Advertisement
Research Article| Volume 4, ISSUE 4, P655-670, December 1984

A Fundamental Approach to the Diagnosis of Diseases of the Thyroid Gland

  • Edward T. Wong
    Correspondence
    Corresponding author: Section of Laboratories and Pathology, Los Angeles County—USC Medical Center, 1200 No. State Street, Los Angeles, California 90033
    Affiliations
    Professor, Department of Pathology, School of Medicine, University of Southern California; Associate Director of Laboratories and Pathology, Los Angeles County—USC Medical Center, Los Angeles, California
    Search for articles by this author
  • Michael W. Steffes
    Affiliations
    Professor and Director, Division of Clinical Chemistry, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
    Search for articles by this author
DOI:https://doi.org/10.1016/S0272-2712(18)30893-X
A Fundamental Approach to the Diagnosis of Diseases of the Thyroid Gland
Previous ArticlePituitary Tumors
Next ArticleControversies in Thyroid Function Testing
      This paper is only available as a PDF. To read, Please Download here.
      Despite the proliferation of thyroid function tests, just three tests, free-T4 index, free-T3 index, and TSH, suffice for the evaluation of the thyroid status of all but a very few patients. In the form of an algorithm the authors outline a logical sequence for the development and interpretation of thyroid function tests that prompts the clinician to integrate the results with clinical assessment.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Bayer M.F.
        Free thyroxine results are affected by albumin concentration and nonthyroidal illness.
        Clin. Chim. Acta. 1983; 130: 391-396
        • Bermudez F.
        • Surks M.I.
        • Oppenheimer J.H.
        High incidence of decreased serum triiodothyronine concentration in patients with nonthyroidal disease.
        J. Clin. Endocrinol. Metab. 1975; 41: 27-40
        • Braun B.-E.
        • Müller M.J.
        • Seitz H.J.
        • et al.
        Clinical value of free-thyroxin measurements.
        Clin. Chem. 1983; 29: 2057-2060
        • Burger A.
        • Suter P.
        • Nicod P.
        • et al.
        Reduced active thyroid hormone levels in acute illness.
        The Lancet. 1976; 1: 653-655
        • Chopra I.J.
        • Solomon D.H.
        • Hepner G.W.
        • et al.
        Misleadingly low free thyroxine index and usefulness of reverse triiodothyronine measurement in nonthyroidal illnesses.
        Ann. Intern. Med. 1979; 90: 905-912
        • Clark F.
        • Horn D.D.
        Assessment of thyroid function by the combined use of serum and protein bound iodine and resin uptake of 125I-triiodothyronine.
        J. Clin. Endocrinol. Metab. 1965; 25: 39-45
        • Cotton G.E.
        • Gorman C.A.
        • Mayberry W.E.
        Suppression of thyrotropin (h-TSH) in serums of patients with myxedema of varying etiology treated with thyroid hormones.
        N. Engl. J. Med. 1971; 285: 529-533
        • dos Remedios L.V.
        • Weber P.M.
        • Feldman R.
        • et al.
        Detecting unsuspected thyroid dysfunction by the free thyroxine index.
        Arch. Intern. Med. 1980; 140: 1045-1049
        • Drake J.R.
        • Miller D.K.
        • Evans R.G.
        Cost-effectiveness of thyroid function tests.
        Arch. Intern. Med. 1982; 142: 1810-1812
        • Dunn J.T.
        • Chapman E.M.
        Rising incidence of hypothyroidism after radioactive-iodine therapy in thyrotoxicosis.
        N. Engl. J. Med. 1964; 271: 1037-1042
        • Eisenberg D.
        • Silberman H.
        • Ryan J.
        • et al.
        Prognostic significance of thyroid function tests in critically ill patients.
        Surg. Forum. 1980; 31: 211-213
        • Ekins R.
        • Edwards P.
        • Jackson T.
        • et al.
        Interpretation of labeled-analog free hormone assay. Letter to Editor.
        Clin. Chem. 1984; 30: 491-493
        • Engler D.
        • Donaldson E.B.
        • Stoekigt J.R.
        • et al.
        Hyperthyroidism without triiodothyronine excess: An effect of severe nonthyroidal illness.
        J. Clin. Endocrinol. Metab. 1978; 46: 77-82
        • Epstein K.A.
        • Schneiderman L.J.
        • Bush J.W.
        • et al.
        The “abnormal” screening serum thyroxine (T4): Analysis of physician response, outcome, cost and health effectiveness.
        J. Chronic Dis. 1981; 34: 175-190
        • Fisher D.A.
        Advances in the laboratory diagnosis of thyroid disease.
        Part I. J. Pediatr. 1973; 82: 1-9
        • Fisher D.A.
        Advances in the laboratory diagnosis of thyroid disease.
        Part II. J. Pediatr. 1973; 82: 187-191
        • Gavin L.
        • Castle J.
        • McMahon F.
        • et al.
        Extrathyroidal conversion of thyroxine to 3,3’,5’-triiodothyronine (Reverse-T3) and to 3,5,3’-triiodothyronine (T3) in humans.
        J. Clin. Endocrinol. Metab. 1977; 44: 733-742
        • Gluck F.B.
        • Nusynowitz M.L.
        • Plymate S.
        Chronic lymphocytic thyroiditis, thyrotoxicosis, and low radioiodine uptake. A report of four cases.
        N. Engl. J. Med. 1975; 293: 624-628
        • Goldie D.J.
        • Jones S.R.
        • Thomas M.J.
        A reappraisal of the free thyroxine index.
        The Lancet. 1981; 2: 572-573
        • Gooch B.R.
        • Isley W.L.
        • Utiger R.D.
        Abnormalities in thyroid function tests in patients admitted to a medical service.
        Arch. Intern. Med. 1982; 142: 1801-1805
        • Gordin A.
        • Lamberg B.A.
        Natural course of symptomless autoimmune thyroiditis.
        The Lancet. 1975; 2: 1234-1237
        • Gordin A.
        • Sarinen T.
        • Telkonen R.
        • et al.
        Serum thyrotrophin and the response to thyrotrophin releasing hormone in symptomless autoimmune thyroiditis, and in borderline and overt hypothyroidism.
        Acta Endocrinol. 1974; 75: 274
        • Gupta M.K.
        • Salazar R.
        • Schumacher O.P.
        A solid phase radioimmunoassay for the measurement of free thyroxine.
        Am. J. Clin. Pathol. 1983; 79: 334-340
        • Hershman J.M.
        Clinical application of thyrotropin-releasing hormone.
        N. Engl. J. Med. 1974; 290: 886-890
        • Jackson I.D.M.
        “Hyper-thyroiditis”—A diagnostic pitfall.
        N. Engl. J. Med. 1975; 293: 661-662
        • Kaplan M.M.
        • Larsen P.R.
        • Crantz F.R.
        • et al.
        Prevalence of abnormal thyroid function test results in patients with acute medical illness.
        Am. J. Med. 1982; 72: 9-16
        • Kaptein E.M.
        • Grieb D.A.
        • Spencer C.A.
        • et al.
        Thyroxine metabolism in the low thyroxine state of critical nonthyroidal illnesses.
        J. Clin. Endocrinol. Metab. 1981; 53: 764-771
        • Kaptein E.M.
        • Weiner J.M.
        • Robinson W.J.
        • et al.
        Relationship of altered thyroid hormone indices to survival in nonthyroidal illnesses.
        Clin. Endocrinol. 1982; 16: 565-574
        • Mayberry W.E.
        • Gharib H.
        • Bilstad J.M.
        • et al.
        Radioimmunoassay for human thyrotropin. Clinical value in patients with normal and abnormal thyroid function.
        Ann. Intern. Med. 1971; 74: 471-480
        • Melmed S.
        • Geola F.L.
        • Reed A.W.
        • et al.
        A comparison of methods for assessing thyroid function in nonthyroidal illness.
        J. Clin. Endocrinol. Metab. 1982; 54: 300-306
        • Morley J.E.
        • Slag M.F.
        • Elson M.K.
        • et al.
        The interpretation of thyroid function tests in hospitalized patients.
        J.A.M.A. 1983; 249: 2377-2379
        • Nofal M.M.
        • Beierwaltes W.H.
        • Patno M.E.
        Treatment of hyperthyroidism with sodium iodide I 131. A 16 year experience.
        J.A.M.A. 1966; 197: 605-610
        • Nusynowitz M.L.
        • Young R.L.
        Thyroid dysfunction in the ailing, aging and aberrant.
        J.A.M.A. 1979; 242: 275-276
        • Oppenheimer J.H.
        • Schwartz H.L.
        • Surks M.I.
        • et al.
        Nuclear receptors and the initiation of thyroid hormone action.
        Recent Prog. Horm. Res. 1976; 32: 529-558
        • Schimmel M.
        • Utiger R.D.
        Thyroidal and peripheral production of thyroid hormones. Review of recent findings and their clinical implications.
        Ann. Intern. Med. 1977; 87: 760-768
        • Slag M.F.
        • Morley J.E.
        • Elson M.K.
        • et al.
        Hypothyroxinemia in critically ill patients as a predictor of high mortality.
        J.A.M.A. 1981; 245: 43-45
        • Slag M.F.
        • Morley J.E.
        • Elson M.K.
        • et al.
        Free thyroxine levels in critically ill patients. A comparison of currently available assays.
        J.A.M.A. 1981; 246: 2702-2706
        • Stein R.B.
        • Price L.
        Evaluation of adjusted total thyroxine (free thyroxine index) as a measure of thyroid function.
        J. Clin. Endocrinol. Metab. 1972; 34: 225-228
        • Stock J.M.
        • Surks M.I.
        • Oppenheimer J.H.
        Replacement dosage of L-thyroxine in hypothyroidism.
        A reevaluation. N. Engl. J. Med. 1974; 290: 529-533
        • Stoekigt J.R.
        • De Garis M.
        • Csicsmann J.
        • et al.
        Limitations of a new free thyroxine assay (Amerlex free T4).
        Clin. Endocrinol. 1981; 15: 313-318
        • Surks M.E.
        • Schadlow A.R.
        • Stock J.M.
        • et al.
        Determination of iodothyronine absorption and conversion of L-thyroxine (T4) to L-triiodothyronine (T3) using turnover rate techniques.
        J. Clin. Invest. 1973; 52: 805-811
        • Symons R.G.
        • Walichnowski C.M.
        • Murphy L.J.
        Effectiveness of analysis of free thyroxin concentration in serum for diagnosis of covert thyroid disease.
        Clin. Chem. 1982; 28: 266-270
        • Vagenakis A.G.
        • Braverman L.E.
        Thyroid function tests—which one?.
        Ann. Intern. Med. 1976; 84: 607-608
        • Vallotton M.B.
        • Petrell J.Y.
        • Forbes A.P.
        Distinction between idiopathic primary myxedema and secondary pituitary hypothyroidism by presence of circulating thyroid antibodies.
        J. Clin. Endocrinol. Metab. 1967; 27: 1-10
        • Wartofsky L.
        • Burman K.D.
        Alterations in thyroid function in patients with systemic illness. The “euthyroid sick syndrome.”.
        Endocrine. Rev. 1982; 3: 164-217
        • Wellby M.L.
        • Guthrie L.
        • Reilly C.P.
        Evaluation of a new free thyroxin assay.
        Clin. Chem. 1981; 27: 2022-2024
        • White G.H.
        • Walmsley R.N.
        Can the initial clinical assessment of thyroid function be improved?.
        The Lancet. 1978; 2: 933-935
        • Wilke T.J.
        Five kits for establishing free thyroxin concentration in serum evaluated and correlated with other indices of thyroid status.
        Clin. Chem. 1982; 28: 2051-2056
        • Wilkins T.A.
        • Midgley J.E.M.
        Interpretation of free thyroxine radioassay data.
        Letter. The Lancet. 1982; 2: 324
        • Wong E.T.
        • Bradley S.G.
        • Schultz A.L.
        Elevations of thyroid-stimulating hormone during acute nonthyroidal illness.
        Arch. Intern. Med. 1981; 141: 873-875
        • Wong E.T.
        • McCarron M.M.
        • Shaw S.T.
        Ordering of laboratory tests in a teaching hospital. Can it be improved?.
        J.A.M.A. 1983; 249: 3076-3080
        • Wong E.T.
        • Shultz A.L.
        Changing values for the normal thyroid radioactive iodine uptake test.
        J.A.M.A. 1977; 238: 1741-1743

      53. Screening for thyroid disease. Editorial. The Lancet, 2:128-130, 1981

      54. Thyroid Function Tests—Progress and Problems. Editorial. The Lancet, 1:164-165, 1983

      Article info

      Identification

      DOI: https://doi.org/10.1016/S0272-2712(18)30893-X

      Copyright

      © 1984 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX