Graves' disease laboratory findings: Difference between revisions

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==Overview==
==Overview==
 
The laboratory findings for Graves' disease are elevated levels of serum thyroxine (T4) and triiodothyronine (T3) and undetectable serum TSH.
== Laboratory Findings ==
== Laboratory Findings ==
The laboratory findings for Graves' disease are:
*Elevated levels of serum thyroxine (T4) and triiodothyronine (T3)
*Undetectable serum TSH.


*Another sign of Graves' disease is [[hyperthyroidism]], i.e. over-production of the [[thyroid hormone|thyroid hormones]] T3 and T4. Although, [[hypothyroidism]] has also been associated and may be the causating factor in some patients. Hyperthyroidism can be confirmed by measuring elevated blood levels levels of free (unbound) T3 and T4.  
Total T4 and T3 measurements are influenced by multiple conditions affecting serum thyroxine-binding globulin (TBG) thus, free thyroid hormone (free T4 (FT4) and free T3 (fT3)) are the gold standard measurements to diagnose Graves' disease.<ref name="pmid17673120">{{cite journal |vauthors=Dufour DR |title=Laboratory tests of thyroid function: uses and limitations |journal=Endocrinol. Metab. Clin. North Am. |volume=36 |issue=3 |pages=579–94, v |year=2007 |pmid=17673120 |doi=10.1016/j.ecl.2007.04.003 |url=}}</ref><br>
 
Antibodies against the TSH receptor (TRAbs) are pathognomonic for Graves' disease. They are detectable in the serum of about 98% of untreated patients.<ref name="pmid20594972">{{cite journal |vauthors=Zöphel K, Roggenbuck D, Schott M |title=Clinical review about TRAb assay's history |journal=Autoimmun Rev |volume=9 |issue=10 |pages=695–700 |year=2010 |pmid=20594972 |doi=10.1016/j.autrev.2010.05.021 |url=}}</ref>
*Other useful laboratory measurements include [[thyroid-stimulating hormone]] (TSH, low in Graves' disease due to negative feedback from the elevated T3 and T4), and protein-bound [[iodine]] (elevated).
<br>Detection of TRAbs rules out other causes of thyrotoxicosis.<ref name="pmid23539719">{{cite journal |vauthors=Barbesino G, Tomer Y |title=Clinical review: Clinical utility of TSH receptor antibodies |journal=J. Clin. Endocrinol. Metab. |volume=98 |issue=6 |pages=2247–55 |year=2013 |pmid=23539719 |pmc=3667257 |doi=10.1210/jc.2012-4309 |url=}}</ref><br>
 
Nnti-thyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies are also detectable in many patients with Graves' disease but it's not recommended to measure them in all patients for diagnosis.
*Thyroid-stimulating antibodies may also be detected [[serology|serologically]]. Thyroid-stimulating antibodies bind and stimulate the TSH receptor. Anti-TSHR ABs are 80-95% sensitive, 80-90% specific for Graves’.


==References==
==References==
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Revision as of 15:31, 20 December 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

The laboratory findings for Graves' disease are elevated levels of serum thyroxine (T4) and triiodothyronine (T3) and undetectable serum TSH.

Laboratory Findings

The laboratory findings for Graves' disease are:

  • Elevated levels of serum thyroxine (T4) and triiodothyronine (T3)
  • Undetectable serum TSH.

Total T4 and T3 measurements are influenced by multiple conditions affecting serum thyroxine-binding globulin (TBG) thus, free thyroid hormone (free T4 (FT4) and free T3 (fT3)) are the gold standard measurements to diagnose Graves' disease.[1]
Antibodies against the TSH receptor (TRAbs) are pathognomonic for Graves' disease. They are detectable in the serum of about 98% of untreated patients.[2]
Detection of TRAbs rules out other causes of thyrotoxicosis.[3]
Nnti-thyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies are also detectable in many patients with Graves' disease but it's not recommended to measure them in all patients for diagnosis.

References

  1. Dufour DR (2007). "Laboratory tests of thyroid function: uses and limitations". Endocrinol. Metab. Clin. North Am. 36 (3): 579–94, v. doi:10.1016/j.ecl.2007.04.003. PMID 17673120.
  2. Zöphel K, Roggenbuck D, Schott M (2010). "Clinical review about TRAb assay's history". Autoimmun Rev. 9 (10): 695–700. doi:10.1016/j.autrev.2010.05.021. PMID 20594972.
  3. Barbesino G, Tomer Y (2013). "Clinical review: Clinical utility of TSH receptor antibodies". J. Clin. Endocrinol. Metab. 98 (6): 2247–55. doi:10.1210/jc.2012-4309. PMC 3667257. PMID 23539719.

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