clinical signs of
Course – • Multiple thyroid nodules with no signs of malignancy:
THYROID
malignancy – MULTIPLE COLLOID • Hard nodule (NOT
Tests & Results -
ADENOMATOUS GOITER due to
Reading &
• Cystic / complex thyroid nodules – COLLOID calcifications)
Interpretation
• With signs of
CYSTS / COLLOID ADENOMATOUS NODULES
invasion (fixed,
• Solitary / multiple thyroid nodules with signs hoarseness)
of malignancy – THYROID CANCER • With signs of
spread (neck
Options: nodes, distant
• Needle biopsy mass)
• Outright operation
 Health Issue CHALLENGES
Course – Lot of OVER-READING using the TIRADS Lot of needle biopsy
THYROID
Tests & Results - TIRADS = Thyroid Imaging Reporting and Data
Reading & System (For thyroid nodules seen)
Interpretation • TIRADS 1
• TIRADS 2
• TIRADS 3
• TIRADS 4
• TIRADS 5
• TIRADS 6
 Health Issue CHALLENGES
Course –
Illustration 1
THYROID
Tests & Results - ZC, 66-y-o female
Reading & In 2016, my clinical diagnosis was Multiple Colloid
Interpretation Adenomatous Goiter. I have been following her
up for 6 years with the same diagnosis with no
biopsy.
One day, in 2022, she went for an ultrasound on
her own. Reading was TIRADS 5 for one nodule.
She had herself biopsy. It showed adenomatous
nodule. I WAS RIGHT AFTERALL.
 Health Issue
Course –
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue
Course –
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue
Course –
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue
Course –
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue ROJoson’s recommendations and advice in the
Course – reading and interpretation of the ultrasound
THYROID results:
Tests & Results -
THE RESULTS OR DIAGNOSES ARE NOT FINAL YET
Reading &
Interpretation UNTIL SEEN BY A THYROID SPECIALIST-CLINICIAN.
 Health Issue In the reports issued by the radiologists, there is Clinical correlation means
Course – gathering all other available
usually a caveat statement to the patient medical data and information
THYROID receiving the reports: CORRELATE CLINICALLY. (such as age, sex, symptoms
Tests & Results - and signs, other lab tests) to a
Or “This result is best interpreted by your particular test to determine
Reading &
Interpretation attending physician in correlation with your their mutual or reciprocal
relations and to establish an
clinical data, imaging and other laboratory orderly connection (through
results.” comparing and contrasting)
with the goal of coming out
with a clinical diagnosis that
is as accurate as possible.
 Health Issue My other recommendations:
Course – • You can take a look and read the contents if
THYROID you want.  However, as a layperson, chances
Tests & Results - you will not understand and more so, interpret
Reading & the narrative descriptions and conclusions of
Interpretation the certified readers.  So, have the narrative
diagnostic reports read and interpreted by a
trusted physician-clinician or your attending
physician and let him / her make a decision on
the report.
 Health Issue • Even for the physician-clinicians or attending
Course – physicians, they have to interpret the words or
THYROID phrases used by the certified readers and to
Tests & Results - read between the lines.
Reading & • In addition, they have to correlate the findings
Interpretation and conclusions of the readers with the
symptoms and signs, other tests and other
circumstantial situations that a patient may
have to make a decision whether everything is
normal; a finding is a mere biological variation;
something abnormal is being suspected;
and/or there is really an abnormality going on.
 
 Health Issue • At times, they have to check the accuracy of
Course – the reports and may have to have discussion
THYROID with the readers of the narrative diagnostic
Tests & Results - reports.
Reading &
Interpretation • So, have the narrative diagnostic reports read
and interpreted by a trusted physician-clinician
or your attending physician and let him / her
make a decision on the report.
 Health Issue
How I usually read and interpret the reports
Course –
THYROID As a thyroid specialist, these are what I usually do
Tests & Results - in terms of reading and interpreting the
Reading & ultrasound reports:
Interpretation
 Health Issue I read the reports and take note first of any red
Course – flags for cancer in the narrative descriptions and
THYROID conclusions.
Tests & Results -
I first look at the conclusions. If there is a TIRADS
Reading &
Interpretation conclusion, I take note of this first.
 Health Issue If there are conclusions for possible cancer, I then
Course – look at the narrative descriptions and study the
THYROID bases for the radiologist’s making conclusions.
Tests & Results -
If bases are valid, then I tentatively accept the
Reading &
Interpretation conclusions. Tentatively, because I still have to
examine the patient’s neck. I still have to
correlate the reports with the physical
examination findings as well as other data and
information such as other tests done and also the
historical data.
 Health Issue If there are uncertainties or incongruencies in the
Course – bases and in the reports, then, I examine the
THYROID patient, particularly the neck, and then make a
Tests & Results - decision, essentially, whether to repeat the
Reading & ultrasound in another institution to be read by
Interpretation another reader.
 Health Issue If the reports do not contain any red flags for
Course – cancer, just the same, I do scrutiny of the reports
THYROID to check for any incongruencies. I also examine
Tests & Results - the patient’s neck to correlate the reports with
Reading & my clinical findings.
Interpretation
 Health Issue So, whatever be the report, I CORRELATE Clinical correlation means
Course – gathering all other available
CLINICALLY. medical data and information
THYROID (such as age, sex, symptoms
I particularly examine / palpate the patient’s neck
Tests & Results - and signs, other lab tests) to a
(a must for all thyroid specialists) and then decide particular test to determine
Reading &
Interpretation and explain. their mutual or reciprocal
relations and to establish an
orderly connection (through
comparing and contrasting)
with the goal of coming out
with a clinical diagnosis that
is as accurate as possible.
Health Issue Course How radiologists read and write their reports
BREAST One, there are a lot of subjectivity in the radiologists’ interpretations of
Ultrasound &
the findings in ultrasound. As a result, there are a lot of interobserver
Mammogram
variations, meaning, given the same ultrasound plates, two different
Results -
Reading & readers read and interpret them differently.
Interpretation
Health Issue Course How radiologists read and write their reports
BREAST Two, the TIRADS is something recent in the Philippines. Not all
Ultrasound &
radiologists are adept in reporting using TIRADS.
Mammogram
Results -
Reading & THERE IS A LOT OF OVER-READING.
Interpretation
Health Issue Course How radiologists write their reports
BREAST Three, radiologists commonly put recommendations after their
Ultrasound &
conclusions. Examples of recommendations are: tissue-biopsy; follow-up
Mammogram
ultrasound; etc.
Results -
Reading & My recommendation is just to consider them as personal
Interpretation recommendation from the radiologists. We cannot stop them from giving
their personal recommendations.
One does not have to follow them. Let your thyroid specialist decide on
what to do next. The thyroid specialist may not also follow the
recommendations of the radiologists.
REMEMBER their CAVEATS: CLINICIAN TO CORRELATE CLINICALLY.
 Health Issue So, to emphasize, personally, whatever be the Clinical correlation means
Course – gathering all other available
report, I CORRELATE CLINICALLY. medical data and information
THYROID (such as age, sex, symptoms
I particularly examine / palpate the patient’s neck
Tests & Results - and signs, other lab tests) to a
(a must for all thyroid specialists) and then decide particular test to determine
Reading &
Interpretation and explain. their mutual or reciprocal
relations and to establish an
orderly connection (through
comparing and contrasting)
with the goal of coming out
with a clinical diagnosis that
is as accurate as possible.
 Health Issue ROJoson’s Advice with Summary and Take Away
Course –
THYROID
Tests & Results -
Reading &
Interpretation
 Health Issue Contents of PEP TALK on THYROID Test Results - Summary
Course – Reading and Interpretation Take Away
THYROID • General recommendations on reading and interpreting
Tests & Results - lab tests with numeric values and narrative descriptions
and conclusions
Reading & • How I read and interpret thyroid test results – thyroid
Interpretation function tests and thyroid ultrasound
• Idiosyncrasies of radiologists in reading and writing
thyroid ultrasound results
• Examples of challenges in reading and interpretation of
thyroid function tests and thyroid ultrasound
• ROJoson’s advice in reading and interpreting thyroid
function test and thyroid ultrasound
 Health Issue Although the reports are written for healthcare Summary
Course – professionals, not patients, there is a lot you can Take Away
THYROID learn by looking, studying, and learning from
Tests & Results - them (especially after this PEP Talk).
Reading &
Interpretation In the end, however, always have a TRUSTED
thyroid specialist-clinician read and interpret
them for you.
 Health Issue Learn how to palpate your own thyroid. Summary
Course – Do regular thyroid self-examination. You may Take Away
THYROID not need thyroid tests if you do regular • Indications:
Tests & Results - thyroid examination. • To screen for a disease
Reading & or exclude its presence
Interpretation Do diagnostic tests only when indicated. in high risk patients
• To have a more definite
diagnosis after clinical
If you do diagnostic tests outside of the evaluation
indications, you will end up with a lot of false • To determine severity
positive alarming readings which can cause of a disease present
undue anxiety; which may lead to other and to prognosticate (to
project outcome)
unnecessary tests; which may lead to
• To monitor progress of
unnecessary operations not to say expenses. disease and treatment
 Health Issue At the end of the day, Summary
Course – Take Away
THYROID Have a trusted thyroid specialist to review and
Tests & Results - interpret and do a clinical correlation.
Reading &
Interpretation
 Health Issue After hearing the explanations and Summary
Course – recommendations on what to do next by your Take Away
THYROID attending physician, feel free to ask questions as
Tests & Results - needed for further clarifications. The decision on
Reading & what to do next should be a shared one between
Interpretation you and your attending physician.  
 Health Issue If there is a need for a second opinion from Summary
Course – another physician on the conclusion and Take Away
THYROID recommendations on what to do next, go ahead.
Tests & Results - You have the right to seek a second opinion. This
Reading & is part of patient empowerment. Knowing the
Interpretation principles and processes of reading and
interpreting laboratory tests and their associated
caveats is also part of patient empowerment.
 Health Issue Be always in touch with reliable medical Take Away in
Course – information on how physicians read and interpret relation to
THYROID thyroid function tests and thyroid ultrasound.
Patient
Tests & Results - Knowledge is power; it gives power.
Reading & Empowerment
Interpretation
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of oneself by having
some idea on how physicians read and
interpret thyroid function tests and thyroid
ultrasound.
 Empowerment My PEP TALK today
objective - for is entitled: THYROID
Health Issue Test Results -
laypeople to have an
Course – Reading and
understanding of the
THYROID Interpretation.
importance of
Tests & Results
reading and
- This is part of the
interpreting
Reading & Health Issue Course.
THYROID test results
Interpretation
in their health
management.