“How are thyroid evaluations performed?”

Your primary care physician can draw your blood and test for thyroid function tests. Initial testing usually is a TSH +/- Free T4/Free T3 depending on symptoms.

Thyroid evaluations are done with simple blood tests that measure the amount of thyroid hormone in your body. Occasionally, an ultrasound of your thyroid is need to check for enlarged thyroid or nodules on the thyroid.

Richard Lipman, MD

Dear Patient: thyroid evaluations performed by your physician with a medical history, physical exam and thyroid blood work. A throid ultrasound may be ordered if indicated.

Respectfully

Marvin A Leder MD FACP FACE

To evaluate the thyroid, a blood test by a doctor needs to be performed, starting with primary care doctor.

Dr. Marina Strizhevsky

As with any medical problem, evaluation for possible thyroid problems starts with the history and review of bodily systems. The doctor is looking for symptoms and risk factors compatible with a thyroid disorder. Risk factors include family history, especially for first-degree relatives, exposure to ionizing radiation and certain medications, and exposure to iodine. The physical exam may yield further clues for a thyroid problem. But the evaluation quickly turns to laboratory tests because the findings at history and physical examination are frequently non-specific and overlap with those of other non-thyroidal disorders.

Basic laboratory evaluation of the thyroid includes thyroid stimulating hormone (TSH), free T4, free T3 and appropriate antibodies, such as anti-thyroglobulin, anti-thyroid peroxidase (anti-TPO), or, in cases of suspected Graves disease, thyroid stimulating immunoglobulin (TSI), and TRAb (thyrotropin receptor antibodies. Sometimes erythrocyte sedimentation rate (ESR) is added in cases of thyroiditis due to viral infection

The physical exam is often non-specific and can underestimate the size and texture of the thyroid in many cases. Thyroid ultrasound (US) has become the standard imaging technology that serves as a significant extension of the physical examination.

In some cases it becomes necessary to measure and image the regional function of the thyroid gland to find nodules and regions that produce too much or too little thyroid hormone (so-called "hot" and "cold" nodules or regions, respectively) using radioactive iodine (RAI) tracers. These are called RAI uptake studies. These nuclear medicine tests can determine whether the thyroid is either making excessive thyroid hormone, or releasing stored thyroid hormone due to injury.

We emphasize that not all alf these tests may be required in every case, and indeed, the diagnosis can frequently be made by history, physical and the first round of blood tests. While treatment may be started after minimal initial diagnosis, it is becoming standard to include thyroid US at baseline evaluation because nodules frequently coexist with other thyroid diseases. After lab tests, thyroid US, and if needed, RAI uptake and scan, the diagnosis will be confirmed. A logical care plan then can be recommended to include hormonal, nutritional or drug therapy, and fine-needle biopsy as indicated.

There are other tests such as blood or urine iodine, erythrocyte selenium, deiodinases, thyroid binding globulin, thyroglobulin, reverse T3, and basal core body temperature, that have specialized uses, but are seldom needed.

Through blood tests.

There may be several steps though most of the time only 2 steps. 1) see your physician & have him/her feel your neck to see if your thyroid gland is enlarged or has nodules 2) the DR. should draw blood & send to the lab for analysis for a free T4 & TSH. If they have found enlargement they may want to get a measurement of thyroid antibodies 3) If no enlargement or nodules this is all that is needed. If the is enlargement or nodules then a thyroid sonogram (ultrasound) should be performed. 4) if enlargement or nodules, then a biopsy should be performed. This can be done in the office with local numbing of the area. This is to see if the nodules are benign (usually) or malignant (uncommon). There are blood tests for cancer as well but are not needed if no enlargement or nodules. I hope this helps.