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What is Thyroiditis test? 

Thyroiditis profile is a group of tests done to diagnose thyroiditis. It includes total (T3, T4 and thyroid-stimulating hormone (TSH)), anti-thyroglobulin (anti-Tg) and anti-thyroid peroxidase (anti-TPO) tests. 

Thyroiditis refers to the inflammation of the thyroid gland. This condition may cause either over- or under-production of the thyroid hormones.

The thyroid gland is present in the lower neck. It is a butterfly-shaped gland and produces hormones that help in metabolism. 

Some of the possible causes of thyroiditis include infections or the side effects of medications or radiation. Thyroiditis may also be genetic or seen as an autoimmune disorder, a condition in which the body attacks itself. 

Here are the different types of thyroiditis:

  • Hashimoto’s thyroiditis: Hashimoto’s thyroiditis is an autoimmune condition that affects women more than men. It occurs when your immune system starts damaging your thyroid cells. This condition leads to hypothyroidism, and thyroid replacement therapy is generally required for treatment. 
  • Silent thyroiditis: Silent thyroiditis is the second commonest form of thyroiditis. It is also an autoimmune disease that occurs due to the presence of anti-thyroid antibodies in your body. 
  • Post-partum thyroiditis: Post-partum thyroiditis is a fairly uncommon autoimmune condition that may appear in women shortly after childbirth.
  • Drug-induced thyroiditis: Certain drugs such as lithium, cytokines, interferons and amiodarone may cause this type of thyroiditis in a small number of people. 
  • Radiation-induced thyroiditis: This type of thyroiditis occurs due to the radiation used for the treatment of cancer or radioactive iodine that is used to treat hyperthyroidism. 
  • Acute thyroiditis or suppurative thyroiditis: It is a rare condition that is caused by bacteria or infectious organisms.
  • Subacute thyroiditis or de Quervain’s thyroiditis: A painful condition that is usually shows up a few weeks after a viral infection.

Thyroiditis can be diagnosed by a series of blood tests that detect the amount of thyroid hormone, TSH and antibodies present in the body as mentioned below:

  • T3 (triiodothyronine) test: This test checks for the levels of T3 in your blood. T3 is present in the free (not attached to anything) and bound (attached to a protein) forms. The total T3 levels include both bound and free T3.
  • T4 (thyroxine) test: It is a blood test that measures the T4 levels in your body. Just like T3, T4 is present in bound and free forms. It is produced by the thyroid gland along with T3. T4 total includes free and bound T4. T4 works along with T3 to control metabolism and processes such as body temperature, brain development, heart functioning and breathing.
  • TSH test: The TSH test checks for the levels of Thyroid-stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland, which is present at the base of the brain. This hormone is responsible for controlling the levels of thyroid hormones (T3 and T4) in the body. If the thyroid gland produces too much of the thyroid hormone, the pituitary gland decreases the amount of TSH to lower the levels of thyroid hormones. When the thyroid hormones are too low, the pituitary produces more TSH, which stimulates the thyroid gland to increase the production of thyroid hormones.
  • Anti-TPO antibody test: Anti-TPO antibody test checks for the levels of antibodies against the enzyme thyroid peroxidase. Thyroid peroxidase helps in producing T3 and T4 in the thyroid gland. A lack of thyroid peroxidase leads to hypothyroidism. 
  • Anti-Tg antibody test: Anti-Tg antibody test is a blood test that checks for the levels of antibodies produced against a protein made by the thyroid gland known as thyroglobulin. Thyroglobulin plays an important role in the production and storage of thyroid hormones.
  1. Why is a Thyroiditis test done?
  2. How do you prepare for Thyroiditis test?
  3. How is a Thyroiditis test performed?
  4. What do Thyroiditis test results mean?

Why is a Thyroiditis test done?

Your doctor may order a thyroiditis profile if they notice symptoms of thyroiditis. 

 Thyroiditis has three stages:

  • Thyrotoxic phase: An increased release of hormones due to inflamed thyroid
  • Hypothyroid phase: Reduced secretion of thyroid hormones due to an initial excessive release of the hormones for a few months or weeks
  • Euthyroid phase: Thyroid hormone levels become normal; this phase may be between the thyrotoxic phase and hypothyroid phase or after the recovery of the gland from thyroiditis

Varied symptoms are seen according to the phase and type of thyroiditis. Let us have a look at the symptoms:

Hyperthyroid phase: Usually lasts for one to three months. In this phase, there is an excess of thyroid hormone leakage due to cell damage. The following symptoms of hyperthyroidism may appear: 

Hypothyroid phase: This phase is noticed more commonly. It generally lasts for a longer time and may become permanent. If thyroid hormone levels decrease due to cell damage, it may show the following symptoms:

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How do you prepare for Thyroiditis test?

You may need to fast before the test. Inform your doctor if you are pregnant, you have acute or chronic illnesses or are extremely stressed.

Tell your healthcare provider about all the medications that you are consuming. This includes vitamins, supplements, herbs, non-prescription drugs and illegal drugs.

Thyroid drugs may affect the results of T3 and anti-Tg antibodies test and drugs including steroids, birth control medicines and seizure medicines may affect the T3 and T4 test results. Phenytoin, dopamine, phenothiazines and glucocorticoids may interfere with TSH test results, 

Results of the T3 test are also affected by foods like seaweed, which are rich in iodine. 

How is a Thyroiditis test performed?

All the tests of a thyroiditis profile are performed on a blood sample. The sample will be drawn from a vein in your arm in the following way:

  • A technician will tie a band, called a tourniquet, around your upper arm and wipe a site below it with an antiseptic solution.
  • Using a syringe and needle, they will draw the required amount of blood from the vein. You may feel a prick when the technician inserts the needle. 
  • After the sample is drawn, the technician will take off the tourniquet. 
  • He/she will transfer the blood sample in a labelled bottle and send it to the laboratory for testing.

Most blood tests are safe; however, some patients feel dizzy or uneasy after the test or notice a bruise at the needle insertion site. This is usually nothing to worry about. Though, inform your doctor if the bruise doesn’t go away or if you notice an infection developing at the site.

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What do Thyroiditis test results mean?

Normal results:

  • Total T3: 75-195 nanograms per deciliter (ng/dL)
  • Total T4: 4.6-11.2 micrograms per decilitre (mcg/dL)
  • TSH: 0.5-5 microunits per millilitre (µU/mL); ideally, perform this test in the morning as the TSH values may change as the day progresses
  • Anti-Tg antibody: 0-4.0 international units per millilitre (IU/mL)
  • Anti-TPO antibody: 0-9.0 IU/mL

Abnormal results:

These test results are approximate and may vary from laboratory to laboratory. If your readings are not in the normal range, it may not necessarily mean that you have a thyroid disorder.

If your T3 levels are high, it could indicate conditions like:

If the levels of T3 are lower than normal, it could indicate the following:

  • Thyroiditis (the most common type is Hashimoto disease) 
  • Starvation 
  • Underactive thyroid gland

If your T4 levels are above the normal range, it could mean that you have hyperthyroidism, whereas if your levels are below normal, it could indicate hypothyroidism.

High TSH may be an indication of hypothyroidism. Whereas low TSH could be due to different conditions like:

  • Graves’ disease 
  • Toxic nodular goitre
  • Too much iodine (e.g., iodine contrast used in imaging tests)

If anti-Tg antibodies are found in your blood, your result is positive. This may be observed in some conditions such as:

  • Hashimoto thyroiditis
  • Subacute thyroiditis 
  • Graves’ disease
  • Underactive thyroid

If you have anti-TPO antibodies in your blood, you may have Hashimoto’s thyroiditis.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. American Academy of Family Physicians [Internet]. Leawood (KS). US; Thyroiditis
  2. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Adult and Children's Health Encyclopedia
  3. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Blood Test: Thyroid Stimulating Hormone (TSH)
  4. Guber HA, Farag AF. Evaluation of endocrine function. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 24.
  5. Weiss RE, Refetoff S. Thyroid function testing. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 78.
  6. Salvatore D, Davies TF, Schlumberger MJ, Hay ID, Larsen PR. Thyroid physiology and diagnostic evaluation of patients with thyroid disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 1
  7. National Health Service [internet]. UK; Blood Tests
  8. UFHealth [internet]: University of Florida; TSH test. Gainesville. Florida. US; TSH test
  9. ARUP Labs [Internet]. University of Utah. Salt Lake city. Utah. US; Thyroglobulin Antibody
  10. Mount Sinai [Internet]. Icahan School of Medicine. New York City (NY). U.S.A.; T3 test
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