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Interpreting Thyroid Function Tests

Pt Info:CC: palpitations82 y/o F presents with hyperactivity, sweating, palpitations, wt loss, insomnia, moist skin, fine hair, irregular menses, diarrheaPE: tachy, elevated SBP, damp skin, lid lag, hyperreflexive DTRLabs: CBC wnl, BMP wnl, TSH <0.01 (L), T4 4.1 (H), T3 wnl. Objectives. Patho

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Interpreting Thyroid Function Tests

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    1. Interpreting Thyroid Function Tests DOMMR Rozina Mithani

    2. Pt Info: CC: palpitations 82 y/o F presents with hyperactivity, sweating, palpitations, wt loss, insomnia, moist skin, fine hair, irregular menses, diarrhea PE: tachy, elevated SBP, damp skin, lid lag, hyperreflexive DTR Labs: CBC wnl, BMP wnl, TSH <0.01 (L), T4 4.1 (H), T3 wnl

    3. Objectives Pathophysiology Thyrotoxicosis Hypothyroid

    4. Hormone Regulation TRH ? TSH iodine uptake, organification synthesis & release of thyroid hormone T4/T3 Regulate: basal metabolism, thermogenesis, lipogenesis fetal CNS development

    5. Thyroid Hormones Thyroxine (T4) Thyroid gland t1/2: 8 days Triiodothyronine (T3) 80% in Periphery Liver/kidney remove iodine from T4 Regulate Thyroid Hormone-dependent genes t1/2: 1-1.5 days T4 ? T3 Decreased: Meds: propranolol, PTU, corticosteroids, amiodarone Illness: cytokine mediated

    6. Binding Proteins T4/T3 99% protein bound Prevents excess tissue uptake Maintains accessible reserve Thyroxine-binding globulin (TBG) - 70% Inc: E2, 5-FU, Methadone, Tamoxifen Dec: Androgens, Corticosteroids, Niacin Albumin – 15-20% Transthyretin – 10-15%

    7. TFTs

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