Thyroid examination – endocrinology

Required for assessing thyroid function and structure In basic research Includes: Hormonal, immunological და Instrumental Investigations.

Hormonal research

Thyroid-stimulating hormone (TSH)
Free thyroxine (fT4)
Free triiodothyronine (fT3)

The purpose of the examination is to determine the functional state of the thyroid gland, detect pathological changes, and assess the effectiveness of current treatment.

The required blood sample is taken from a vein.

TSH (Thyroid Stimulating Hormone) It is not a thyroid hormone, but it plays a crucial role in the functioning of the gland. This hormone is produced by the pituitary gland, an endocrine gland in the brain, and ensures that the thyroid gland produces the following hormones: Thyroxine (T4) and triiodothyronine (T3) Production in adequate and stable quantities.

Functional testing can be conducted in two directions: it is possible to perform only TSH at the first stage and, if a deviation from the norm is detected, then perform other hormonal tests, or from the very beginning, perform TSH + fT4, and if necessary, fT3 tests simultaneously.

The results obtained are reviewed by an endocrinologist in combination with the ultrasound image, and a decision is made about the need for further additional testing.

Possible interpretation of the results:

TSH norm + FT4 norm + FT3 norm _ euthyroidism
High TSH + Normal FT4 + Normal FT3 _ Mild (subclinical) hypothyroidism
TSH high + FT4 low + FT3 low or normal _ hypothyroidism
Low TSH + Normal FT4 + Normal FT3 _ Mild (subclinical) hyperthyroidism
TSH low + FT4 high or normal + FT3 high or normal _ hyperthyroidism
Low TSH + Low FT4 + Low FT3 _ Pituitary (secondary) hypothyroidism

With hypothyroidism Decreased thyroid function is observed;

With hyperthyroidism – pathological activation of thyroid function;

Euthyroidism Yes, the thyroid gland is functioning normally.

Immunological research

Anti-Thyroid Peroxidase Antibodies (Anti-TPO)
Anti-thyroglobulin antibodies (Anti-TG)
Anti-thyroid-stimulating hormone receptor antibodies (TSHr-Ab)

The purpose of the antibody test is to determine the autoimmune nature of the thyroid dysfunction, which determines the specifics of the treatment course. Therefore, the test is indicated for the detection of an enlarged thyroid gland or various functional disorders based on hormonal tests.

In autoimmune diseases, the immune system, which is designed to fight foreign bodies that enter the body, mistakenly attacks its own cells, leading to chronic inflammation, tissue damage, and/or dysfunction.

Thus, thyroid antibodies lead to the development of chronic thyroid diseases, such as chronic autoimmune thyroiditis, or Hashimoto's thyroiditis, and diffuse toxic goiter, or Graves' disease.

Anti-TPO – It is measured in cases of hypothyroidism and is a marker of Hashimoto's thyroiditis. It is also elevated in Graves' disease.
Anti-TG – Elevated in Hashimoto's thyroiditis. The test is also used in the postoperative management of thyroid tumors.
TSHr-Ab – Its increase is associated with Graves' disease and is used for the differential diagnosis of disorders characterized by pathologically increased thyroid function.

It is possible for antibodies to increase in the presence of a completely healthy thyroid gland, which indicates a high risk of developing the disease in the future, so in such cases, it is necessary to monitor the condition of the thyroid gland at certain intervals.

A blood sample is taken from a vein and does not require special preparation.

Instrumental research

Thyroid ultrasound

The method is used to visualize the thyroid gland and its surrounding structures to detect changes in the organ's size, contour, tissue, and blood vessels, and to detect pathological nodular formations.

The most common purposes for using the survey are:

Determine whether a nodular mass found during manual examination of the neck is in the thyroid gland or in the surrounding tissue.
Evaluation of the nodule: Does it have characteristics that indicate its benign nature or, conversely, the need for biopsy?
Clarification of the number of nodular formations
Evaluation of changes in node dimensions in dynamics

Some ultrasound features of a nodule strongly indicate its benign nature, while others raise suspicion that it may be a malignant tumor.
There are also frequent cases when it is impossible for a radiologist to differentiate the nature of a nodule with complete accuracy.
In the first case, periodic ultrasound monitoring is sufficient, while for the last two situations, biopsy of the pathological formation and microscopic examination/evaluation are recommended.

Ultrasound examination cannot determine the functional state of the gland; this requires additional hormonal tests and, in some cases, radionuclide scanning.