Investigating Suspected Thyroid Dysfunction

Section	Recommendation
Indications for Tests for Thyroid Dysfunction	- Test if clinical suspicion of thyroid disease exists, but a single symptom may not confirm thyroid disease. - Offer tests for those with type 1 diabetes, other autoimmune diseases, or new-onset atrial fibrillation. - Consider testing for those with depression or unexplained anxiety. - Test children and young people with abnormal growth, unexplained behaviour or school performance changes. - Recognize that thyroid dysfunction symptoms in menopausal women might be misattributed to menopause. - Avoid testing during acute illnesses unless thyroid dysfunction is suspected to be the cause (acute illnesses might skew results). - Don't test solely based on type 2 diabetes.
Tests When Thyroid Dysfunction is Suspected	- For adults (when pituitary disease isn't suspected): Measure thyroid-stimulating hormone (TSH) alone. - If TSH is above the reference range, measure free thyroxine (FT4). - If TSH is below the reference range, measure both FT4 and free tri-iodothyronine (FT3). - For suspected secondary thyroid dysfunction in adults or for children/young people: Measure both TSH and FT4. - Measure FT3 if TSH is below the reference range. - If symptoms worsen or new symptoms arise, consider repeating the tests, but wait at least 6...

Section

Recommendation

Indications for Tests for Thyroid Dysfunction

- Test if clinical suspicion of thyroid disease exists, but a single symptom may not confirm thyroid disease.
- Offer tests for those with type 1 diabetes, other autoimmune diseases, or new-onset atrial fibrillation.
- Consider testing for those with depression or unexplained anxiety.
- Test children and young people with abnormal growth, unexplained behaviour or school performance changes.
- Recognize that thyroid dysfunction symptoms in menopausal women might be misattributed to menopause.
- Avoid testing during acute illnesses unless thyroid dysfunction is suspected to be the cause (acute illnesses might skew results).
- Don't test solely based on type 2 diabetes.

Tests When Thyroid Dysfunction is Suspected

- For adults (when pituitary disease isn't suspected): Measure thyroid-stimulating hormone (TSH) alone.
- If TSH is above the reference range, measure free thyroxine (FT4).
- If TSH is below the reference range, measure both FT4 and free tri-iodothyronine (FT3).
- For suspected secondary thyroid dysfunction in adults or for children/young people: Measure both TSH and FT4.
- Measure FT3 if TSH is below the reference range.
- If symptoms worsen or new symptoms arise, consider repeating the tests, but wait at least 6...

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