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Any inappropriateness of measured values, for instance a low-normal TSH together with a low-normal T 4 may signal tertiary (central) disease and a TSH to TRH pathology. Elevated reverse T 3 (RT 3 ) together with low-normal TSH and low-normal T 3 , T 4 values, which is regarded as indicative for euthyroid sick syndrome, may also have to be ...
Normally, TSH would rise into the concentration range measurable with less sensitive TSH assays. Third generation TSH assays do not have this limitation and thus TRH stimulation is generally not required when third generation TSH assays are used to assess degree of suppression.
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.
If the TSH level is normal or low and serum free T 4 levels are low, this is suggestive of central hypothyroidism (not enough TSH or TRH secretion by the pituitary gland or hypothalamus). There may be other features of hypopituitarism , such as menstrual cycle abnormalities and adrenal insufficiency .
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]
Another study demonstrated the TSH index to inversely correlate to thyroid's secretory capacity and thyroid volume. [26] It is unclear if this finding reflects shortcomings of the index (i.e. low specificity in the setting of subclinical hypothyroidism) or plastic responses of the pituitary gland to beginning hypothyroidism. [citation needed]
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