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Thyroid Disease Testing

Thyroid disease refers to any dysfunction of the thyroid gland. This dysfunction may be due to a variety of etiologies, including autoimmune processes (eg, Graves disease, Hashimoto disease), thyroid cancer, specific drugs (eg, amiodarone, kinase inhibitors, lithium), viral infection, or iodine deficiency, among other causes. Thyroid disease is classified as hypothyroidism (insufficient thyroid hormone) or hyperthyroidism (excess thyroid hormone). Because the clinical signs and symptoms of thyroid disease are nonspecific, laboratory testing is required for diagnosis. Accurate diagnosis is required for appropriate treatment. Laboratory testing for thyroid disease in pregnancy is particularly challenging, and testing recommendations differ from those for nonpregnant patients. The preferred initial test for thyroid disease is thyroid stimulating hormone (TSH) with reflex to free thyroxine (free T4) testing. Results from these tests are used to guide additional testing.

Initial Evaluation of Thyroid Function

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Analytical Considerations in the Evaluation of Thyroid Function

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Hypothyroidism

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Thyrotoxicosis - Hyperthyroidism

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Thyroid Disease in Pregnancy

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Autoimmune Thyroiditis

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Thyroid Nodules

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Thyroid Cancer

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Medical Experts

Contributor

Straseski

Joely A. Straseski, PhD, MS, MT(ASCP), DABCC, FAACC

Joely A. Straseski, PhD, MS, MT(ASCP), DABCC, FAACC

Professor of Pathology (Clinical), University of Utah

Section Chief, Chemistry; Medical Director, Endocrinology; Co-Director, Automated Core Laboratory, ARUP Laboratories

References

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Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: an integrated approach. Am Fam Physician. 2014;90(6):389-396.

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Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician. 2012;86(3):244-251.

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Kravets I. Hyperthyroidism: diagnosis and treatment. Am Fam Physician. 2016;93(5):363-370.

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Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421.

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Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028.

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Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315-389.

Last Update: October 2022 Content Review: December 2020