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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 TRH test involves administration of a small amount of TRH intravenously, [1] following which levels of TSH will be measured at several subsequent time points using samples of blood taken from a peripheral vein. [citation needed] The test is used in the differential diagnosis of secondary and tertiary hypothyroidism.
Thyroid-stimulating hormone (also known as thyrotropin, thyrotropic hormone, or abbreviated TSH) is a pituitary hormone that stimulates the thyroid gland to produce thyroxine (T 4), and then triiodothyronine (T 3) which stimulates the metabolism of almost every tissue in the body. [1]
A fasting response is common in critical illness. NTIS as a result of fasting may be regarded as a healthy and adaptive mechanism that reduces energy expenditure. [10] Fasting in healthy, euthyroid people causes reduced T3 and elevated rT3, although TSH is usually unchanged. [3] [5] [10] Even moderate weight loss can lower T3. [2]
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]
The first laboratory test to be helpful in assessing thyroid status was the serum protein-bound iodine, which came into use around the 1950s. In 1971, the thyroid stimulating hormone (TSH) radioimmunoassay was developed, which was the most specific marker for assessing thyroid status in patients. [81]
It was originally developed to deliver a method for fast screening for resistance to thyroid hormone. [1] [2] Today it is also used to get an estimate for the set point of thyroid homeostasis, [3] especially to assess dynamic thyrotropic adaptation of the anterior pituitary gland, including non-thyroidal illnesses. [4]
In sub-clinical hyperthyroidism, serum TSH is abnormally low, but T4- and T3-levels fall within laboratory reference ranges. [47] It primarily affects the skeleton and the cardiovascular system (abnormalities in other systems have also been reported), in a similar but less severe and less frequent way than overt hyperthyroidism does.
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