How is Hashimoto’s thyroiditis diagnosed. What are the key blood tests for detecting Hashimoto’s disease. Can Hashimoto’s thyroiditis be cured. How does Hashimoto’s affect thyroid hormone levels.

Understanding Hashimoto’s Thyroiditis: An Autoimmune Thyroid Disorder

Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disorder that affects the thyroid gland. In this condition, the immune system mistakenly attacks the thyroid, leading to inflammation and impaired function. Hashimoto’s is the most common cause of hypothyroidism in the United States.

The exact cause of Hashimoto’s remains unknown, but factors like genetics, environmental triggers, and hormonal changes may play a role. Women are 5-10 times more likely to develop Hashimoto’s than men. The condition typically develops between ages 30-50 but can occur at any age.

Key Blood Tests for Diagnosing Hashimoto’s Thyroiditis

Diagnosing Hashimoto’s thyroiditis involves several blood tests to assess thyroid function and detect antibodies. The main tests include:

• Thyroid Stimulating Hormone (TSH)
• Free T4 (Thyroxine)
• Thyroid Peroxidase Antibodies (TPOAb)
• Thyroglobulin Antibodies (TgAb)

Thyroid Stimulating Hormone (TSH)

TSH is produced by the pituitary gland to stimulate thyroid hormone production. In Hashimoto’s, TSH levels are often elevated as the body tries to compensate for low thyroid hormone levels. Normal TSH range is typically 0.4-4.0 mIU/L, but levels above 2.5 mIU/L may indicate early thyroid dysfunction.

Free T4 (Thyroxine)

Free T4 measures the amount of unbound thyroxine in the blood. In Hashimoto’s, Free T4 levels may be low or normal. The normal range is usually between 0.8-1.8 ng/dL, but this can vary by lab.

Thyroid Antibodies

The presence of thyroid antibodies is a hallmark of Hashimoto’s thyroiditis. The two main antibodies tested are:

• Thyroid Peroxidase Antibodies (TPOAb): Present in 95% of Hashimoto’s cases
• Thyroglobulin Antibodies (TgAb): Found in about 60-80% of patients

Elevated levels of these antibodies indicate autoimmune thyroid disease, even if thyroid function tests are normal.

Interpreting Thyroiditis Blood Test Results

Interpreting thyroiditis blood test results requires considering multiple factors. Here’s a general guide:

• High TSH + Low Free T4 + Positive Antibodies: Overt hypothyroidism due to Hashimoto’s
• High TSH + Normal Free T4 + Positive Antibodies: Subclinical hypothyroidism with Hashimoto’s
• Normal TSH + Normal Free T4 + Positive Antibodies: Euthyroid Hashimoto’s (normal thyroid function with autoimmune markers)

It’s important to note that thyroid function can fluctuate in Hashimoto’s, and repeated testing may be necessary for accurate diagnosis and treatment.

Treatment Options for Hashimoto’s Thyroiditis

While there is no cure for Hashimoto’s thyroiditis, treatment aims to manage symptoms and restore normal thyroid function. The primary treatment options include:

Thyroid Hormone Replacement

Levothyroxine, a synthetic form of T4, is the standard treatment for hypothyroidism caused by Hashimoto’s. The goal is to normalize TSH levels and alleviate symptoms. Dosage is individualized and may require adjustment over time.

Monitoring and Adjusting Treatment

Regular blood tests are essential to monitor thyroid function and adjust medication as needed. Typically, TSH and Free T4 are checked every 6-8 weeks when starting treatment, then annually once stable.

Addressing Lifestyle Factors

While not a replacement for medical treatment, certain lifestyle changes may support thyroid health:

• Balanced diet rich in selenium, zinc, and iodine
• Stress management techniques
• Regular exercise
• Adequate sleep

Complications and Long-term Outlook of Hashimoto’s Thyroiditis

If left untreated, Hashimoto’s thyroiditis can lead to various complications:

• Goiter (enlarged thyroid gland)
• Heart problems (increased risk of heart disease and heart failure)
• Mental health issues (depression, decreased cognitive function)
• Myxedema (severe hypothyroidism that can be life-threatening)
• Pregnancy complications (infertility, miscarriage, preeclampsia)

With proper treatment and management, most people with Hashimoto’s can lead normal, healthy lives. Regular monitoring and medication adjustment are key to maintaining optimal thyroid function.

Hashimoto’s Thyroiditis in Special Populations

Pregnancy and Hashimoto’s

Pregnancy can affect thyroid function and vice versa. Women with Hashimoto’s require close monitoring during pregnancy as thyroid hormone requirements increase. Untreated hypothyroidism can lead to complications for both mother and baby.

Children and Adolescents

Hashimoto’s can occur in children and adolescents, although it’s less common. Symptoms may be subtle, and proper diagnosis is crucial to ensure normal growth and development.

Elderly Patients

Older adults may present with atypical symptoms of hypothyroidism, such as cognitive decline or depression. Careful assessment and treatment are important to improve quality of life.

Latest Research and Future Directions in Hashimoto’s Thyroiditis

Ongoing research in Hashimoto’s thyroiditis focuses on several areas:

• Genetic factors and environmental triggers
• Role of gut microbiome in autoimmune thyroid disease
• Novel treatment approaches (e.g., immunomodulatory therapies)
• Personalized medicine for optimal thyroid hormone replacement

These advancements may lead to improved diagnostic tools and more targeted treatments in the future.

Living with Hashimoto’s Thyroiditis: Practical Tips and Support

Managing Hashimoto’s thyroiditis extends beyond medical treatment. Here are some practical tips for living with the condition:

• Educate yourself about the disease
• Keep a symptom journal to track changes
• Take medications consistently as prescribed
• Communicate openly with your healthcare provider
• Join support groups or online communities
• Consider working with a nutritionist for dietary guidance

Remember, everyone’s experience with Hashimoto’s is unique. Finding the right balance of treatment and lifestyle changes may take time, but with patience and proper care, most people can effectively manage the condition.

Understanding your thyroiditis blood test results is crucial for managing Hashimoto’s thyroiditis effectively. Regular monitoring, adherence to treatment, and a holistic approach to health can help you maintain optimal thyroid function and overall well-being. If you have concerns about your thyroid health or test results, always consult with your healthcare provider for personalized advice and guidance.

Hashimoto Thyroiditis | Lab Tests Online

Sources Used in Current Review

American Thyroid Association. Hashimoto’s thyroiditis. Available online at https://www.thyroid.org/hashimotos-thyroiditis/. Accessed July 29, 2019.

March 3, 2018. Mayo Clinic Staff. Hashimoto’s disease. Available online at https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855. Accessed July 29, 2019.

March 2, 2018. Lee SL, Nagelberg SB. Hashimoto thyroiditis. Available online at https://emedicine.medscape.com/article/120937-overview. Accessed July 29, 2019.

May 5, 2019. Mincer IJ. Hashimoto thyroiditis. Available online at https://www.ncbi.nlm.nih.gov/books/NBK459262/. Accessed July 29, 2019.

Johns Hopkins Medicine. Hashimoto’s thyroiditis. Available online at https://www.hopkinsmedicine.org/health/conditions-and-diseases/hashimotos-thyroiditis. Accessed July 29, 2019.

September 2017. National Institute of Diabetes and Digestive and Kidney Disease. Hashimoto’s disease. Available online at https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease. Accessed July 29, 2019.

(October 18, 2018) U.S. Department of Health & Human Services, Office on Women’s Health, Hashimoto’s Disease. Available at https://www.womenshealth.gov/a-z-topics/hashimotos-disease. Accessed October 2019.

Sources Used in Previous Reviews

(2006 January). Hashimoto’s Thyroiditis. Womenshealth.gov [On-line information]. Available online at http://www.4woman.gov/faq/hashimoto.htm.

Hurd, R. (2006 May 12, Updated). Chronic thyroiditis (Hashimoto’s disease). MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000371.htm.

(© 2004). Hashimoto’s Disease and Other Forms of Thyroiditis. Thyroid Foundation of America, AllThyroid.org [On-line information]. Available online at http://www.tsh.org/disorders/thyroiditis/hashimotos_disease. html.

(© 2004). Chronic Lymphocytic Thyroiditis (Hashimoto’s Disease). Thyroid Foundation of America, AllThyroid.org [On-line information]. Available online at http://www.tsh.org/disorders/thyroiditis/chronic_lymphocytic_thyroiditis.html.

(2003 February 1, Revised). Thyroiditis. Merck Manual Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/print/sec13/ch263cj163d/html.

Eckman, A. (Updated 2010 April 19). Chronic thyroiditis (Hashimoto’s disease) MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000371.htm. Accessed November 2010.

(2009 May). Hashimoto’s Disease. National Endocrine and Metabolic Diseases Information Service [On-line information]. Available online at http://www.endocrine.niddk.nih.gov/pubs/Hashimoto/. Accessed November 2010.

Lee, S. et. al. (Updated 2010 March 12). Hashimoto Thyroiditis. eMedicine [On-line information]. Available online at http://emedicine. medscape.com/article/120937-overview. Accessed November 2010.

Mayo Clinic Staff (2009 February 3). Hashimoto’s disease. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/print/hashimotos-disease/DS00567/DSECTION=all&METHOD=print. Accessed November 2010.

Meikle, A (Updated 2009 August). Autoimmune Thyroid Disease – Thyroiditis. ARUP Consult. [On-line information]. Available online at http://www.arupconsult.com/Topics/Thyroiditis.html. Accessed November 2010.

Markenson, J. (2009 December 7). Rheumatic Manifestations of Endocrine Diseases. Medscape Today from Curr Opin Rheumatol. 2010;22(1):64-71. [On-line information]. Available online at http://www.medscape.com/viewarticle/713289. Accessed November 2010.

American Thyroid Association. 2014. Hypothyroidism. Available online at http://www.thyroid.org/wp-content/uploads/patients/brochures/ata-hypothyroidism-brochure.pdf. Accessed April 3, 2015.

Clinical Thyroidology. 2014. Summaries for the Public from Clinical Thyroidology. Vol 7, Issue 9. Available online at http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-7-issue-9/vol-7-issue-9-p-10-11/. Accessed April 3, 2015.

National Institute of Diabetes and Digestive and Kidney Diseases. 2014. Hashimoto’s Disease. Available online at http://www.niddk.nih.gov/health-information/health-topics/endocrine/hashimotos-disease/Pages/fact-sheet.aspx. Accessed April 2, 2015.

U.S. Department of Health and Human Services. 2012. Hashimoto’s disease fact sheet. Available online at http://www.womenshealth.gov/publications/our-publications/fact-sheet/hashimoto-disease.html. Accessed April 2, 2015.

U.S. National Library of Medicine. October, 2014. Underactive thyroid: Deciding whether to treat subclinical hypothyroidism. Available online at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072784/. Accessed April 3, 2015.

Thyroid Blood Test Results: Understanding TSH Levels

If there’s a bright side to hypothyroidism, or an underactive thyroid, it’s that treatment usually just involves taking daily medication, and testing is limited to a simple blood test. Your hypothyroidism test results are your doctor’s blueprint for prescribing the right dose of synthetic thyroid hormone medication and tracking how well it’s working.

Thyroxine, Triiodothyronine, and TSH Levels

The main job of the thyroid gland is to make the hormone thyroxine, also known as T4 because it has four iodine molecules. The thyroid also makes the hormone triiodothyronine, known as T3 because it has three iodine molecules, but in smaller amounts, explains Cathy Doria-Medina, MD, an endocrinologist with HealthCare Partners Medical Group in Torrance, California. “The thyroid gland makes mostly T4, [and] the T4 has to be converted to T3, because T3 is the part of thyroxine that actually does the work,” she says.

The pituitary gland at the base of the brain controls hormone production in your body. It makes thyroid-stimulating hormone (TSH), which tells the thyroid gland how much T4 and T3 to produce. The TSH level in your blood reveals how much T4 your pituitary gland is asking your thyroid gland to make. If your TSH levels are abnormally high, it could mean you have an underactive thyroid, or hypothyroidism. That’s because it indicates your pituitary gland is producing more TSH in an effort to stimulate your thyroid to produce thyroid hormone, according to the Mayo Clinic.

“TSH levels go in the opposite direction of your thyroid hormone,” Dr. Doria-Medina explains. “If you’re making too little thyroid hormone, your TSH will go up. If you’re making too much thyroid hormone, your TSH will go down.”

What’s normal can vary depending on a number of factors, including the laboratory where your blood test is done, she adds. A normal range for TSH in most laboratories is 0.4 milliunits per liter (mU/L) to 4.0 mU/L.

If your TSH is higher than 4.0 mU/L on repeat tests, you probably have hypothyroidism.

Your doctor may also order a T4 test. Most of the T4 in your blood attaches to a protein, and when it does, it can’t get into your cells. Only T4 that is unattached or “free” can get into your cells to go to work. A blood test can measure how much free T4 if available.

Hypothyroidism Tests: A Measure of Treatment Success

Hypothyroidism is treated with daily medication. Taking synthetic thyroid hormone medication can bring your T4 and TSH levels back to their normal ranges. Once you’re on the right dose, your symptoms should subside.

When you first start taking medication, your doctor will need to monitor your blood to fine-tune the dosage. “Initially you will need to be tested more frequently,” Doria-Medina says. “A person who is newly diagnosed and taking medication for hypothyroidism should be tested every six weeks until the dosage is just right.”

The dose you start with is your doctor’s educated guess about what’s best for you — most likely the lowest dose possible to avoid side effects, which can include a rapid heartbeat and restlessness.

Medication for hypothyroidism is slow acting, and it can take several weeks for your body to adjust. If your TSH is still high and your symptoms haven’t subsided after 6 to 10 weeks, your doctor will likely increase the dose, and you’ll need your blood tested again after another 6 to 10 weeks.

How to Keep Hypothyroidism Under Control

Because you’ll need to take thyroid medication every day for the rest of your life, even after the right dose is found, your hormone levels will be monitored regularly to be sure that your treatment is working properly. “Eventually, most people with hypothyroidism can just be seen yearly by their doctor,” Doria-Medina says.

The American Thyroid Association recommends that you keep your TSH within a narrow range of 0.5 to 2.5 mU/L, but don’t be alarmed if your test results vary a little. Some variation is normal because your pituitary gland sends out TSH in pulses, not a steady stream. Also, factors like the time of day you’re tested can make a difference. TSH levels are likely to be higher at night and lower during the day. Some people, including those who are pregnant or those with a history of thyroid cancer, have different TSH goals. Talk to your doctor about the target TSH range that’s right for you.

If you have new or worsening symptoms or your health status changes — such as if you become pregnant, go through menopause, or are given another medicine that can interfere with the absorption of your thyroid hormones, such as anticonvulsants, certain antacids, or iron or calcium supplements — you should see your doctor and have your blood tested again, even if it’s ahead of schedule.

Thyroid Blood Tests

Overview

What are thyroid blood tests and why are they taken?

Thyroid blood tests are used to tell if your thyroid gland is functioning properly by measuring the amount of thyroid hormones in your blood. They are done by withdrawing blood from a vein in your arm. These blood tests help to diagnose thyroid diseases.

The thyroid is a butterfly-shaped gland located in the front part of your neck. Its job is to produce thyroid hormones, which travel through your bloodstream and regulate many aspects of your body’s metabolism, including temperature, weight, and energy.

Thyroid blood tests show if you have:

• Hyperthyroidism: Overactive thyroid producing more thyroid hormones than your body needs. Hyperthyroidism speeds up your metabolism, which can cause weight loss, rapid heartbeat, insomnia, puffiness around the eyes, anxiety and other symptoms. The most common cause of hyperthyroidism is Graves’ disease.
• Hypothyroidism: Underactive thyroid producing too few thyroid hormones. Hypothyroidism slows down your metabolism, which can cause weight gain, menstrual irregularity, dry and puffy skin, fatigue and other symptoms. The most common cause of hypothyroidism is Hashimoto’s disease.

Thyroid blood tests are used to diagnose thyroid disorders associated with hyper- or hypothyroidism. These include:

Test Details

What blood tests are done to test the thyroid?

Thyroid blood tests include:

• Thyroid-stimulating hormone (TSH) is produced in the pituitary gland and regulates the balance of thyroid hormones –- including T4 and T3 — in the bloodstream. This is usually the first test your provider will do to check for thyroid hormone imbalance. Most of the time, thyroid hormone deficiency (hypothyroidism) is associated with an elevated TSH level, while thyroid hormone excess (hyperthyroidism) is associated with a low TSH level. If TSH is abnormal, measurement of thyroid hormones directly, including thyroxine (T4) and triiodothyronine (T3) may be done to further evaluate the problem. Normal test range for an adult: 0.40 – 4.50 mIU/mL (milli-international units per liter of blood).
• T4: thyroxine tests for hypothyroidism and hyperthyroidism, and used to monitor treatment of thyroid disorders. Low T4 is seen with hypothyroidism, whereas high T4 levels may indicate hyperthyroidism. Normal range for an adult: 5.0 – 11.0 ug/dL (micrograms per deciliter of blood).
• FT4: Free T4 or free thyroxin is a method of measuring T4 that eliminates the effect of proteins that naturally bind T4 and may prevent accurate measurement. Normal test range for an adult: 0.9 – 1.7 ng/dL (nanograms per deciliter of blood)
• T3: triiodothyronine tests help diagnose hyperthyroidism or to show the severity of hyperthyroidism. Low T3 levels can be observed in hypothyroidism, but more often this test is useful in the diagnosis and management of hyperthyroidism, where T3 levels are elevated. Normal range: 100 – 200 ng/dL (nanograms per deciliter of blood).
• FT3: Free T3 or free triiodothyronine is a method of measuring T3 that eliminates the effect of proteins that naturally bind T3 and may prevent accurate measurement. Normal range: 2.3 – 4.1 pg/mL (picograms per milliliter of blood)

These tests alone aren’t meant to diagnose any illness but may prompt your healthcare provider to do additional testing to evaluate for a possible thyroid disorder.

Additional blood tests might include:

• Thyroid antibodies: These tests help identify different types of autoimmune thyroid conditions. Common thyroid antibody tests include microsomal antibodies (also known as thyroid peroxidase antibodies or TPO antibodies), thyroglobulin antibodies (also known as TG antibodies), and thyroid receptor antibodies (includes thyroid stimulating immunoglobulins [TSI] and thyroid blocking immunoglobulins [TBI]).
• Calcitonin: This test is used to diagnose C-cell hyperplasia and medullary thyroid cancer, both of which are rare thyroid disorders.
• Thyroglobulin: This test is used to diagnose thyroiditis (thyroid inflammation) and to monitor treatment of thyroid cancer.

Results and Follow-Up

What more should I know about thyroid blood tests?

Ranges noted here are approximate; your providers’ may differ slightly. It’s important that you remember abnormal readings do not necessarily mean a thyroid disorder is present, as each test can be affected by a variety of factors.

No preparation is required for these tests. They can be taken any time of day without fasting.

Thyroid Function Tests | American Thyroid Association

WHAT IS THE THYROID GLAND?

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

HOW DOES THE THYROID GLAND FUNCTION?

The major thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four iodine atoms. To exert its effects, T4 is converted to triiodothyronine (T3) by the removal of an iodine atom. This occurs mainly in the liver and in certain tissues where T3 acts, such as in the brain. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is made in the pituitary gland located at the base of the brain, called thyroid stimulating hormone (abbreviated TSH). The amount of TSH that the pituitary sends into the bloodstream depends on the amount of T4 that the pituitary sees. If the pituitary sees very little T4, then it produces more TSH to tell the thyroid gland to produce more T4. Once the T4 in the bloodstream goes above a certain level, the pituitary’s production of TSH is shut off. In fact, the thyroid and pituitary act in many ways like a heater and a thermostat. When the heater is off and it becomes cold, the thermostat reads the temperature and turns on the heater. When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Thus, the thyroid and the pituitary, like a heater and thermostat, turn on and off. This is illustrated in the figure below.

T4 and T3 circulate almost entirely bound to specific transport proteins. If the levels of these transport proteins changes, there can be changes in how much bound T4 and T3 is measured. This frequently happens during pregnancy and with the use of birth control pills. The “free” T4 or T3 is the hormone that is unbound and able to enter and affect the body tissues.

TESTS

Blood tests to measure these hormones are readily available and widely used, but not all are useful in all situations. Tests to evaluate thyroid function include the following:

TSH TESTS
The best way to initially test thyroid function is to measure the TSH level in a blood sample. Changes in TSH can serve as an “early warning system” – often occurring before the actual level of thyroid hormones in the body becomes too high or too low. A high TSH level indicates that the thyroid gland is not making enough thyroid hormone (primary hypothyroidism). The opposite situation, in which the TSH level is low, usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism). Occasionally, a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the thyroid (secondary hypothyroidism). In most healthy individuals, a normal TSH value means that the thyroid is functioning properly.

T4 TESTS
T4 is the main form of thyroid hormone circulating in the blood. A Total T4 measures the bound and free hormone and can change when binding proteins differ (see above). A Free T4 measures what is not bound and able to enter and affect the body tissues. Tests measuring free T4 – either a free T4 (FT4) or free T4 index (FTI) – more accurately reflect how the thyroid gland is functioning when checked with a TSH.

The finding of an elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to disease in the thyroid gland. A low TSH and low FT4 or FTI indicates hypothyroidism due to a problem involving the pituitary gland. A low TSH with an elevated FT4 or FTI is found in individuals who have hyperthyroidism.

T3 TESTS
T3 tests are often useful to diagnosis hyperthyroidism or to determine the severity of the hyperthyroidism. Patients who are hyperthyroid will have an elevated T3 level. In some individuals with a low TSH, only the T3 is elevated and the FT4 or FTI is normal. T3 testing rarely is helpful in the hypothyroid patient, since it is the last test to become abnormal. Patients can be severely hypothyroid with a high TSH and low FT4 or FTI, but have a normal T3.

FREE T3
Measurement of free T3 is possible, but is often not reliable and therefore not typically helpful.

REVERSE T3
Reverse T3 is a biologically inactive protein that is structurally very similar to T3, but the iodine atoms are placed in different locations, which makes it inactive. Some reverse T3 is produced normally in the body, but is then rapidly degraded. In healthy, non-hospitalized people, measurement of reverse T3 does not help determine whether hypothyroidism exists or not, and is not clinically useful.

THYROID ANTIBODY TESTS

The immune system of the body normally protects us from foreign invaders such as bacteria and viruses by destroying these invaders with substances called antibodies produced by blood cells known as lymphocytes. In many patients with hypothyroidism or hyperthyroidism, lymphocytes react against the thyroid (thyroid autoimmunity) and make antibodies against thyroid cell proteins. Two common antibodies are thyroid peroxidase antibody and thyroglobulin antibody. Measuring levels of thyroid antibodies may help diagnose the cause of the thyroid problem. For example, positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies in a patient with hypothyroidism result in a diagnosis of Hashimoto’s thyroiditis. While detecting antibodies is helpful in the initial diagnosis of hypothyroidism due to autoimmune thyroiditis, following their levels over time is not helpful in detecting the development of hypothyroidism or response to therapy. TSH and FT4 are what tell us about the actual thyroid function or levels.

A different antibody that may be positive in a patient with hyperthyroidism is the stimulatory TSH receptor antibody (TSI). This antibody causes the thyroid to be overactive in Graves’ Disease. If you have Graves’ disease, your doctor might also order a thyrotropin receptor antibody test (TSHR or TRAb), which detects both stimulating and blocking antibodies. Following antibody levels in Graves’ patients may help to assess response to treatment of hyperthyroidism, to determine when it is appropriate to discontinue antithyroid medication, and to assess the risk of passing antibodies to the fetus during pregnancy.

THYROGLOBULIN
Thyroglobulin (Tg) is a protein produced by normal thyroid cells and thyroid cancer cells. It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. It is used most often in patients who have had surgery for thyroid cancer in order to monitor them after treatment. Tg is included in this brochure of thyroid function tests to communicate that, although measured frequently in certain scenarios and individuals, Tg is not a primary measure of thyroid hormone function.

NON-BLOOD TESTS

RADIOACTIVE IODINE UPTAKE
Because T4 contains iodine, the thyroid gland must pull a large amount of iodine from the bloodstream in order to make an appropriate amount of T4. The thyroid has developed a very active mechanism for doing this. Therefore, this activity can be measured by having an individual swallow a small amount of iodine, which is radioactive. The radioactivity allows the doctor to track where the iodine goes. By measuring the amount of radioactivity that is taken up by the thyroid gland (radioactive iodine uptake, RAIU), doctors may determine whether the gland is functioning normally. A very high RAIU is seen in individuals whose thyroid gland is overactive (hyperthyroidism), while a low RAIU is seen when the thyroid gland is underactive (hypothyroidism). In addition to the radioactive iodine uptake, a thyroid scan may be obtained, which shows a picture of the thyroid gland and reveals what parts of the thyroid have taken up the iodine (see Thyroid Nodules brochure).

MEDICATIONS THAT INTERFERE WITH THYROID FUNCTION TESTING

There are many medications that can affect thyroid function testing. Some common examples include:

• Estrogens, such as in birth control pills, or in pregnancy, cause high levels of total T4 and T3. This is because estrogens increase the level of the binding proteins. In these situations, it is better to ask both for TSH and free T4 for thyroid evaluation, which will typically be in the normal range.
• Biotin, a commonly taken over-the-counter supplement, can cause the measurement of several thyroid function tests to appear abnormal, when they are in fact normal in the blood. Biotin should not be taken for 2 days before blood is drawn for thyroid function testing to avoid this effect.

Overactive thyroid (hyperthyroidism) – Diagnosis

See a GP if you think you may have an overactive thyroid (hyperthyroidism).

A diagnosis will be based on your symptoms and the results of a blood test that assesses how well your thyroid is working.

Thyroid function blood test

A GP may arrange for you to have a blood test to check your thyroid hormone levels. This is known as a thyroid function test.

The test checks the levels of:

• thyroid-stimulating hormone (TSH) – a hormone produced by the pituitary gland (a gland at the base of the brain) which controls the production of thyroid hormones
• triiodothyronine (T3) – one of the main thyroid hormones
• thyroxine (T4) – another of the main thyroid hormones

Your thyroid hormone levels will be compared to what’s normal for a healthy person of your age. A low level of TSH and high levels of T3 and/or T4 usually means you have an overactive thyroid.

Doctors may refer to these measurements as “free” T3 and T4 (FT3 and FT4).

What’s considered normal varies depending on things such as your age and the exact testing technique used by the laboratory.

Find out more about a TSH blood test

Further tests

If your thyroid hormone levels are high, you may be referred to a specialist for further tests to find out what’s causing it.

Further blood tests

You may have another blood test to look for anti-thyroid antibodies.

These are usually found if you have Graves’ disease, a common cause of an overactive thyroid.

A blood test called erythrocyte sedimentation rate (ESR) may also be done to check for inflammation in your body.

If there are signs of inflammation, the increase in thyroid hormones is caused by thyroiditis (inflammation of the thyroid).

Find out more about an ESR blood test.

Thyroid scan

A thyroid scan may be used to look for problems such as lumps (nodules) on your thyroid.

You’ll be asked to swallow a small amount of a slightly radioactive substance that will be absorbed by your thyroid. It can also be given by injection.

A scan is then done to see how much of the substance has been absorbed and to examine the size and shape of your thyroid.

Page last reviewed: 24 September 2019
Next review due: 24 September 2022

Thyroid Panel | Labcorp

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(April 27, 2007) MedlinePlus, Medical Encyclopedia. Thyroid Function Tests. Available online at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. Accessed May 2008.

Quest Diagnostics. Thyroid Function Panel. Available online through http://www.questdiagnostics.com. Accessed May 2008.

Shomon, Mary. Thyroid Blood Tests. About.com Guide. Updated: March 27, 2007. Available online at http://thyroid.about.com/od/gettestedanddiagnosed/a/bloodtests.htm. Accessed June 22, 2010.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. Louis: Elsevier Saunders; 2006, Pp. 2053, 2063-2064.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds (2005). Harrison’s Principles of Internal Medicine, 16th Edition, McGraw Hill, Pg 2119.

ARUP Lab Tests. Thyroid Panel. Available online at http://www.aruplab.com/guides/ug/tests/0070141.jsp. Accessed February 2011.

National Endocrine and Metabolic Diseases Information Service. Thyroid Function Tests. Available online at http://endocrine.niddk.nih.gov/pubs/thyroidtests/index.htm. Accessed February 2011.

MedlinePlus Medical Encyclopedia. TSH Test. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003684.htm. Accessed February 2011.

MedlinePlus Medical Encyclopedia. T3 Test. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003687.htm. Accessed February 2011.

MedlinePlus Medical Encyclopedia. T4 Test. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003517.htm. Accessed February 2011.

MedlinePlus Medical Encyclopedia. T3RU Test. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003688.htm. Accessed February 2011.

Mosby’s Manual of Diagnostic and Laboratory Tests. Pagana and Pagana. 4th edition, Pg. 512.

(Updated 2014 May 14). Thyroid Tests. National Endocrine and Metabolic Diseases Information Service [On-line information]. Available online at http://endocrine.niddk. nih.gov/pubs/thyroidtests/index.aspx. Accessed January 2015.

(2012 June 4). Thyroid Function Tests. American Thyroid Association [On-line information]. Available online at http://www.thyroid.org/blood-test-for-thyroid/. Accessed January 2015.

(© 1995–2015). Thyroid Function Cascade, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/83633. Accessed January 2015.

Meikle, A. W. and Straseski, J. (Updated 2014 July). Thyroid Disease. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ThyroidDz.html?client_ID=LTD. Accessed January 2015.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 431-449.

Thyroid Tests (for Parents) – Nemours Kidshealth

What Is the Thyroid?

The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest. It makes two types of thyroid hormones: T3 (triiodothyronine) and T4 (thyroxine). It helps the body do many things, such as get energy from food, grow, and go through sexual development.

The pituitary is a pea-sized gland at the bottom of the brain that makes thyroid stimulating hormone (TSH). TSH triggers the thyroid to make more thyroid hormone. The pituitary gland and the thyroid gland send messages back and forth to each other about how much hormone to make to keep the levels normal.

What Is Thyroid Disease?

Some diseases of the thyroid or pituitary gland cause the thyroid to make too much or not enough thyroid hormone:

• If the thyroid is overactive, it releases too much thyroid hormone, causing hyperthyroidism. The body use up energy more quickly than it should, and chemical activity (like metabolism) in the cells speeds up. Symptoms include sweating, trembling, weight loss, and fast heartbeat.
• If the thyroid is underactive, it makes too little thyroid hormone, causing hypothyroidism. The body uses up energy more slowly, and chemical activity (metabolism) in the cells slows down. Symptoms include tiredness, feeling cold, constipation, dry skin, and slow height growth in children.

What Are Thyroid Blood Tests?

Doctors use blood tests to check for thyroid or pituitary problems. In kids already diagnosed with thyroid or pituitary problems, the tests are used to guide treatment.

Commonly ordered thyroid blood tests include:

• T4 test: This is done to measure the blood level of the hormone T4 (thyroxine). It might be done in one or both of the following ways:
  • total T4, which measures the entire amount of thyroxine in the blood, including the amount attached to blood proteins that help carry the hormone through the bloodstream
  • free T4, which measures only the thyroxine that’s not attached to proteins. This is the part of T4 in the blood that affects how the body’s cells work.
    The results of the T4 blood tests can help diagnose hyperthyroidism or hypothyroidism and guide treatment.
• TSH test: A thyroid stimulating hormone (TSH) test can help tell how well the thyroid is working. If a thyroid disease prevents the gland from making enough thyroid hormone, the pituitary gland releases more TSH into the blood. If the thyroid is making too much thyroid hormone, the pituitary releases less TSH, which can lower the levels of TSH in the blood.
• T3 total test: The T3 total test measures the other major thyroid hormone in the blood. It often helps doctors diagnose hyperthyroidism.
• thyroid antibodies test: Hashimoto’s thyroiditis is an
  autoimmunecondition in which the immune system attacks the thyroid gland. To diagnose it, doctors check for high levels of antibodies that are a sign of the immune system’s attack on proteins in the thyroid gland. Usually, two types of thyroid antibodies are measured: thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPO).

In some cases, abnormal thyroid test results can be due to a medicine, an ongoing medical condition, or pregnancy. In these cases, there may be nothing wrong with the thyroid or pituitary glands themselves.

The normal ranges of thyroid function test results vary by age. Doctors think about this carefully when they interpret them.

What if I Have Questions?

If you have any questions about a thyroid blood test, speak with your doctor. You can also talk to the technician who’s doing the blood draw before the procedure.

Blood test for Anti-TPO in the laboratory KDL

Thyroid peroxidase (TPO) – is an enzyme responsible for the production of thyroid hormones. It provides the formation of an active form of iodine by oxidizing iodide for the synthesis of triiodothyronine (T3) and thyroxine (tetraiodothyronine, T4). TPO synthesis is regulated by thyroid-stimulating hormone (TSH). Thyroid peroxidase is a common antigen – in some cases, the body perceives it as a foreign agent and forms antibodies to it – antibodies to microsomal thyroid peroxidase (anti-TPO) .

When is anti-TPO antibody testing usually prescribed?

The test for antibodies to thyroid peroxidase (anti-TPO) is the most informative test for determining autoimmune thyroid diseases.

The test is prescribed for patients with signs of thyroid dysfunction, as well as pathological test results for TSH, free T4 and free T3.

To get a more complete picture of the state of the thyroid gland, you can take an analysis for antibodies to TPO along with an analysis for TSH and other thyroid hormones or take a comprehensive test – “Examination of the thyroid gland, screening”, which, in addition to hormones, also includes antibodies to thyroglobulin . ..

What do the test results mean?

If the level of antibodies to TPO is within the normal range, then most likely the symptoms of thyroid dysfunction are associated with another, non-autoimmune cause. However, a certain percentage of patients do not have antibodies in the initial stages of the disease, they may appear later. Therefore, the doctor may refer you to retest after some time.

Most often, an increased level of antibodies to TPO is observed in patients with Hashimoto’s thyroiditis.In this disease, the presence of high antibodies is about 90% of cases, which confirms its autoimmune origin. Also, with a frequency of 60% -80% of antibodies are found in Graves’ disease.

Patients with other autoimmune diseases (such as adrenal insufficiency, rheumatoid arthritis, type 1 diabetes) may show antibodies to thyroperoxidase. The test results can also be used by endocrinologists when deciding whether to treat a patient with subclinical hypothyroidism.

Approximately 5% of healthy people have antibodies to thyroperoxidase. The prevalence of these antibodies is generally higher in women and tends to increase with age. The presence of antibodies to thyroid peroxidase indicates an increased risk of developing thyroid disease in the future. Patients with antibodies to TPO without visible thyroid dysfunction require regular examination, as they are significantly more likely to develop thyroid disease in the future.

Timing of the test.

Typically the TPO antibody result is ready in 1-2 days.

How do I prepare for the analysis?

No special training required. More details can be found in the “Preparation” section.

Analysis of TTG price from CMD. Thyroid-stimulating hormone. Blood on ttg price

Reference values ​​(standard variant):

Reference values ​​for the pregnant category:

We draw your attention to the fact that the interpretation of the research results, the establishment of the diagnosis, as well as the appointment of treatment, in accordance with Federal Law No. 323-FZ “On the Fundamentals of Health Protection of Citizens in the Russian Federation” dated November 21, 2011, must be performed by a doctor of the appropriate specialization.

90,000 Get tested for thyroid hormones

The thyroid gland is an important regulator of metabolic processes in the human body. Hormonal disruption leads to a chain of disorders that affects many organs and their systems. Tests for hormones are an integral and most informative part of diagnosing the condition of the gland.

Indications for research are:

• suspicion of dysfunction of the gland (hyperthyroidism or hypothyroidism), diffuse toxic goiter;
• regular monitoring of hormone levels in case of identified pathologies;
• cardiac arrhythmia;
• delay in sexual and mental development in childhood;
• amenorrhea;
• infertility;
• impotence.

Examination of thyroid function is necessary when planning a pregnancy, since hormone levels affect conception and bearing of a fetus.

Investigated indicators

You can get tested for thyroid hormones in the clinic “Ona”. To assess the work of the gland, the following indicators are evaluated:

• T4 (thyroxine) is a thyroid hormone that regulates energy metabolism and metabolism. A decrease in the level of total thyroxine is observed in hypothyroidism, an increase in thyrotoxicosis, toxic goiter, and hyperthyroidism. Free thyroxine deviates from the norm due to increased or decreased metabolism.
• T3 (triiodinthyronine) is a thyroid hormone derived from T4. The study is carried out to detect hyperthyroidism, to control the treatment of goiter and replacement therapy with L-thyroxine.
• TSH (thyroid stimulating hormone of the pituitary gland) – stimulates the production of hormones T3 and T4 by the thyroid gland. The concentration of the hormone is the higher, the more reduced the function of the thyroid gland, and vice versa.
• Antibodies to TPO (thyroid peroxidase) – autoantibodies to an enzyme that acts as a catalyst in the synthesis of hormones T3 and T4.An increased rate is characteristic of autoimmune processes in the thyroid gland. These include autoimmune thyroiditis and diffuse toxic goiter.
• Antibodies to TG (thyroglobulin) – antibodies to a protein synthesized by the thyroid gland and located in its follicles. An increased level of antibodies is characteristic of the state of autoimmune deficiency, diffuse toxic goiter, tumors of the thyroid gland, various autoimmune diseases and chromosomal abnormalities.
• Antibodies to TSH receptors – produced against thyroid-stimulating hormone receptors located on the surface of thyroid cells.These antibodies enhance the synthesis of thyroid hormones by the thyroid gland. An increased rate is characteristic of diffuse toxic goiter.

Preparation for the delivery of tests

Blood for analysis is taken from a vein, as a rule, from 8 to 10 am, on an empty stomach. The patient should be at rest for 30 minutes before taking blood. On the eve, it is recommended to exclude increased physical activity, refrain from drinking alcohol and smoking. 2-4 weeks before the initial check of the level of thyroid hormones, it is necessary to stop taking medications that affect the function of the thyroid gland.When monitoring treatment, they are excluded from taking them on the day of the study before blood sampling. 3 days before the analysis, stop taking iodine-containing drugs.

The hormone concentration values ​​may vary depending on the laboratory method, the age and gender of the patient, therefore the specialist focuses on the reference values ​​indicated on the laboratory form. The test results are objective data that guide the endocrinologist when assessing the condition and function of the thyroid gland.The diagnosis and the appointment of treatment are carried out only as a result of a comprehensive examination of the patient.

Thyroid hormone tests

The thyroid gland is the most important organ that directly affects the proper functioning of the heart, tissues and muscles. The thyroid gland synthesizes, accumulates and secretes thyroid hormones into the blood. In the event of a violation of their level, a failure occurs in the metabolic processes of the body, as well as in the work of the nervous, reproductive, cardiovascular, and digestive systems.

Diseases of the thyroid gland and their symptoms

The most common diseases caused by thyroid pathology are hyperthyroidism and thyrotoxicosis.

Hyperthyroidism is manifested by rapid heartbeat, weight loss, sweating, irritability and nervousness, hand tremors, exophthalmos, and sleep disturbances.

With hypothyroidism, the patient has bradycardia, weight gain, dry skin, hair loss, constipation, chilliness, fatigue, lethargy, depression.In severe forms, this disease is a path to heart failure and coma.

In order to prevent the development of diseases at the initial stage, it is very important to undergo an examination on time, which can be prescribed by an endocrinologist, therapist, pediatrician and obstetrician-gynecologist.

Thyroid hormone test

Thyroid function screening is a blood test that measures the level of thyroid hormones, which can reveal whether it is hyper or hypofunctional.

This laboratory study makes it possible to assess the quality of the thyroid gland, prescribe the correct treatment and monitor the results of the therapy.

At the first visit, a full comprehensive analysis is most often prescribed, which includes the following hormones:

• Thyroid-stimulating hormone
• TSH – regulates the function of the thyroid gland, maintains the necessary concentration of thyroid hormones. Normal values ​​for an adult are 0.3 – 4.2 μIU / ml.
• Triiodothyronine total 90 140

• T3 is the most important thyroid hormone, whose task is to absorb oxygen by tissues.The norm of an adult is 1.2 – 3.1 nmol / l.
• General thyroxine 90 140

• T4 is another important hormone responsible for plastic and energy metabolism. Normal values ​​are 66 – 181 nmol / L.
• Triiodothyronine free 90 140

• Free T3 is part of the thyroid hormone. It acts as a kind of regulator in metabolic processes and is responsible for the operation of various systems (nervous, cardiovascular, etc.). The norm of an adult is 3.1 – 6.8 pmol / l.
• Free thyroxine 90 140

• Free T4 is part of the total T4, which is also responsible for the regulation of metabolism. The indicators of the norm are 10.8 – 22.0 pmol / l.
• Antibodies to thyroperoxidase 90 140

• AntiTPO – are responsible for the formation of a peculiar form of iodine in TG.
• Antibodies to thyroglobulin 90 140

• AntiTG is a kind of marker of a disease such as Hashimoto’s thyroiditis.
• Antibodies to the TSH receptor
• Anti-pTTG – The presence of these antibodies is used to detect the symptoms of Graves ‘disease (Graves’ disease).

In case of malfunction of the thyroid gland, the indices of certain hormones decrease or decrease. For example, with an increased level of T3 or T4, the metabolism is accelerated. This leads to an increased heart rate, rapid weight loss, increased sweating, and more.

Preparation for the test for thyroid hormones

Before donating blood for hormones, the following requirements must be observed:

• Blood sampling is done on an empty stomach (no earlier than 3 hours after eating).Only pure water can be consumed 90 140
• Smoking should be stopped at least half an hour or an hour before the study, alcohol consumption – no later than 12 hours
• Stop taking hormones for 48 hours
• Physical activity should be minimized on the eve of analyzes
• Stop taking iodine-containing drugs and thyroid hormones within 3 days.

You can conduct a study of the thyroid gland in any branch of the network “Medical Commission No. 1” close to you.We work seven days a week in 7 districts of St. Petersburg. The centers are equipped with high-tech laboratories, and only qualified specialists work. The analysis results will be ready as soon as possible.

Registration for the study is available online on our website or by phone +7 (812) 380-82-54

Make an appointment >>>

Riedel’s thyroiditis. Observation from practice | Pokrovskaya

Relevance

Riedel’s thyroiditis (fibrosing thyroiditis, Riedel’s thyroiditis) is an extremely rare form of thyroiditis, characterized by the replacement of the thyroid parenchyma with connective tissue.The most common clinical manifestations are “woody” density of the gland, non-displacement on palpation, compression of adjacent structures (trachea, esophagus, vessels and nerves) [1, 2]. This disease is named after the German surgeon Riedel, who reported several cases of thyroiditis with severe fibrosis at the International Congress of Surgery in 1894. The prevalence in the population is 1.06 cases per 100,000 people and 0.05-0.06% of all visits about diseases of the thyroid gland.Riedel’s thyroiditis is more common in women and manifests itself over the age of 50 [3, 4].

Several theories of the occurrence of Riedel’s thyroiditis have been proposed. There are opinions that Riedel’s thyroiditis may be the outcome of subacute thyroiditis, Hashimoto’s thyroiditis, or a drug-induced disease. Familial forms of multiple fibrosclerotic lesions, including Riedel’s thyroiditis, have been noted, but the etiology is still unknown [4, 5]. According to [1, 6], Riedel’s thyroiditis is considered as an IgG4-associated disease that unites a group of fibroinflammatory changes in various organs (Mikulich’s disease, Küttner’s tumor, autoimmune pancreatitis, Ormond’s disease, etc.).).

Riedel’s thyroiditis does not have an acute onset, in a short period of time (up to several weeks) fibrous tissue completely replaces the thyroid tissue, causing it to thicken, then the process moves to nearby organs, which causes characteristic complaints: an increase in the neck region, shortness of breath, hoarseness, associated with impaired mobility of the vocal cords, cough, difficulty breathing. The severity and degree of tracheal obstruction in most cases determine the clinical picture.In terms of functional activity, both euthyroidism and thyrotoxicosis can be observed, followed by complete replacement of thyroid tissue with connective tissue and the development of hypothyroidism. The most common symptom of the disease is the stony density of the thyroid gland, spreading to the surrounding structures. Lymph nodes are usually not enlarged [7].

Despite the availability of many modern diagnostic methods, it is impossible to make a diagnosis before the histological and, which is extremely important, before the immunohistochemical (IHC) study of the surgical material.When carrying out an ultrasound examination (ultrasound), an enlargement of the thyroid gland and a thickening of its structure are visualized. Computed tomography (CT) may confirm compression syndrome. Puncture biopsy confirms the benign quality of the formation, the presence of fibrosis. A radioisotope study is characterized by a decrease in the uptake of a radiopharmaceutical [2]. All these methods do not allow to prove the presence of this particular disease. Riedel’s thyroiditis is difficult to distinguish from aggressive types of malignant tumors of the thyroid gland (sarcoma, anaplastic cancer, thyroid lymphoma), so the final diagnosis can only be made after morphological and IHC studies of the postoperative material.Morphological signs of Riedel’s thyroiditis are: inflammatory infiltration in the thyroid gland with spread to the surrounding tissues, represented by a mixed population of lymphocytes, plasma cells, eosinophils, the absence of granulomas and elements of malignant neoplasm. A feature is also the defeat of medium and small veins in the tissues of the gland, which leads to obliterating phlebitis. Modern data suggest conducting IHC studies as a differential diagnosis of Riedel’s thyroiditis with other forms of thyroiditis, according to which a large number of IgG4 + plasma cells is revealed in the postoperative material as another confirmation of the IgG4 + -associated nature of the disease [3, 8].

Conservative treatment includes taking glucocorticoids to eliminate the inflammatory reaction (prednisolone 15-100 mg / day) or tamoxifen (10-20 mg / day). The mechanism of action of the latter is not fully understood, but it is believed that the effect is associated with inhibition of fibroblast proliferation. In patients refractory to glucocorticoid and tamoxifen therapy, rituximab may be used. There is evidence of a positive effect of adding mycophenolate mofetine, which has antifibrosing properties, to prednisolone therapy [1, 8].In the presence of life-threatening symptoms and ineffectiveness of drug treatment of Riedel’s thyroiditis, surgical intervention is indicated – thyroidectomy. However, in some cases, surgical treatment is problematic due to dense infiltration of the thyroid gland and surrounding tissues. Sometimes, to eliminate the symptoms of compression, they are limited to dissection of the isthmus, removal of the isthmus, hemithyroidectomy. The incidence of postoperative complications (paralysis of the recurrent laryngeal nerve, postoperative hypoparathyroidism) reaches 30% [8].

Thus, Riedel’s thyroiditis is a rather rare thyroid disease with an unknown etiology, difficult to differentiate from malignant neoplasms at the pre-surgical stage and requiring a careful choice of treatment method. It should be noted that in a fairly large number of cases of suspected Riedel’s thyroiditis after a postoperative morphological (!) Diagnosis, clinical manifestations of the progression of a malignant neoplasm of the thyroid gland are noted in the near future, which makes the diagnostic error obvious.

The presented clinical case describes the course of Riedel’s thyroiditis, accompanied by subfebrile fever, leukocytosis and an increase in ESR, resolved after surgical treatment.

Case description

Patient E., 52 years old, in September 2018, was admitted to the surgery department with a diagnosis: “Hypothyroidism as a result of autoimmune thyroiditis, hypertrophic form (Vg.zh. – 150 ml). Tracheal compression syndrome. Fever of unknown origin ”. Upon admission, the patient complained of a mass in the neck, a feeling of a “lump in the throat,” a daily increase in body temperature to 38 ° C during the last 6 months (usually in the afternoon), profuse, mainly nighttime profuse sweating.

From the anamnesis it is known that about 10 years ago, ultrasound of the neck organs revealed an enlargement of the thyroid gland, with hormonal research – thyrotoxicosis, therapy with thyreostatics and beta-blockers was prescribed (scintigraphy and determination of antibodies to the TSH receptor were not performed). Subsequently, hypothyroidism developed, since that time he has been taking levothyroxine sodium at a dose of 50 mcg / day.

Since April 2018, he has noted an increase in body temperature to 38.6 ° C (on average 37.2–38.0 ° C), since the same time, he has noted a rapid growth of education in the neck region.According to ultrasound of the thyroid gland, its structure corresponds to autoimmune thyroiditis, volume 98 cm: right lobe 34 × 40 × 86 mm, isthmus 19 mm, left lobe 27 × 36 × 90 mm. The contours are indistinct, uneven, the echogenicity is sharply reduced. The structure is heterogeneous with fibrous tightness. There are several hypoechoic nodes up to 11 mm along the upper contour of the isthmus. According to hormonal studies: TSH – 15 mIU / L, in connection with which the dose of sodium levothyroxine was increased to 100 μg / day. For an increase in body temperature in connection with the recommendation of specialists at the place of residence, he took glucocorticoids for 2 months (prednisolone 5 mg per day, followed by an increase to 10 mg per day) with a temporary positive effect and further discontinuation of the drug.At the time of admission, he takes 1-3 NSAID tablets per day with a temporary positive effect.

Results of physical, laboratory and instrumental research

Upon admission to the department, the patient’s condition is relatively satisfactory, blood pressure 150/100 mm Hg, heart rate 76 beats / min. Body temperature 37.7 ° C. On examination, the anterior surface of the neck is deformed; on palpation, the thyroid gland is significantly enlarged in volume, of a dense, stony consistency, displaced upon swallowing (Fig.one).

Fig. 1. The appearance of the patient’s neck.

CT scan of the neck organs was performed: CT-picture of diffuse goiter, gland volume 151 ml. Moderate deformation of the tracheal lumen (less than 1/3). The enlargement of the lymph nodes of the mediastinum (upper, pre- and paratracheal groups) (Fig. 2, 3).

The laboratory data obtained during the preoperative examination are presented in the table.

Fig. 2. MSCT of the chest organs in a longitudinal section.

Fig. 3. MSCT of the chest organs in cross section.

Table. Laboratory research data upon admission

In connection with a long-term fever of unknown origin with an increase in body temperature up to 38 ° C, signs of an inflammatory process according to laboratory studies, a diagnostic search was carried out to find out its possible causes.Examined for chronic infections: HIV, hepatitis B, C, syphilis, malaria, salmonellosis, typhus – negative.

General urine analysis – no inflammatory changes.

To exclude infective endocarditis, echocardiography was performed: LVEF – 66%. The chambers of the heart are not dilated. The ventricular myocardium is not thickened. No zones of LV myocardial asynergy were found. The global systolic function of the LV myocardium is not impaired. The valve train has not been changed.

To exclude lymphoproliferative, inflammatory, and oncological diseases, CT scan of the chest and abdominal organs was performed: no focal and infiltrative changes in the chest or abdominal cavity were found.According to the X-ray data of the sinuses of the skull and subsequent examination by an otorhinolaryngologist, chronic polysinusitis was diagnosed, antibacterial, anti-inflammatory therapy was prescribed – in dynamics without a positive effect (body temperature remains 37.2–37.7 ° C during the day, KLA – leukocytosis 16 × 109 cells / l , ESR 114 mm / h).

According to the results of a puncture biopsy of the thyroid gland, carried out at the National Medical Research Center of Endocrinology: in two preparations, a cytological picture of chronic autoimmune thyroiditis with a pronounced fibrous component was obtained.According to the Bethesda classification – II diagnostic category.

The patient underwent surgery: thyroidectomy under the control of an Inomed neuromonitor (the amplitude of the signals during the control determinations V1, R1, V2, R2 is adequate). When isolating, pronounced technical difficulties were noted, associated not so much with the enlargement of the thyroid gland due to both lobes, but due to its stony density, vitreous edema and immobile tight adhesion with the trachea and prethyroid muscles (Fig.4). Adequate visualization of the parathyroid glands failed.

Fig. 4. Postoperative thyroid medication.

Histological examination of both lobes with an isthmus and a pyramidal lobe established chronic lymphocytic thyroiditis with an outcome in diffuse fibrosis of the thyroid stroma similar to Riedel’s fibrous thyroiditis (Fig. 5). The parenchyma of the thyroid gland is replaced by lymphocytic inflammatory infiltrate and diffuse fibrosis. The follicular epithelium of the thyroid gland is practically absent.Single residual cells of the follicular epithelium are atrophic and difficult to recognize. No parathyroid glands (PTG) were found in the material removed as a single block.

Fig. 5. The histological picture of the postoperative material of the thyroid gland.

The postoperative material was reviewed by an independent morphologist with an IHC study. Histologically: the tissue of the thyroid gland can hardly be traced due to gross fibrosis with a pronounced storiform (moire) pattern and moderately pronounced diffuse lymphoplasmic cell infiltration with a predominance of plasma cells in the infiltrate with a slight admixture of eosinophils.The follicular tissue of the gland is atrophied over a greater extent, only a few follicles are preserved. The borders of the gland are erased due to the spread of fibroinflammatory changes to the adjacent soft tissues. There is no necrosis. There is an increased number of vessels with inflammatory infiltration of the walls, obliteration of the lumen of the veins (obliterating phlebitis) (Fig. 6).

Fig. 6. Obliterating phlebitis (staining with hematoxylin-eosin).

An IHC study with antibodies to CD138 (B-A38) and IgG4 (MRQ-44) confirms the presence of a large number of CD138 + plasma cells in the infiltrate, most of which express IgG4.The CD138 + / IgG4 + ratio is more than 60%. More than 100 IgG4 + plasma cells are detected in one field of view at a magnification of × 400 (Fig. 7). Conclusion: morphological and immunohistochemical changes correspond to IgG4-associated thyroiditis.

Fig. 7. IgG4 + plasma cells during the IHC study.

On the second day after the operation, leukocytosis remained up to 11 × 10 ⁹ cells / l, ESR 106 mm / h. From the second day after the operation, stable normalization of body temperature.Cough impulse is an effective, positive symptom of Khvostek. Complains of hoarseness (video laryngoscopy on the 3rd day – full mobility of the vocal cords), tingling in the fingers, numbness in the area of ​​the nasolabial folds. Due to hypocalcemia, low PTH level (1 pg / ml), replacement therapy with calcium preparations, preparations of the active form of vitamin D was started. Levothyroxine was prescribed at a dose of 137 μg / day.

At follow-up examination 1, 3 and 6 months after the operation, the patient noted the normalization of body temperature (36.5–36.8 ° C with repeated measurements), according to the control KLA, the absence of leukocytosis, normalization of ESR, a significant improvement in general well-being.Ultrasound scan 6 months after surgery – condition after thyroidectomy, no lymphadenopathy. Coarsening of the voice persists, the level of PTH is low, the level of total blood Ca while taking 1 μg of alfacalcidol and 1.5 g of calcium carbonate is low, the level of P is at the upper limit of the norm. There are no clinical manifestations of hypocalcemia.

Discussion

This clinical example demonstrates the complexity of the diagnosis and treatment of Riedel’s thyroiditis. A feature of this observation is a clear connection between an increase in body temperature and the debut of an enlargement and thickening of the thyroid gland in April 2018.and its regression the next day after removal of the thyroid gland, which indicates that such a coincidence is not accidental. However, in the literature available to us, we did not find descriptions of an increase in body temperature in this disease.

It should be noted that treatment with glucocorticoids was carried out in insufficient dosage, adopted for the treatment of Riedel’s thyroiditis (10 mg per day was used for a month without effect, it is possible to use up to 60-100 mg per day). However, the lack of an accurate diagnosis, which is possible on the basis of histological and IHC studies, and the inadequacy of the cytological study (limited for objective reasons, the capabilities of the method) make such treatment questionable.

You should also pay attention to the picture obtained during the IHC study – a large number of IgG4 + plasma cells, which is comparable with the data of modern literature on the belonging of Riedel’s thyroiditis to the group of IgG4 + -associated diseases. In retrospect, we understand that it would be interesting to assess IgG4 in the patient’s blood plasma before surgery, as well as to conduct a comprehensive examination to search for possible manifestations of systemic fibrosis.

Particular attention should be paid to the technical aspects of the operation, the complexity of which is higher due to the specific nature of the disease.

Vitreous edema of adjacent tissues and their pronounced infiltration during the operation should force one to be especially scrupulous about the volume of surgical treatment. In this case, the possibility of using intraoperative monitoring of the innervation of the larynx is especially important, which makes it possible to prevent bilateral paralysis of the larynx. If the signal from the recurrent laryngeal nerve is lost after hemithyroidectomy, it is necessary to limit this volume of surgery on the day of surgery, since it removes the main clinical problem – tracheal compression syndrome.In our observation, no signal loss occurred when using a neuromonitor, which made it possible to continue the operation up to the volume of thyroidectomy. Coarsening of the voice, which persists for a long time in the absence of impaired mobility of the vocal cords (data from postoperative laryngoscopy), clinically indicates damage to the external branch of the superior laryngeal nerve.

Unfortunately, the cause of persistent hypoparathyroidism often remains unclear (during surgical mobilization, the PTG was not detected, in the macroscopic preparation it was not identified).The violation of their blood circulation is obvious. In this situation, it is difficult to overestimate the possibility of using intraoperative fluorescents (alasens, indocyanine green), which make it possible to identify the PTG and, in some cases, assess their viability and resolve the issue of autotransplantation into the PTG muscle, devoid of trophism.

Conclusion

The peculiarity of monitoring patients with Riedel’s thyroiditis is the need to control possible tumor manifestations for at least six months.This is due, as we indicated above, to the complexity of the morphological assessment and underdiagnosis of aggressive forms of thyroid cancer. Our observation was sent to the press after 11 months of postoperative observation of the patient.

Additional information

Patient consent. Medical data published with the written consent of the patient.

Conflict of interest. The authors declare no obvious and potential conflicts of interest related to the publication of this article.

Contribution of authors: All authors were directly involved in the patient’s treatment, made a significant contribution to the preparation of the article, read and approved the final version before publication.

90,000 Analysis for TSH (thyroid stimulating hormone): norm, decoding, how to take

The thyroid gland is the most important organ of internal secretion, which controls almost all processes. It produces several vital hormones that keep the entire body functioning properly.According to the official statistics of the World Health Organization, about 3% of the population suffers from thyroid diseases. This is due to various reasons: comorbidities, genetic predisposition, living in an iodine-deficient area, and so on. Therefore, it is important to periodically check thyroid-stimulating hormone more reddenedly, as this will help to timely identify abnormalities in the hormonal balance and begin effective drug treatment.

Why TSH analysis is needed

The TSH level is an important diagnostic indicator for judging the functioning of the thyroid gland.This hormone is secreted by the pituitary gland, affects the production of T3 and T4 (play an important role in growth, intellectual and physical development, energy reserves, fat and protein metabolism). TSH is responsible for regulating the processes of iodine delivery to the thyroid gland and enhancing lipolysis. T3 and T4 have a significant impact on the functioning of the internal systems of the body. In addition to metabolic processes, they control cardiovascular activity, digestion, reproductive function, and even mental health.TSH, T3 and T4 are tightly linked, therefore, in medical practice, they are studied simultaneously. The concentration of the latter hormones is inversely proportional to the TSH content: as soon as a sufficient amount of T3 and T4 appears in the body, the release of TSH stops and vice versa.

Analysis for hormone TSH , more often, is prescribed at:

• Hypothyroidism and goiter.
• Infertility and other disorders of the reproductive system.
• Undergoing hormone replacement therapy.
• Violation of cardiovascular activity.
• Myopathy.
• Disorder of the menstrual cycle.
• Psychological disorders.
• Delayed sexual and intellectual development in childhood.

Disruption of TSH synthesis can occur as a result of several reasons, including:

• Traumatic brain injury, large blood loss, damage to the hypothalamic-pituitary system (neoplasms, hemorrhages).
• Tumors of the pituitary gland (both benign and malignant) that increase the synthesis of hormones. As a result of this, an active and uncontrolled hormonal production occurs, leading to the appearance of hypothyroidism, diabetes mellitus, infertility, etc.
• Lesion of other endocrine glands, including neoplasms or adrenal insufficiency.
• Insufficiency of the hypothalamic-pituitary system. May occur against the background of infection (meningitis), poisoning with toxic substances, autoimmune pathologies or brain surgery.
• Hemorrhagic stroke (in this case, endocrine disorders fade into the background, since cerebral symptoms predominate).
• The concentration of TSH in women may change due to complications during childbirth or abortion, during pregnancy (described in more detail below). Therefore, TSH during pregnancy is always performed in the 1st trimester.

Preparation for procedure

It is extremely important to know how to pass analysis of TTG , since the implementation of the preparatory measures will allow you to obtain the most reliable data.Preparation includes:

1. 3 days before blood sampling, you need to give up alcoholic beverages, smoking, playing sports, refrain from stress and temperature extremes.
2. Stop drug therapy (if possible and with doctor’s approval).
3. Do not have breakfast before the procedure, maximum – a glass of water without gas. It is recommended to stop eating any food 12 hours before the study.

How the study is conducted

Passing the analysis for TSH is a widespread procedure that does not require special medical instruments or equipment.It is carried out in all clinical laboratories (both paid and public). It is recommended to donate blood in the morning (from 8 to 11 o’clock). The setting of the TSH concentration is carried out using a chemiluminescent immunoassay on microparticles, which has a high level of accuracy. For this, blood serum obtained from the patient’s vein is used. The procedure itself does not cause severe pain, but may be accompanied by minor discomfort. As a rule, you can get the result within 1-2 business days.It is important to understand that the patient receives only diagnostic data on his hands, without decoding and making a diagnosis. This is done exclusively by the attending physician. If the TSH analysis is the norm of , then the WHO recommends that the next examinations be carried out no earlier than a year later. If there are problems with the thyroid gland, the frequency of the procedure should be increased up to 2 times a year. You can take a TSH test at the medart clinic.

What can affect the results of the TSH test

The norm of the hormone TSH may vary due to the effects on the body of various external or internal factors.This is especially true for the time of day. The maximum concentration is observed at night (from 2 to 4 in the morning and from 6 to 8 in the morning), and the minimum – from 5 to 7 in the evening. In the absence of adequate sleep at night, hormonal synthesis is disrupted. In addition, a decrease in TSH can become a symptom of pregnancy and breastfeeding, which is regarded as a normal variant. Certain medications can also change the TSH concentration. The thyroid gland is closely connected with other internal organs, therefore, a disorder in their functioning significantly affects hormonal production.In women of the middle-aged category and men in old age, the maximum value of thyroid-stimulating hormone is found in December. With menopause, TSH growth is allowed in the absence of signs of an increase in the thyroid gland in size.

Thyroid stimulating hormone: norm

Normal TSH directly depends on the person’s age. For each age period, this value has different indicators, which is noticeable in the first months after birth. Reference values ​​are:

As can be seen from the table, the change in normal TSH levels varies throughout life.Therefore, only a medical professional must make a conclusion on the results of the analysis, comparing them with the norm. When decoding, the endocrinologist can also take into account the characteristics of each organism, gender (according to statistics, women develop thyroid problems 2 times more often than men), a history of diseases, medication and much more.

Decoding

An increase in the concentration of TSH in the blood may indicate:

• Primary hypothyroidism , even in the absence of clinical symptoms.But, as medical practice shows, with a detailed questioning of a person, it is often revealed that it is impossible to engage in physical activity for a long time, fatigue, loss of strength, an unstable psycho-emotional state, a tendency to depression, memory impairment, dry skin, brittle hair.
• Subacute thyroiditis is an inflammation of the thyroid gland. With this disease, organ tissue is damaged due to infection of the upper respiratory tract. The patient has pain in the thyroid gland and an increase in its size, myalgia and the inability to engage in physical activity for a long time.
• The presence of a tumor , contributing to the uncontrolled production of the hormone. Often occurs with an oncological process localized in the thyroid gland, lungs and mammary gland, as well as with pituitary adenoma.
• Thyroid hormone resistance .
• Therapy with certain groups of medicines , which, as a side effect, can increase the production of TSH.

A decrease in the normal values ​​of TSH may occur due to:

• Lesion of the thyroid gland.
• Itsenko-Cushing’s syndrome (develops with damage to the adrenal glands, as a result of which the synthesis of cortisol increases and the value of TSH decreases).
• Severe traumatic brain injury.
• Hemorrhagic stroke in the pituitary gland or hypothalamus.

TSH during pregnancy

Chorionic gonadotropin has a similar molecular structure with thyroid-stimulating hormone, which determines the activation of the thyroid gland. In the 1st trimester, the concentration of thyroid hormones increases, and TSH decreases.In the future, thyrotropin returns to normal. Therefore, TSH rate strongly depends on the trimester and should be determined exclusively by the attending physician.

A slight deviation from normal values ​​(no more than 5 mU / liter) may develop as a consequence of the transferred psycho-emotional overstrain in a pregnant woman.A persistently elevated TSH concentration during pregnancy can be a sign of the following conditions:

• Inflammation in the thyroid gland.
• Severe gestosis.
• Neoplasms in the organs of the endocrine system.
• Pituitary adenoma.
• Hypotheriosis.
• Adrenal insufficiency.
• Serious diseases of internal organs, etc.

If a low TSH level during pregnancy is detected in the 1st trimester, then the woman does not need to worry.Such a change can be caused by the appearance of signs of toxicosis, often manifested as nausea and vomiting. Normal hormonal indicators appear only in the second trimester, when symptoms decline with toxicosis.

The danger is a decrease in thyroid-stimulating hormone against the background of damage to the endocrine system. Therefore, it is extremely important to regularly monitor the hormonal background and, if even small deviations are detected, seek medical help. Lack of timely medical intervention can lead to miscarriage, premature birth, preeclampsia, fetal hypoxia, growth retardation and child development.

TSH in men

Normal values ​​ TSH in men fully correspond to the norms for non-pregnant women (both in childhood and in adulthood). The causes, symptoms and consequences of these disorders are also similar to those described above. The only symptomatic difference for men is impotence, which can occur against a background of hormonal imbalance. There are also no differences in preparation for the procedure for taking blood serum and the manipulation itself.

Thyroid biopsy | Praetor

The procedure for a biopsy of the thyroid gland consists in the fact that the doctor, using medical instruments, obtains a fragment of tissue from an organ or neoplasm for histological examination of the cells of this tissue. Usually, the procedure takes place under the supervision of an ultrasound machine.

Nodules (nodes) are a very common pathology of the thyroid gland. Formations that have reached sizes over 1 cm are subject to puncture biopsy followed by histological examination for a more accurate diagnosis and early detection of malignant neoplasms.

Under some conditions, your thyroid gland can grow in size. Doctors call it goiter.

Before the procedure, it is recommended to have a blood test (thyroid hormone) to see how well the organ is functioning, and to have an ultrasound scan. If the results are of any concern, your doctor will recommend a biopsy.

What will a thyroid biopsy show?

In most cases, a nodule or goiter is not dangerous.Problems are caused by:

• Cysts, fluid-filled nodules that can cause neck pain or make swallowing difficult. They are very rare cancers, but may still need treatment.
• Graves’ disease (diffuse toxic goiter, Basedow’s disease, hyperthyroidism), causing the thyroid gland to grow and produce too much hormone.
• Hashimoto’s disease (autoimmune thyroiditis), in which an organ is damaged by your immune system, so it produces less hormones than normal and then swells.
• Infection in which a virus causes pain and swelling of the thyroid gland.
• Large thyroid nodules or goiter that are problematic due to their size. They can get into surrounding parts of the body and make it difficult to breathe or swallow.
• Toxic nodules or goiter, which is almost never cancer but can cause the organ to release too much hormone.
• Cancer, which accounts for about 10% of cases.

When is a biopsy necessary?

A biopsy helps the doctor determine the cause of the nodule or goiter. But you don’t need it for all thyroid problems. For example, your symptoms, blood tests, and an ultrasound scan will be enough to determine if you have Graves’ disease.

Your doctor will probably want to check for any nodule larger than 1 centimeter, especially if the ultrasound shows that the nodule is hard, calcium-laden, and has no clear boundaries around it.

You can also have a biopsy without a nodule if you have severe pain and your thyroid gland is growing rapidly.

Types of thyroid biopsy

In most cases, a fine needle aspiration biopsy (TIAPB) is done, but there may be other options.

1. Aspiration. This test uses a small needle. Using an ultrasound scan, the doctor inserts a needle into the neck to take a sample for analysis.You can feel the needle moving slightly. The specialist can repeat this several times to get to different parts of the node or goiter, take samples from nearby lymph nodes. The procedure takes about half an hour.
2. Core biopsy. Similar to aspiration, but with a larger needle. If your doctor isn’t getting clear answers on the aspiration biopsy, this may be a good backup plan.
3. Operating room. Doctors rarely use this method on the thyroid gland.To remove the knot, a hole must be made in the neck. It could even mean removing half of the organ.

Thyroid biopsy results

You can get results in just a few days, although it can take up to 2 weeks. Check with your doctor after your procedure.

What happens next depends on what the research has shown. If it is not cancer and you have no other symptoms, you and your doctor can simply watch; this involves scheduled follow-up visits to check what is happening, such as a change in an existing nodule or a new one.