Clinical and Interpretive

This test utilizes a cascaded testing approach to efficiently evaluate and monitor functional thyroid status. 

The cascade begins with TSH, thyroid-stimulating hormone as a screening assay. In patients with an intact pituitary-thyroid axis, TSH provides a physiologic indicator of the functional level of thyroid hormone activity. Increased TSH indicates inadequate thyroid hormone, and suppressed TSH indicates excess thyroid hormone.

Transient TSH abnormalities may be found in seriously ill, hospitalized patients, so this is not the ideal setting to assess thyroid function. However, even in these patients, TSH works better than total T4 (thyroxine, an alternative screening test).

When TSH is normal, no additional testing will be necessary. However, when the TSH result is abnormal, appropriate follow-up tests will automatically be performed.

Serum T3 (triiodothyronine) levels often are depressed in sick and hospitalized patients, caused in part by the biochemical shift to the production of reverse T3. Therefore, T3 generally is not a reliable predictor of hypothyroidism. However, in a small subset of hyperthyroid patients, hyperthyroidism may be caused by overproduction of T3 (T3 toxicosis). To help diagnose and monitor this subgroup, T3 is measured on all specimens with suppressed TSH and normal free T4 concentrations.

Detectable concentrations of antithyroperoxidase (anti-TPO) antibodies are observed in patients with autoimmune thyroiditis and may cause the destruction of thyroid tissue, eventually resulting in hypothyroidism. Anti-TPO antibodies are measured in all specimens with elevated TSH concentrations.