Goiter laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with | Patients with goiter may be in a [[euthyroid]], [[hypothyroid]] or [[hyperthyroid]] state. Patients should be evaluated for free [[T4]], [[T3]], [[TSH]] levels and [[Thyroid peroxidase|TPO]] [[antibodies]]. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
'''Thyroid function tests:''' | '''Thyroid function tests:''' | ||
*Patients with | *Patients with goiter may be in a [[euthyroid]], [[hypothyroid]] or [[hyperthyroid]] state. | ||
*When the serum [[TSH]] is below normal levels, then the serum free [[T4]] and [[T3]] should should be evaluated. The most likely diagnosis in patients with overt or subclinical hyperthyroidism and goiter is either [[Multinodular goiter]] (MNG) or [[Grave's disease]]. | *When the serum [[TSH]] is below [[normal]] levels, then the serum free [[T4]] and [[T3]] should should be evaluated. The most likely diagnosis in patients with overt or subclinical [[hyperthyroidism]] and goiter is either [[Multinodular goiter]] (MNG) or [[Grave's disease]]. | ||
*When the [[TSH]] is above normal levels, then the free [[T4]] should be evaluated. [[Hashimoto's thyroiditis]] is the most probable diagnosis in patients presenting with overt or subclinical hypothyroidism, except for patients for those in the areas of iodine deficiency leading to endemic goiter. | *When the [[TSH]] is above [[normal]] levels, then the free [[T4]] should be evaluated. [[Hashimoto's thyroiditis]] is the most probable diagnosis in patients presenting with overt or subclinical [[hypothyroidism]], except for patients for those in the areas of [[iodine deficiency]] leading to endemic goiter. | ||
*'''Thyroid peroxidase antibodies ([[Thyroid peroxidase|TPO]]):''' <ref name="Ris-StalpersBikker2010">{{cite journal|last1=Ris-Stalpers|first1=Carrie|last2=Bikker|first2=Hennie|title=Genetics and phenomics of hypothyroidism and goiter due to TPO mutations|journal=Molecular and Cellular Endocrinology|volume=322|issue=1-2|year=2010|pages=38–43|issn=03037207|doi=10.1016/j.mce.2010.02.008}}</ref> | *'''Thyroid peroxidase antibodies ([[Thyroid peroxidase|TPO]]):''' <ref name="Ris-StalpersBikker2010">{{cite journal|last1=Ris-Stalpers|first1=Carrie|last2=Bikker|first2=Hennie|title=Genetics and phenomics of hypothyroidism and goiter due to TPO mutations|journal=Molecular and Cellular Endocrinology|volume=322|issue=1-2|year=2010|pages=38–43|issn=03037207|doi=10.1016/j.mce.2010.02.008}}</ref> | ||
**In patients with goiter, serum [[Thyroid peroxidase|TPO]] antibodies have to be evaluated. In patients with goiter and and normal [[TSH]] levels, [[Thyroid peroxidase|TPO]] antibodies are measured to rule out [[Hashimoto's thyroiditis]]. | **In patients with goiter, serum [[Thyroid peroxidase|TPO]] [[antibodies]] have to be evaluated. In patients with goiter and and normal [[TSH]] levels, [[Thyroid peroxidase|TPO]] [[antibodies]] are measured to rule out [[Hashimoto's thyroiditis]]. | ||
**In the United States, [[Thyroid peroxidase|TPO]] antibodies are mostly elevated in patients with elevated [[TSH]] (hypothyroidism) and goiter, and the most likely diagnosis is [[Hashimoto's thyroiditis]]. | **In the [[United States]], [[Thyroid peroxidase|TPO]] [[antibodies]] are mostly elevated in patients with elevated [[TSH]] ([[hypothyroidism]]) and goiter, and the most likely diagnosis is [[Hashimoto's thyroiditis]]. | ||
*The following laboratory testing should be carried out for: | *The following laboratory testing should be carried out for: | ||
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**Serum [[cholesterol]] | **Serum [[cholesterol]] | ||
**Thyroid [[scintigraphy]] | **Thyroid [[scintigraphy]] | ||
*Anti-[[Thyroid peroxidase|TPO]] | *Anti-[[Thyroid peroxidase|TPO]] [[antibodies]] detected in most [[Autoimmune thyroid diseases|autoimmune thyroid disease]] (eg, [[Hashimoto's thyroiditis]], idiopathic [[Myxedema]], and [[Grave's disease]]) | ||
*Urinary | *Urinary iodine levels less than 10 mcg/dL is suggestive of [[iodine deficiency]] | ||
==References== | ==References== | ||
Revision as of 16:49, 13 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients with goiter may be in a euthyroid, hypothyroid or hyperthyroid state. Patients should be evaluated for free T4, T3, TSH levels and TPO antibodies.
Laboratory Findings
Thyroid function tests:
- Patients with goiter may be in a euthyroid, hypothyroid or hyperthyroid state.
- When the serum TSH is below normal levels, then the serum free T4 and T3 should should be evaluated. The most likely diagnosis in patients with overt or subclinical hyperthyroidism and goiter is either Multinodular goiter (MNG) or Grave's disease.
- When the TSH is above normal levels, then the free T4 should be evaluated. Hashimoto's thyroiditis is the most probable diagnosis in patients presenting with overt or subclinical hypothyroidism, except for patients for those in the areas of iodine deficiency leading to endemic goiter.
- Thyroid peroxidase antibodies (TPO): [1]
- In patients with goiter, serum TPO antibodies have to be evaluated. In patients with goiter and and normal TSH levels, TPO antibodies are measured to rule out Hashimoto's thyroiditis.
- In the United States, TPO antibodies are mostly elevated in patients with elevated TSH (hypothyroidism) and goiter, and the most likely diagnosis is Hashimoto's thyroiditis.
- The following laboratory testing should be carried out for:
- Serum TSH
- Serum T3
- Serum T4
- Serum thyroglobulin
- Serum cholesterol
- Thyroid scintigraphy
- Anti-TPO antibodies detected in most autoimmune thyroid disease (eg, Hashimoto's thyroiditis, idiopathic Myxedema, and Grave's disease)
- Urinary iodine levels less than 10 mcg/dL is suggestive of iodine deficiency
References
- ↑ Ris-Stalpers, Carrie; Bikker, Hennie (2010). "Genetics and phenomics of hypothyroidism and goiter due to TPO mutations". Molecular and Cellular Endocrinology. 322 (1–2): 38–43. doi:10.1016/j.mce.2010.02.008. ISSN 0303-7207.