#thyroid function tests

Standard Tests

TSH levels

Free T4 (fT4) levels

Measurements of total T4 + T3 used to be common however detects both bound and free T3 + T4

Elevated total T4 may occur in healthy individuals if there is an increase in binding protein concentrations

Reliable tests now exist for free T4 + T3

T3 = 3.9-6.7 pmol/L

T4 = 12-22 pmol/L

Thyroid-stimulating hormone

Produced by the pituitary gland, not the thyroid, however:

TSH levels are controlled by negative feedback – can be indication of thyroid function (changes in T3+T4 will result in changes in TSH to try compesate)

TSH levels greatly elevated in hypothyroidism – >10 fold increase over reference values

More sensitive marker than decreased fT4 - increased TSH occurs before fT4 decreases

TSH levels greatly supressed in hyperthyroidism

Low concentrations can also occur in non-thyroidal illness

TSH measurement is the first-line test of thyroid function.

Free T4 + T3 Measurements

Desirable as free hormone is clinically relevant

Total levels can change under conditions that alter thyroxine-binding globulin (TBG) levels e.g. pregnancy

Large changes in TBG may still affect fT4 + fT3 levels

fT3 levels often normal in hypothyroidism

fT3 levels usually raised more than fT4 levels in hyperthyroidism

Unless complicated by an illness effecting conversion of T4 to T3

Therefore: – fT4 levels are a better indication of hypothyroidism

fT3 levels are a better indication of hyperthyroidism

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Thyroid Function Tests-It’s More Than Just TSH

Understanding thyroid function tests can be intimidating. How do you know if what they are testing for is what you need? I know from experience that most doctors will only test TSH levels, but that only tells part of your story!

There can be several reasons why your thyroid isn’t functioning as it should. But one test that shows how much thyroid hormone is in your system does not tell the…