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Get enhanced insights for diagnosing and managing thyroid disorders

Thyroid disorders have many etiologies, manifestations, and potential therapies. Quest Diagnostics offers solutions that can help you diagnose, treat, and monitor every type of thyroid disease.

Get guideline-based thyroid testing from the lab that knows endocrinology

Testing from Quest Diagnostics can help you diagnose, treat, monitor, and prevent complications related to every type and etiology of thyroid disease. Quest’s broad range of endocrinology tests are aligned to the most recent clinical practice guidelines—including those from the American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE)—for better disease management.

Key thyroid tests from Quest

Test Code Test Name Recommended Clinical Use
899 TSH Detects TSH levels for differential diagnosis of primary, secondary, and tertiary hypothyroidism; also useful in screening for hyperthyroidism
867 T4 (Thyroxine), Total Used to help diagnose hypothyroidism and hyperthyroidism
861 T3 Uptake Used with measurement of thyroxine (T4) to calculate the free T4 index to assess thyroid diseases
866 T4 Free (FT4) Used to diagnose hypothyroidism and hyperthyroidism
35167 T4 Free, Direct Dialysis Used for the differential diagnosis of euthyroid hyperthyroxinemia from hyperthyroidism or for the differential diagnosis of euthyroid hypothyroxinemia from hypothyroidism
7444 Thyroid Panel with TSH Includes T3 Uptake; T4 (Thyroxine), Total; Free T4 Index (T7); TSH A complete panel used to diagnose hypothyroidism and hyperthyroidism
7260 Thyroid Peroxidase and Thyroglobulin Antibodies Useful in the diagnosis and management of a variety of thyroid disorders, including autoimmune thyroiditis, Hashimoto’s disease, Graves’ Disease, and certain types of goiter
90810 Thyroglobulin, LC/MS/MS Used in the detection of residual or recurrent thyroid cancer
30551 TSI (Thyroid Stimulating Immunoglobulin) Used to detect Graves’ disease; can also assist in predicting hyperthyroidism in neonates
5738 TRAb (TSH Receptor Binding Antibody) Used to diagnose and manage Graves’ disease, neonatal hypothyroidism, and postpartum thyroid dysfunction
90814 Thyroid Cancer (Thyroglobulin) Monitor If thyroglobulin antibody is negative, thyroglobulin is tested on the Beckman Coulter DxI; if thyroglobulin antibody is positive, thyroglobulin is tested by LC/MS/MS Used for the determination of thyroglobulin autoantibodies, with subsequent measurement of thyroglobulin
Thyroid disorders and causes

Hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) are the most common thyroid disorders. Common causes of these disorders include immune system disorders Graves’ disease, for hyperthyroidism, and Hashimoto’s disease, for hypothyroidism.

Hypo- and hyperthyroidism: symptoms, risk factors, and complications
Disorder Signs and symptoms2 Risk factors2-10 Complications11-14
Hypothyroidism Poor memory and concentration Hoarseness Slow pulse rate Delayed reflex relaxation Cold extremities/feeling cold Carpal tunnel syndrome Fatigue Weight gain and poor appetite Hair loss Shortness of breath Constipation Female sex Middle age (>50) Family history of thyroid or other autoimmune diseases Other autoimmune disorders Goiter High levels of low-density lipoprotein Heart disease Enlarged heart Mental health issues Myxedema (in rare cases) Birth defects
Hyperthyroidism Nervousness or irritability Fatigue/muscle weakness Heat intolerance Trouble sleeping Hand tremors Irregular heartbeat Weight loss Frequent bowel movements/diarrhea Goiter Graves’ ophthalmopathy Age 20–40 years Family history Female sex Other autoimmune disorders Pregnancy Smoking Physical/emotional stress Heart rhythm disorders Congestive heart failure Thyroid stor
When to screen for hypo- and hyperthyroidism

Hypothyroidism14

ATA/AACE guidelines recommend screening for all patients with symptoms of hypothyroidism. For patients who are asymptomatic, recommendations vary widely. However, a thyroid-stimulating hormone (TSH) test is generally recommended for patients ≥50–60 years old, especially women.

Guidelines also state that there is compelling evidence to support screening in patients with:

  • Autoimmune disease (e.g., type 1 diabetes)
  • Pernicious anemia
  • Family history
  • History of neck radiation
  • History of thyroid surgery
  • Abnormal thyroid examination
  • Psychiatric disorders, including patients taking amiodarone or lithium
  • Hypertension, cardiac dysrhythmia, or congestive heart failure

View the complete hypothyroidism screening and diagnosis algorithm.

Hyperthyroidism15

ATA/AACE guidelines recommend screening for all patients with symptoms of hyperthyroidism. Once a diagnosis is made, the etiology should be determined.

Monitoring thyroid disorder—and avoiding complications

Hypothyroidism14

ATA/AACE provide guidelines for managing hypothyroidism in:

  • Patients with overt hypothyroidism on levothyroxine therapy
  • Patients with secondary hypothyroidism
  • Patients with type 1 diabetes
  • Pregnant patients with overt hypothyroidism on levothyroxine therapy
  • Hypothyroid pregnant patients with a history of Graves’ disease who were treated with radioactive iodine or thyroidectomy

Hypothyroidism15

ATA/AACE provide guidelines for managing hyperthyroidism in:

  • Patients on antithyroid medication (ATD), most commonly methimazole (MMI)
  • Patients on radioactive iodine
  • Patients with drug-associated thyrotoxicosis
  • Patients with amiodarone-induced thyrotoxicosis
  • Pregnant patients
  • Patients who undergo surgery

References

  1. American Thyroid Association. General information/press room. Available at www.thyroid.org/media-main/about-hypothyroidism. Accessed March 30, 2018.
  2. Nussey S, Whitehead S. Chapter 3: The thyroid gland. Endocrinology: An Integrated Approach. Oxford: BIOS Scientific Publishers; 2001.
  3. Pramyothin P, Leung AM, Pearce EN, et al. Clinical problem-solving. A hidden solution. N Engl J Med. 2011;365(22):2123–2137.
  4. Ginsberg J, Lewanczuk RZ, Honore LH. Hyperplacentosis: A novel cause of hyperthyroidism. Thyroid. 2001;11:393–396.
  5. Patil-Sisodia K, Mestman JH. Graves hyperthyroidism and pregnancy: A clinical update. Endocr Pract. 2010;16(1):118–129.
  6. Flynn RV, MacDonald TM, Morris AD, et al. The thyroid epidemiology, audit and research study; thyroid dysfunction in the general population. J Clin Endocrinol Metab, 2004;89:3879–3884.
  7. Tamai H, Kasagi K, Takaichi Y. Development of spontaneous hypothyroidism in patients with Graves’ disease treated with antithyroidal drugs: clinical, immunological, and histological findings in 26 patients. J Clin Endocrinol Metab. 1989;69(1):49–53.
  8. Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med. 1991;325(9):599–605.
  9. Buisset E, Leclerc L, Lefebvre J-L, et al. Hypothyroidism following combined treatment for hypopharyngeal and laryngeal carcinoma. Am J Surg. 1991;162:345–347.
  10. UCLA Endocrine Surgery Encyclopedia. Secondary hypothyroidism. Available at www.uclahealth.org/endocrine-center/hypothyroidism-secondary. Accessed March 30, 2018.
  11. DeGroot LJ. Graves’ disease and the manifestations of thyrotoxicosis. 2015. Available at www.ncbi.nlm.nih.gov/books/NBK285567. Accessed March 30, 2018.
  12. Ginsburg J. Diagnosis and management of Graves’ disease. CMAJ. 2003;168(5):575–585.
  13. Stern RA, Robinson B, Thorner AR, et al. A survey study of neuropsychiatric complaints in patients with Graves’ disease. J Neuropsychiatry Clin Neurosci. 1996;8(2):181–185.
  14. 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.
  15. American Thyroid Association. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016:26(10):1343–1423.

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