Thyroid Function Tests

I. INVASIVE DIAGNOSTIC TEST

A. TSH Tests

The best way to initially test thyroid function is to measure the TSH level in a blood sample. A high TSH level
indicates that the thyroidgland is failing because of a problem that is directly affecting the thyroid (primary
hypothyroidism). The opposite situation, in which the TSH level is low, usually indicates that the person has an
overactive thyroid that is producing too much thyroid hormone (hyperthyroidism). Occasionally, a low TSH may
result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the
thyroid (secondary hypothyroidism). In most healthy individuals, a normal TSH value means that the thyroid is
functioning normally.
B. T4 Tests
T4 circulates in the blood in two forms: 1) T4 bound to proteins that prevent the T4 from entering the various
tissues that need thyroid hormone and 2) free T4, which does enter the various target tissues to exert its effects.
The free T4 fraction is the most important to determine how the thyroid is functioning, and tests to measure this
are called the Free
C. T3 Tests
T3 tests are often useful to diagnosis hyperthyroidism or to determine the severity of the hyperthyroidism.
Patients who are hyperthyroid will have an elevated T3 level. In some individuals with a low TSH, only the T3 is
elevated and the FT4 or FTI is normal. T3 testing rarely is helpful in the hypothyroid patient, since it is the last
test to become abnormal. Patients can be severely hypothyroid with a high TSH an low FT4 or FTI, but have a
normal T3.

D. Thyroid Biopsy

A thyroid biopsy is a procedure in which a small sample of tissue is removed from the thyroid gland and looked
at under a microscope for cancer, infection, or other thyroid problems.

A sample of thyroid tissue can be taken by:

 Fine-needle biopsy. Your doctor puts a thin needle through the skin and into the thyroid gland. Many thyroid
specialists like to use a needle biopsy method rather than surgery.
 Open biopsy. Your doctor makes a cut (incision) through the skin to see the thyroid gland. This method is done
when other tests have not found the cause of your symptoms.

Why It Is Done

A thyroid biopsy is done to:

 Find the cause of a lump (nodule) found in the thyroid gland. Lumps in the thyroid gland may be found during a
physical examination or seen on a thyroid ultrasound test or radioactive thyroid scan.
 Find the cause of a goiter. Symptoms of a goiter include breathing and swallowing problems, paralyzed vocal
cords, a feeling of fullness in the neck, and weight loss.

PRE-TEST NURSING INTERVENTION

 Have the patient sign the consent form.

 Assess client’s allergy to any medicines, including anesthetics.
 Assess if the client had bleeding problems or had taken blood thinners, such as aspirin or warfarin.
 Before having a thyroid biopsy, blood tests may be necessary to see whether you have any bleeding problems or
blood-clotting disorders.
  Advise the patient not to eat or drink anything for 10 hours before an open biopsy. Normal diet is resumed after
the biopsy.

INTRA-TEST NURSING INTERVENTION

 Ask the patient to remove his/her dentures (if he/she wears them) and all jewelry or metal objects from around
his/her neck and upper body.
 Inform the patient that having the head tipped backward may cause little discomfort and a quick sting in the
neck is usually felt during the procedure.

POST-TEST NURSING INTERVENTION

 The biopsy site may be sore and tender for 1 to 2 days. You can take nonprescription pain medicine, such as
acetaminophen, for the discomfort.

E. Radioactive iodine uptake

Because T4 contains much iodine, the thyroid gland must pull a large amount of iodine out from the blood
stream in order for the gland to make an appropriate amount of T4. The thyroid has developed a very active
mechanism for doing this. Therefore, this activity can be measured by having an individual swallow a small
amount of iodine, which is radioactive. The radioactivity allows the doctor to track where the iodine molecules
go. By measuring the amount of radioactivity that is taken up by the thyroid gland (radioactive iodine uptake,
RAIU), doctors may determine whether the gland is functioning normally. A very high RAIU is seen in individuals
whose thyroid gland is overactive (hyperthyroidism), while a low RAIU is seen when the thyroid gland is
underactive (hypothyroidism). In addition to the radioactive iodine uptake, a thyroid scan may be obtained,
which shows a picture of the thyroid gland.

PRE-TEST NURSING INTERVENTION

 Assess the client’s medication such as anti-thyroid drugs or medicines Medicines that contain iodine, such as
iodized salt, kelp, cough syrups, multivitamins, or the heart medicine amiodarone (such as Cordarone or
Pacerone). Doctors advise patient when to stop antithyroid medication prior to the procedure, usually 5 – 7
days.
 Advise the patient not to eat for 2 hours before the test.
 Prior to the test, patient is advised to follow a low-iodine diet.

II. NON INVASIVE THYROID FUNCTION TEST

III. NURSING IMPLICATIONS
When thyroid tests are scheduled, it is necessary to determine whether the patient has taken medications or agents that
contain iodine because these may alter the test results. Iodine-containing medications include contrast agents and those
used to treat thyroid disorders. Less obvious sources of iodine are topical antiseptics, multivitamin preparations, and
food supplements frequently found in health food stores; cough syrups; and amiodarone, an antiarrhythmic agent.
Other medications that may affect test results are estrogens, salicylates, amphetamines, chemotherapeutic agents,
antibiotics, corticosteroids, and mercurial diuretics. The nurse asks the patient about the use of these medications and
notes their use on the laboratory requisition. Chart 42-1 gives a partial list of agentsthat may interfere with accurate
testing of thyroid gland function.