Thyroid Disorders Testing Algorithm
[Pages:1]Thyroid Disorders Testing
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INDICATIONS FOR TESTING Increased or decreased metabolism (heat or cold intolerance, weight loss or gain,
depression, anxiety, etc) Family history of autoimmune thyroiditis Goiter on physical exam
Low TSH ? suggests hyperthyroidism
ORDER Thyroid Stimulating Hormone with Reflex
to Free Thyroxine
Normal TSH and free T4
High TSH ? suggests
hypothyroidism
Low free T4
Central hypothyroidism Severe illness
Thyroid disease unlikely
Primary hypothyroidism Thyroid ablation removal Euthyroid sick syndrome Transient thyroiditis
Low free T4
Normal free T4
Euthyroid sick syndrome
Subclinical hyperthyroidism
Drug interference
If still concerned with hyperthyroidism, ORDER
Triiodothyronine, Total (Total T3)
Thyroid hormone resistance
TSH resistance TSH secreting adenoma
High free T4
Normal
High
High free T4
Hyperthyroidism
Hyperthyroidism unlikely
T3 hyperthyroidism
Subclinical hypothyroidism Euthyroid sick syndrome Transient thyroiditis Autoimmune thyroiditis
Normal free T4
ORDER Thyroid Stimulating Immunoglobulin (TSI)
Thyroid Peroxidase (TPO) Antibody Thyroid Stimulating Hormone Receptor Antibody (TRAb)
TSI Ab+ TPO+ TRAb+
Clinical indications of Graves ophthalmologic
disease present
Diffuse thyroid gland enlargement
TPO AbTSI Ab-
CONSIDER Thyroid Antibodies Triiodothyronine, Total (Total T3) T3 by dialysis
Normal T3
Low T3
Positive antibodies
Negative antibodies
Graves disease
Probable toxic nodule/s
Hypothyroidism
T3
Automimmune Thyroid disease
unlikely
hypothyroidism thyroid disease
unlikely
Facilitate treatment decisions CONSIDER
Radioiodine thyroid scan and % uptake
? 2006 ARUP Laboratories. All Rights Reserved.
Last updated: November 2018
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