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Similar endocrine phenotypes are observed in fetal life and in hibernating mammals. [2] The most common hormone pattern in nonthyroidal illness syndrome is low total and free T3, elevated rT3, and normal T4 and TSH levels, although T4 and TSH suppression may occur in more severe or chronic illness. [3]
TSH levels are determined by a classic negative feedback system in which high levels of T3 and T4 suppress the production of TSH, and low levels of T3 and T4 increase the production of TSH. TSH levels are thus often used by doctors as a screening test, where the first approach is to determine whether TSH is elevated, suppressed, or normal. [25]
Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid. [1] TFTs may be requested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy.
The syndrome can present with variable symptoms, even between members of the same family harboring the same mutation. [1] Typically most or all tissues are resistant to thyroid hormone, so despite raised measures of serum thyroid hormone the individual may appear euthyroid (have no symptoms of over- or underactivity of the thyroid gland).
The diagnosis of hyperthyroidism is confirmed by blood tests that show a decreased thyroid-stimulating hormone (TSH) level and elevated T 4 and T 3 levels. TSH is a hormone made by the pituitary gland in the brain that tells the thyroid gland how much hormone to make. When there is too much thyroid hormone, the TSH will be low.
Most people with thyroid cancer do not have symptoms at the time of diagnosis and thyroid nodules and thyroid cancer is usually found incidentally on imaging of the neck. [ 10 ] [ 14 ] Up to 65% of adults have small nodules in their thyroids, but typically under 10% of these nodules are found to be cancerous. [ 15 ]
The diagnosis may be suspected based on symptoms and confirmed with blood tests and radioiodine uptake. [1] [4] Typically, blood tests show a raised T 3 and T 4, low TSH, increased radioiodine uptake in all areas of the thyroid, and TSI antibodies. [4] The three treatment options are radioiodine therapy, medications, and thyroid surgery. [1]
Typically, Free T 4 is the preferred test for hypothyroidism, [69] as Free T 3 immunoassay tests are less reliable at detecting low levels of thyroid hormone, [70] and they are more susceptible to interference. [69] Free T 4 levels will usually be lowered, but sometimes might be normal. [71]
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