Thyroid function abnormalities primarily encompass two conditions: Hypothyroidism (commonly referred to as "hypothyroid") and Hyperthyroidism (commonly referred to as "hyperthyroid").
Thyroid function testing plays a vital role in early detection of thyroid diseases and is one of the essential components of a health-up.
Thyroid function abnormalities can give rise to various health issues. Hypothyroidism (commonly referred to as "hypothyroid") patients may experience weight gain, hair loss, memory impairment, and even myxedema coma. Hyperthyroidism (commonly referred to as "hyperthyroid") patients may experience fatigue, heat intolerance, excessive sweating, weight loss, palpitations, insomnia, and arrhythmias. In severe cases, atrial fibrillation, heart failure, and thyroid crisis can occur. Furthermore, thyroid dysfunction can affect fertility and intellectual development in offspring. Due to its subtle presentation, misdiagnosis and underdiagnosis are common. However, serological testing is safe and accurate, aiding in the early detection of thyroid function abnormalities and timely intervention.
Serum thyroid hormone testing is an important means of assessing thyroid function, including free T4, free T3, total T4, and total T3 levels. Among these, T4 is primarily secreted by the thyroid gland, while T3 is partially converted from T4 in peripheral tissues. Total T4 and total T3 can be further divided into bound and unbound forms, with bound T4 binding to thyroxine-binding globulin (TBG) and serving as a storage and transport form of thyroid hormone, whereas unbound T4 represents the active fraction of thyroid hormone and reflects thyroid function. Serum thyroid-stimulating hormone (TSH) is a sensitive marker for screening thyroid function abnormalities, with third-generation immunoassays having a sensitivity of less than 0.01 mU/L. Strict internal quality control and participation in external quality assessment are required for thyroid function testing.
It is recommended to use the reference range established by the National Academy of Clinical Biochemistry (NACB) in the United States to determine whether thyroid function is abnormal based on serum TSH and thyroid hormone levels. The reference range is defined as the 2.5th to 97.5th percentile, taking into account factors such as age, circadian rhythm, and pregnancy that can influence serum TSH and thyroid hormone levels.
For individuals at high risk of hypothyroidism or hyperthyroidism, it is recommended to supplement TSH testing with thyroid hormone measurements. The preferred combination is TSH, FT4, and FT3. Alternatively, the combination of TSH, FT4, and TT3 can also be considered.
For individuals who have abnormal results in TSH testing alone during physical examinations, it is recommended to seek further diagnosis in a clinical department or to complete thyroid hormone testing at a healthcare management (physical examination) center.
If all thyroid function tests (TSH, T4, T3) have been conducted and abnormalities are found, it is recommended to stratify the individuals based on the combination of abnormal results for TSH, T4, and T3.
For individuals with a history of autoimmune thyroiditis or hypothyroidism, it is recommended to include thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) testing in addition to thyroid function evaluation. These additional tests help in assessing the presence of autoimmune diseases.
Summary: Physical examinations play a crucial role in detecting thyroid dysfunction. When feasible in terms of medical testing capabilities and financial capacity, thyroid function testing should be performed at healthcare management centers. It is important to follow the post-testing management process for individualized management based on the results.
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