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1. In vitro methods: 1.1. Basal hormone determinations 1.2. Dinamic tests 1.3. Other specific laboratory findings
2. In vivo methods: 2.1. Radioactive iodine uptake: RAIU (thyroid Tc-uptake) 2.2. Thyroid scintigraphy: TSG 2.3. Thyroid ultrasound 2.4. Fine-needle aspiration biopsy: FNAB 3. Nonspecific investigations
During systemic illness normal or fT4 with TSH in the acute phase and in the recovery phase. Dopamine or glucocorticoid administration TSH , normal fT4 and fT3.
1. In vitro investigations
1.1. Basal hormonal assessments: TSH fT4, FT4 - free-T4; total T4 fT3, FT3 - free T3; total T3
A. Serum TSH: normal range: 0.5-4.5 mIU/L Diagnostical value (interpretation of pathological values): TSH : primary hypothyroidism (subclinical or overt form) TSH-secreting pituitary adenoma Refetoff syndrome (thyroid hormone resistance) TSH : hyperthyroidism central hypothyroidism systemic illness Dopamine or glucocorticoid administration
B. Serum free-T4 (fT4, FT4) normal range: 0.8-2 ng/dL or 0.7-2.5 ng/dL 9-30 pmol/L Diagnostical value (interpretation of pathological values): fT4 : overt hyperthyroidism TSH-secreting pituitary adenoma fT4 : overt hypothyroidism (primary or central) Refetoff syndrome
C.Serum T3 or free-T3: normal range: 0,5-1,5 ng/mL or 0,2 0,5 ng/dL 3-8 pmol/L Diagnostical value only in hyperthyroidism: fT3 and fT4 : overt hyperthyroidism fT3 and fT4 normal: overt hyperthyroidism with T3
high fT4
fT4 low
Central hypothyroidism
N
Subclin. hyperthyroidism
low
Overt primary hypothyroidism
N
Subclin. primary hypothyroidism
high
TSHsecreting pituitary adenoma/ Resitance to TH
A. TRH stimulation test B. TSH stimulation test (Queridos test) C. T3 suppression test (Werner s test)
A. TRH stimulation test - TRH 200-400 g iv. - TSH measure at 0, 20, 30, 60 Interpretation: - N: stimulated TSH 7mIU/L
- exaggerated response: I. hypothyroidism
exaggerated response, but tardive and prolonged: III hypothyr. low or absent response: II. hypothyroidism or high thyroid hormone levels: hyperthyroidism or exogenous thyroid hormones.
Thyroglobulin (TG): - to show the remnant thyroid tissue or recurrence (in thyroid bed or
metastases) in case of thyroid cancer after total thyroidectomy - differential diagnosis between hyperthyroidism (TG) and exogenous thyroid hormone in excess (TG ) - diagnostic value in congenital myxedema (TG )
Tumor markers:
- TG (in thyroid cancer, see above) - calcitonin: normal range < 1.5 ng/L, high in MTC - nonspecific tumormarker: ACE carcinoembryonic ag. (MTC)
2. In vivo investigations: 2.1. Radioactive iodine uptake: RAIU - determines the intrathyroidal iodine turnover - a jeun 10 Ci I131 or 40 Ci I123 - RIAU normal range:
I123 : 6h = 5-15% 24h= 8-30% I131 : 2h= 20 5% 24h= 40 5% 48h= lower with 5-15% to the value at 24h Tc99m: 0.5-3% RIAU : hyperthyroidism iodine deficient goiter RIAU : acompanying thyroiditis thyroid hormone administration iodine exposure hypothyroidism, lack of thyroid tissue
Terms: - thyroid nodules: - isofunctional nodule - hyperfunctional or hot nodule high uptake - hypofunctional or cold nodule low or absent uptake - compensated autonomous thyroid adenoma - decompensated autonomous thyroid adenoma Contraindications: - pregnancy, nursing mother - 6 months before conception - suckling, infancy - only for I131
Japanese flag aspect decompensated autonomous adenoma, hot nodule with a cold part, surrounded by the inhibited thyroid tissue
Hot nodul in right lobe, inhibited intact thyroid tissue decompensated autonomous adenoma aspect of Japanese flag
Thyroid nodules
Hashimotos thyroiditis
PET CT
Elastography
- benign: about 70 % out of results; - malignant: 1- 5 %; - suspected, follicular lesion: 11-13%; - inadequate, non-diagnostic: 11-13%.
The sensibility and specificity is 90%.