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Thyroid Profile (5 Parameters)
Thyroid
5 parameters
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TFT + Free T3/T4 + Anti-TPO.
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Parameters
- List of Tests
- Total T3
- Total T4
- TSH
- Free T3
- Free T4
Thyroid Profile (5 Parameters)
- Why is it done?
- Comprehensive thyroid assessment: This 5-parameter panel evaluates thyroid function through multiple measurements, allowing clinicians to differentiate between primary thyroid disorders and secondary pituitary-related dysfunction
- Diagnosis of hyperthyroidism and hypothyroidism: TSH elevation typically indicates primary hypothyroidism, while suppressed TSH with elevated Free T4 and Free T3 suggests hyperthyroidism
- Monitoring thyroid replacement therapy: Patients on levothyroxine or other thyroid medications require periodic thyroid profile testing to ensure appropriate dosing and therapeutic goals
- Evaluation of symptomatic patients: Clinical presentation of fatigue, weight changes, temperature sensitivity, hair loss, or mood disturbances warrants thyroid profile testing
- Screening in high-risk populations: Pregnant women, elderly patients, individuals with autoimmune conditions, and those with family history of thyroid disease require routine screening
- Total T3 measures all circulating T3 (bound and unbound), providing information about overall thyroid hormone production
- Total T4 represents all circulating T4 (bound and unbound), reflecting total thyroid hormone secretion
- TSH (Thyroid Stimulating Hormone) serves as the primary screening test, providing pituitary feedback about thyroid status
- Free T3 measures unbound T3, representing metabolically active thyroid hormone available for tissue utilization
- Free T4 measures unbound T4, reflecting the biologically active hormone that drives metabolic processes
- The combination of these 5 parameters provides superior diagnostic accuracy compared to individual tests, enabling detection of subclinical thyroid disease and complex endocrine disorders
- Normal Range
- Total T3: 80-200 ng/dL (123-309 nmol/L) - Measures total triiodothyronine including protein-bound and free fractions
- Total T4: 4.5-12.0 μg/dL (58-154 nmol/L) - Represents all circulating thyroxine; may be affected by binding protein levels
- TSH: 0.4-4.0 mIU/L (0.4-4.0 mU/L) - Normal range reflects proper hypothalamic-pituitary-thyroid axis function; values above 2.5 mIU/L in pregnancy warrant investigation
- Free T3: 2.3-4.2 pg/mL (3.5-6.5 pmol/L) - Measures unbound, biologically active triiodothyronine independent of binding protein variations
- Free T4: 0.8-1.8 ng/dL (10-23 pmol/L) - Represents the metabolically active thyroxine fraction not bound to carrier proteins
- Note: Reference ranges vary by laboratory methodology and patient population; always consult laboratory-specific reference intervals for accurate interpretation
- Values within normal range: Indicate appropriate thyroid function and optimal metabolic status
- Elevated values (high): Suggest hyperthyroidism or excessive thyroid hormone supplementation
- Decreased values (low): Indicate hypothyroidism or insufficient thyroid hormone production
- Interpretation
- Total T3 elevated: Suggests thyrotoxicosis, Graves' disease, T3 thyroiditis, or excessive thyroid hormone replacement; may also occur with iodine excess or certain medications
- Total T3 decreased: Indicates hypothyroidism, severe systemic illness, malnutrition, or iatrogenic undertreatment of thyroid disease; T3 suppression therapy intentionally lowers this value
- Total T4 elevated: Reflects primary hyperthyroidism, thyroiditis, excessive hormone supplementation, or euthyroid sick syndrome; elevation parallels clinical thyrotoxicosis severity
- Total T4 decreased: Indicates primary hypothyroidism, pituitary insufficiency, or inadequate thyroid hormone replacement; severe illness may also suppress values
- TSH elevated (>4.0 mIU/L): Primary indicator of hypothyroidism where the pituitary compensates for low thyroid hormone; degree of elevation correlates with hormone deficiency severity
- TSH suppressed (<0.4 mIU/L): Indicates hyperthyroidism, excessive thyroid hormone supplementation, or secondary hypothyroidism from pituitary/hypothalamic disease
- Free T3 elevated: Confirms bioavailable T3 excess; particularly useful in T3 thyroiditis or when Total T3 elevation is unclear due to binding protein abnormalities
- Free T3 decreased: Indicates reduced metabolically active T3; may occur in hypothyroidism, systemic illness, or severe caloric restriction
- Free T4 elevated: Definitively establishes thyroid hormone excess; eliminates diagnostic confusion from elevated Total T4 with high binding proteins
- Free T4 decreased: Confirms thyroid hormone deficiency; most reliable indicator of true hypothyroidism when TSH is equivocally elevated
- Pattern interpretation - Classic hyperthyroidism: Elevated Free T4, elevated Free T3, suppressed TSH, elevated Total T4 and T3
- Pattern interpretation - Classic hypothyroidism: Decreased Free T4, decreased Free T3, elevated TSH, decreased Total T4 and T3
- Pattern interpretation - Secondary hypothyroidism: Decreased Free T4, decreased TSH; indicates pituitary or hypothalamic dysfunction rather than primary thyroid failure
- Factors affecting accuracy: Beta-blockers, amiodarone, iodine contrast agents, corticosteroids, and severe illness can alter results; medications affecting thyroid binding proteins include estrogen, androgens, and phenytoin
- Associated Organs
- Thyroid gland (primary organ): All five parameters directly assess thyroid function; the thyroid produces T3 and T4 hormones essential for metabolism, growth, and development
- Pituitary gland (secondary organ): TSH produced by anterior pituitary regulates thyroid hormone secretion; TSH measurement evaluates pituitary function and hypothalamic-pituitary-thyroid axis integrity
- Hypothalamus (secondary organ): Produces TRH (thyrotropin-releasing hormone) regulating TSH production; dysfunction results in secondary hypothyroidism patterns
- Metabolic system: Thyroid hormones regulate metabolism of carbohydrates, fats, and proteins; abnormal levels directly impair nutrient utilization and energy production
- Cardiovascular system: Thyroid hormones regulate heart rate, contractility, and vascular tone; hyperthyroidism increases risk of atrial fibrillation, tachycardia, and hypertension
- Nervous system: Thyroid hormones essential for CNS development and cognitive function; deficiency causes mental lethargy, depression, and impaired concentration
- Reproductive system: Thyroid dysfunction impairs sexual function, fertility, and fetal development; particularly critical in pregnancy for normal neural development
- Skeletal system: Thyroid hormones regulate bone metabolism; hyperthyroidism increases osteoporosis risk while hypothyroidism may impair bone remodeling
- Gastrointestinal system: Thyroid hormones regulate GI motility; hyperthyroidism causes diarrhea while hypothyroidism produces constipation
- Immune system: Autoimmune thyroiditis (Hashimoto's) represents primary pathology; thyroid hormones modulate immune cell function and inflammatory responses
- Conditions diagnosed: Graves' disease (autoimmune hyperthyroidism), Hashimoto's thyroiditis (autoimmune hypothyroidism), toxic nodules, thyroid cancer, thyroiditis variants, and central hypothyroidism
- Complications of untreated hyperthyroidism: Atrial fibrillation, heart failure, osteoporosis, thyroid storm, ophthalmopathy, and accelerated cardiovascular disease
- Complications of untreated hypothyroidism: Myxedema coma, atherosclerosis, hypertension, cognitive impairment, depression, infertility, and neonatal hypothyroidism if untreated in pregnancy
- Follow-up Tests
- Thyroid antibody testing (TPO, thyroglobulin antibodies): Indicated when autoimmune thyroiditis is suspected; essential for confirmed hypothyroidism diagnosis
- TSI (TSH receptor immunoglobulin) or TRAb (TSH receptor antibodies): Confirmatory test for Graves' disease when hyperthyroidism is detected
- Thyroid ultrasound: Recommended when nodules are suspected or to assess gland size, echogenicity, and structural abnormalities
- Radioactive iodine uptake (RAIU) and thyroid scintigraphy: Differentiates between Graves' disease (high uptake), thyroiditis (low uptake), and toxic nodules (focal uptake)
- Fine needle aspiration (FNA) cytology: Necessary when thyroid nodules with concerning features are identified on imaging
- Pituitary function tests: If TSH is suppressed with normal Free T4/T3, secondary hypothyroidism workup includes ACTH, growth hormone, prolactin, and other pituitary hormones
- MRI of pituitary: Indicated when central hypothyroidism is confirmed to rule out mass lesions or pituitary insufficiency
- Repeat thyroid profile in 6-8 weeks: Standard monitoring interval after initiating thyroid hormone replacement therapy to assess treatment adequacy
- Ongoing monitoring frequency: Every 6-12 months after achieving stable replacement dose; annually in well-controlled patients
- Thyroglobulin monitoring: Essential in thyroid cancer patients to detect recurrence or metastatic disease
- PTH and calcium levels: Recommended if abnormal thyroid function is chronic, to assess secondary effects on parathyroid function and bone metabolism
- Lipid panel: Hypothyroidism often causes dyslipidemia; periodic monitoring assesses cardiovascular risk and treatment effectiveness
- ECG (electrocardiogram): Indicated in hyperthyroid patients to screen for atrial fibrillation and assess cardiac effects before treatment initiation
- Pregnancy testing: Mandatory before radioactive iodine therapy; all women of childbearing age with hyperthyroidism require pregnancy assessment before treatment
- Fasting Required?
- Fasting: NOT required - Thyroid profile testing can be performed with or without fasting as food does not affect thyroid hormone measurements
- Timing recommendation: Blood collection is ideally performed in the morning (8-10 AM) when TSH levels are typically highest; time of day affects TSH values significantly
- Levothyroxine medication: Take at least 6-8 hours before blood draw (typically take in the morning, draw in afternoon, or skip one dose morning of test)
- Other thyroid medications: Liothyronine (T3), desiccated thyroid should be withheld 6-8 hours before testing when possible for accurate free fraction measurements
- Beta-blockers: Continue as prescribed; beta-blockers do not require discontinuation before thyroid testing
- Amiodarone: Disclose to laboratory as this medication significantly affects thyroid function and interpretation must account for drug-induced changes
- Iodine supplements and kelp supplements: Discontinue 2-4 weeks before testing as iodine affects hormone production and uptake
- Biotin supplements: High-dose biotin can interfere with immunoassay results; discontinue 2-3 days before testing if possible
- Corticosteroids: Can suppress thyroid hormones; continue regular doses without interruption unless specifically directed otherwise
- Calcium and iron supplements: Separate from levothyroxine by at least 4-6 hours as these minerals reduce thyroid hormone absorption
- Recent contrast studies: Recent iodinated radiocontrast administration can alter thyroid values for up to several weeks; disclose this timing to laboratory
- Stress and illness: Acute illness and extreme stress can temporarily affect thyroid values; testing should ideally be delayed until acute illness resolves
- Pregnancy considerations: All pregnant patients should fast from midnight if lipid panel is ordered simultaneously; thyroid profile alone requires no fasting
- Specimen collection: Standard serum separator tube (SST) for collection; allow 30 minutes for clotting before centrifugation
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