Laboratory Testing in Thyroid Disorders

  • Stefan K. G. GrebeEmail author


For thyroid function evaluation, thyrotropin (TSH) is the usual starting point. TSH shows an exponential response to changing peripheral thyroid hormone levels, thereby providing high clinical detection sensitivity. Thyroxine (T4) or triiodothyronine (T3) is frequently measured alongside, mostly as free hormones (FT4 and FT3), to assess disease severity or treatment response. Some diseases require additional testing to determine the cause of observed abnormalities or to clarify contradictory results of TSH and T4/T3 testing. Thyroid autoantibody testing is important in this context.

Testing for structural thyroid disease centers on tumor markers, mainly thyroglobulin (Tg), calcitonin, and carcinoembryonic antigen, all of which are primarily used for follow-up. Tg immunoassays are not infrequently compromised by anti-Tg autoantibody interferences, which can be partially overcome by mass spectrometry (MS) Tg measurements.

Thyroid function tests and thyroid tumor markers have several limitations, which include (1) inaccurate immunoassay results in a subset of patients due to interferences by binding proteins, autoantibodies, heterophile antibodies, anti-reagent antibodies, or various chemicals, (2) some degree of compromised diagnostic performance due to suboptimal assay precision and inadequate reference ranges for almost all assays, and (3) poor comparability of results obtained by different assays for the same analyte.

These problems can potentially be solved by increased use of physicochemical methods (e.g., dialysis and MS), assay harmonization, improved reference ranges, and utilization of patient-specific reference intervals.


Thyroid function testing Thyrotropin Thyroxine Triiodothyronine Reverse triiodothyronine Thyroid hormone-binding proteins Thyroid autoantibodies Tumor markers Thyroglobulin Calcitonin Carcinoembryonic antigen Competitive immunoassays Immunometric immunoassays Dialysis Centrifugal filtration Mass spectrometry Assay performance characteristics Assay dynamic range Limit of blank Limit of detection Limit of quantitation Accuracy Precision Imprecision Assay comparability Assay harmonization Assay standardization Assay interferences Anti-thyroglobulin autoantibodies Heterophile antibodies Biotin Reference range Reference interval Minimal significant change Index of assay individuality Patient specific reference interval 


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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Laboratory Medicine and PathologyMayo ClinicRochesterUSA

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