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Contents
Guidelines development group 4
Notes on the development and use of the guidelines 5
Types of evidence and the grading of recommendations 7
Abbreviations 8
Presentation conventions 9
Acknowledgements 10
1. Introduction
1.1 Thyroid disease 11
1.2 Thyroid function tests 11
1.3 The patient perspective 11
1.4 The physician perspective 12
1.5 The laboratory perspective 12
1.6 The need for national guidelines 12
2. Indications for thyroid function testing
2.1 Introduction 15
2.2 Screening for thyroid dysfunction 15
2.2 Surveillance of thyroid function 20
2.3 Monitoring of thyroid function 22
3. Hypothyroidism
3.1 Primary hypothyroidism 24
3.2 Subclinical (mild) hypothyroidism 27
3.3 Secondary hypothyroidism 28
3.4 Congenital hypothyroidism 30
4. Hyperthyroidism
4.1 Primary hyperthyroidism 32
4.2 Subclinical (mild) hyperthyroidism 36
4.3 Inappropriate TSH 37
5. Thyroid function in pregnancy
5.1 Introduction 39
5.2 Hypothyroidism 39
5.3 Hyperthyroidism 40
5.4 Post-partum thyroiditis 42
5.5 Screening for thyroid disease during pregnancy 42
5.6 Neonatal thyroid assessment 43
6. Thyroid function testing in thyroid cancer
6.1 Introduction 46
6.2 Differentiated thyroid cancer 46
6.3 Medullary thyroid cancer 49
6.4 Anaplastic thyroid cancer 51 3
Contents (continued)
7. Laboratory aspects of thyroid function testing
7.1 Introduction 52
7.2 Biochemical investigations for thyroid function 52
7.3 Tests to establish if there is thyroid dysfunction 52
7.4 Selective use of thyroid function tests 54
7.5 Reference ranges 55
7.6 Quality control and quality assurance 56
7.7 Interpreting results of thyroid function tests 57
7.8 Follow-up of unusual test results 61
7.9 Laboratory tests used to determine the cause of thyroid dysfunction 61
7.10 Recommended protocol for determining functional sensitivity 66
7.11 Drugs that alter thyroid hormone synthesis, secretion & metabolism 66
8. Areas for further studies 68
Appendix 1 References 69
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