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Thyroid function tests
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<h2 id="thyroid-stimulating-hormone">Thyroid-stimulating hormone</h2> <p><a href="/facts/Thyroid-stimulating_hormone/w8ettSpY">Thyroid-stimulating hormone</a> (TSH, thyrotropin) is generally increased in hypothyroidism and decreased in hyperthyroidism,<a class="footnote-ref" id="fnref:2" href="#fn:2"><sup>2</sup></a> making it the most important test for early detection of both of these conditions.<a class="footnote-ref" id="fnref:3" href="#fn:3"><sup>3</sup></a><a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a> The result of this <a href="/facts/Assay/fPUYjx1I">assay</a> is suggestive of the presence and cause of thyroid disease, since a measurement of elevated TSH generally indicates <a href="/facts/Hypothyroidism/oqtQDu2F">hypothyroidism</a>, while a measurement of low TSH generally indicates <a href="/facts/Hyperthyroidism/H9Eqmbgk">hyperthyroidism</a>.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> However, when TSH is measured by itself, it can yield misleading results, so additional thyroid function tests must be compared with the result of this test for accurate diagnosis.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a><a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a><a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> </p><p>TSH is produced in the <a href="/facts/Pituitary_gland/gdrQyldF">pituitary gland</a>. The production of TSH is controlled by <a href="/facts/Thyrotropin-releasing_hormone/losJq69G">thyrotropin-releasing hormone</a> (TRH), which is produced in the <a href="/facts/Hypothalamus/lCkNt1bM">hypothalamus</a>. TSH levels may be suppressed by excess free T3 (fT3) or free T4 (fT4) in the blood. </p> <h3>History</h3> <p>First-generation TSH assays were done by <a href="/facts/Radioimmunoassay/8VtajdJ8">radioimmunoassay</a> and were introduced in 1965.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> There were variations and improvements upon TSH radioimmunoassay, but their use declined as a new immunometric assay technique became available in the middle of the 1980s.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> The new techniques were more accurate, leading to the second, third, and even fourth generations of TSH assay, with each generation possessing ten times greater functional sensitivity than the last.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> Third generation immunometric assay methods are typically automated.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> Fourth generation TSH immunometric assay has been developed for use in research.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> </p> <h3>Modern standard</h3> <p>Third generation TSH assay is the requirement for modern standards of care. TSH testing in the United States is typically carried out with automated platforms using advanced forms of immunometric assay.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> Nonetheless, there is no international standard for measurement of thyroid-stimulating hormone.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> </p> <h3>Interpretation</h3> <p>Accurate interpretation takes a variety of factors into account, such as the thyroid hormones i.e. <a href="/facts/Thyroxine/9k4xJtCq">thyroxine</a> (T4) and <a href="/facts/Triiodothyronine/MPBz6ApV">triiodothyronine</a> (T3), current medical status (such as pregnancy<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a>),<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> certain medications like <a href="/facts/Propylthiouracil/zRId5hqt">propylthiouracil</a>,<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> temporal effects including <a href="/facts/Circadian_rhythm/rwQh0ClJ">circadian rhythm</a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> and <a href="/facts/Hysteresis/9M2pwR62">hysteresis</a>,<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> and other past <a href="/facts/Medical_history/P2xSfuYF">medical history</a>.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> </p> <h2 id="thyroid-hormones">Thyroid hormones</h2> <h3>Total thyroxine</h3> <p>Total thyroxine is rarely measured, having been largely superseded by free thyroxine tests. Total <a href="/facts/Thyroxine/9k4xJtCq">thyroxine</a> (Total T4) is generally elevated in <a href="/facts/Hyperthyroidism/H9Eqmbgk">hyperthyroidism</a> and decreased in <a href="/facts/Hypothyroidism/oqtQDu2F">hypothyroidism</a>.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> It is usually slightly elevated in pregnancy secondary to increased levels of <a href="/facts/Thyroid_binding_globulin/doovCmnL">thyroid binding globulin</a> (TBG).<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> </p><p>Total T4 is measured to see the bound and unbound levels of T4. The total T4 is less useful in cases where there could be protein abnormalities. The total T4 is less accurate due to the large amount of T4 that is bound. The total T3 is measured in clinical practice since the T3 has decreased amount that is bound as compared to T4. </p><p>Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are: </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>4,<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> 5.5<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a></td><td>11,<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> 12.3<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a></td><td>μg/dL</td></tr><tr><td>60<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a><a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a></td><td>140,<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> 160<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a></td><td>nmol/L</td></tr></tbody></table> <h3>Free thyroxine</h3> <p>Free <a href="/facts/Thyroxine/9k4xJtCq">thyroxine</a> (fT4 or free T4) is generally elevated in <a href="/facts/Hyperthyroidism/H9Eqmbgk">hyperthyroidism</a> and decreased in <a href="/facts/Hypothyroidism/oqtQDu2F">hypothyroidism</a>.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> </p><p>Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are: </p> <table><tbody><tr><td>Patient type</td><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td rowspan="2">Normal adult</td><td>0.7,<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> 0.8<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a></td><td>1.4,<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> 1.5,<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> 1.8<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a></td><td>ng/dL</td></tr><tr><td>9,<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a><a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> 10,<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> 12 <a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a></td><td>18,<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a><a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> 23<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a></td><td>pmol/L</td></tr><tr><td rowspan="2">Infant 0–3 d</td><td>2.0<a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a></td><td>5.0<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a></td><td>ng/dL</td></tr><tr><td>26<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a></td><td>65<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a></td><td>pmol/L</td></tr><tr><td rowspan="2">Infant 3–30 d</td><td>0.9<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a></td><td>2.2<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a></td><td>ng/dL</td></tr><tr><td>12<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a></td><td>30<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a></td><td>pmol/L</td></tr><tr><td rowspan="2">Child/Adolescent 31 d – 18 y</td><td>0.8<a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a></td><td>2.0<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a></td><td>ng/dL</td></tr><tr><td>10<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a></td><td>26<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a></td><td>pmol/L</td></tr><tr><td rowspan="2">Pregnant</td><td>0.5<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a></td><td>1.0<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a></td><td>ng/dL</td></tr><tr><td>6.5<a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a></td><td>13<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a></td><td>pmol/L</td></tr></tbody></table> <h3>Total triiodothyronine</h3> <p>Total <a href="/facts/Triiodothyronine/MPBz6ApV">triiodothyronine</a> (Total T3) is rarely measured, having been largely superseded by free T3 tests. Total T3 is generally elevated in hyperthyroidism and decreased in hypothyroidism.<a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a> </p><p>Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are: </p> <table><tbody><tr><td>Test</td><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td rowspan="2">Total <a href="/facts/Triiodothyronine/MPBz6ApV">triiodothyronine</a></td><td>60,<a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a> 75<a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a></td><td>175,<a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a> 181<a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a></td><td>ng/dL</td></tr><tr><td>0.9,<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a> 1.1<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a></td><td>2.5,<a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a> 2.7<a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a></td><td>nmol/L</td></tr></tbody></table> <h3>Free triiodothyronine</h3> <p>Free <a href="/facts/Triiodothyronine/MPBz6ApV">triiodothyronine</a> (fT3 or free T3) is generally elevated in hyperthyroidism and decreased in hypothyroidism.<a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a> </p><p>Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are: </p> <table><tbody><tr><td>Patient type</td><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td rowspan="2">Normal adult</td><td>3.0<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a></td><td>7.0<a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a></td><td>pg/mL</td></tr><tr><td>3.1<a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a></td><td>7.7<a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a></td><td>pmol/L</td></tr><tr><td rowspan="2">Children 2–16 y</td><td>3.0<a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a></td><td>7.0<a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a></td><td>pg/mL</td></tr><tr><td>1.5<a class="footnote-ref" id="fnref:78" href="#fn:78"><sup>78</sup></a></td><td>15.2<a class="footnote-ref" id="fnref:79" href="#fn:79"><sup>79</sup></a></td><td>pmol/L</td></tr></tbody></table> <h2 id="carrier-proteins">Carrier proteins</h2> <h3>Thyroxine-binding globulin</h3> <p class="note">Main article: <a href="/facts/Thyroxine-binding_globulin/doovCmnL">Thyroxine-binding globulin</a></p> <p>An increased <a href="/facts/Thyroxine-binding_globulin/doovCmnL">thyroxine-binding globulin</a> results in an increased total thyroxine and total triiodothyronine without an actual increase in hormonal activity of thyroid hormones. </p><p>Reference ranges: </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>12<a class="footnote-ref" id="fnref:80" href="#fn:80"><sup>80</sup></a></td><td>30<a class="footnote-ref" id="fnref:81" href="#fn:81"><sup>81</sup></a></td><td>mg/L</td></tr></tbody></table> <h2 id="thyroglobulin">Thyroglobulin</h2> <p>Reference ranges: </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>1.5<a class="footnote-ref" id="fnref:82" href="#fn:82"><sup>82</sup></a></td><td>30<a class="footnote-ref" id="fnref:83" href="#fn:83"><sup>83</sup></a></td><td>pmol/L</td></tr><tr><td>1<a class="footnote-ref" id="fnref:84" href="#fn:84"><sup>84</sup></a></td><td>20 <a class="footnote-ref" id="fnref:85" href="#fn:85"><sup>85</sup></a></td><td>μg/L</td></tr></tbody></table> <h3>Other binding hormones</h3> <ul><li><a href="/facts/Transthyretin/7hxXqxja">Transthyretin</a> (prealbumin)</li> <li><a href="/facts/Albumin/gDmSgAH2">Albumin</a></li></ul> <h2 id="protein-binding-function">Protein binding function</h2> <h3>Thyroid hormone uptake</h3> <p>Thyroid hormone uptake (Tuptake or T3 uptake) is a measure of the unbound <a href="/facts/Thyroxine_binding_globulin/doovCmnL">thyroxine binding globulins</a> in the blood, that is, the TBG that is unsaturated with thyroid hormone.<a class="footnote-ref" id="fnref:86" href="#fn:86"><sup>86</sup></a> Unsaturated TBG increases with decreased levels of thyroid hormones. It is not directly related to triiodothyronine, despite the name T3 uptake.<a class="footnote-ref" id="fnref:87" href="#fn:87"><sup>87</sup></a> </p><p>Reference ranges: </p> <table><tbody><tr><td>Patient type</td><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>Females</td><td>25<a class="footnote-ref" id="fnref:88" href="#fn:88"><sup>88</sup></a></td><td>35<a class="footnote-ref" id="fnref:89" href="#fn:89"><sup>89</sup></a></td><td>%</td></tr><tr><td>In pregnancy</td><td>15<a class="footnote-ref" id="fnref:90" href="#fn:90"><sup>90</sup></a></td><td>25<a class="footnote-ref" id="fnref:91" href="#fn:91"><sup>91</sup></a></td><td>%</td></tr><tr><td>Males</td><td>25<a class="footnote-ref" id="fnref:92" href="#fn:92"><sup>92</sup></a></td><td>35<a class="footnote-ref" id="fnref:93" href="#fn:93"><sup>93</sup></a></td><td>%</td></tr></tbody></table> <h3>Other protein binding tests</h3> <ul><li><a href="/facts/Thyroid_hormone_binding_ratio/rgn9wdy9">Thyroid Hormone Binding Ratio</a> (THBR)</li> <li>Thyroxine-binding index (TBI)</li></ul> <h2 id="mixed-parameters">Mixed parameters</h2> <h3>Free thyroxine index</h3> <p>The Free Thyroxine Index (FTI or T7) is obtained by multiplying the total T4 with T3 uptake.<a class="footnote-ref" id="fnref:94" href="#fn:94"><sup>94</sup></a> FTI is considered to be a more reliable indicator of thyroid status in the presence of abnormalities in plasma protein binding.<a class="footnote-ref" id="fnref:95" href="#fn:95"><sup>95</sup></a> This test is rarely used now that reliable free thyroxine and free triiodothyronine assays are routinely available. </p><p>FTI is elevated in hyperthyroidism and decreased in hypothyroidism.<a class="footnote-ref" id="fnref:96" href="#fn:96"><sup>96</sup></a> </p> <table><tbody><tr><td>Patient type</td><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>Females</td><td>1.8<a class="footnote-ref" id="fnref:97" href="#fn:97"><sup>97</sup></a></td><td>5.0<a class="footnote-ref" id="fnref:98" href="#fn:98"><sup>98</sup></a></td><td></td></tr><tr><td>Males</td><td>1.3<a class="footnote-ref" id="fnref:99" href="#fn:99"><sup>99</sup></a></td><td>4.2<a class="footnote-ref" id="fnref:100" href="#fn:100"><sup>100</sup></a></td><td></td></tr></tbody></table> <h2 id="calculated-and-structure-parameters">Calculated and structure parameters</h2> <p>Derived structure parameters that describe constant properties of the overall <a href="/facts/Thyroid_homeostasis/vl2UQ4YN">feedback control system</a> may add useful information for special purposes, e.g. in diagnosis of <a href="/facts/Euthyroid_sick_syndrome/TWqYy19K">nonthyroidal illness syndrome</a> or <a href="/facts/Secondary_hypothyroidism/oqtQDu2F">central hypothyroidism</a>.<a class="footnote-ref" id="fnref:101" href="#fn:101"><sup>101</sup></a><a class="footnote-ref" id="fnref:102" href="#fn:102"><sup>102</sup></a><a class="footnote-ref" id="fnref:103" href="#fn:103"><sup>103</sup></a><a class="footnote-ref" id="fnref:104" href="#fn:104"><sup>104</sup></a> </p> <h3>Secretory capacity (<i>GT</i>)</h3> <p class="note">Main article: <a href="/facts/Thyroid%2527s_secretory_capacity/57QBV78L">Thyroid's secretory capacity</a></p> <p><a href="/facts/Thyroid%2527s_secretory_capacity/57QBV78L">Thyroid's secretory capacity</a> (<i>GT</i>, also referred to as SPINA-GT) is the maximum stimulated amount of thyroxine the thyroid can produce in one second.<a class="footnote-ref" id="fnref:105" href="#fn:105"><sup>105</sup></a> <i>GT</i> is elevated in hyperthyroidism and reduced in hypothyroidism.<a class="footnote-ref" id="fnref:106" href="#fn:106"><sup>106</sup></a> </p><p><i>GT</i> is calculated with </p><p> G ^ T = β T ( D T + [ T S H ] ) ( 1 + K 41 [ T B G ] + K 42 [ T B P A ] ) [ F T 4 ] α T [ T S H ] {\displaystyle {\hat {G}}_{T}={{\beta _{T}(D_{T}+[TSH])(1+K_{41}[TBG]+K_{42}[TBPA])[FT_{4}]} \over {\alpha _{T}[TSH]}}} </p><p>or </p><p> G ^ T = β T ( D T + [ T S H ] ) [ T T 4 ] α T [ T S H ] {\displaystyle {\hat {G}}_{T}={{\beta _{T}(D_{T}+[TSH])[TT_{4}]} \over {\alpha _{T}[TSH]}}} </p><p> α T {\displaystyle \alpha _{T}} : Dilution factor for T4 (reciprocal of apparent volume of distribution, 0.1 l−1) β T {\displaystyle \beta _{T}} : Clearance exponent for T4 (1.1e-6 sec−1) <i>K</i>41: Dissociation constant T4-TBG (2e10 L/mol) <i>K</i>42: Dissociation constant T4-TBPA (2e8 L/mol) <i>D</i><i>T</i>: EC50 for TSH (2.75 mU/L)<a class="footnote-ref" id="fnref:107" href="#fn:107"><sup>107</sup></a> </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>1.41<a class="footnote-ref" id="fnref:108" href="#fn:108"><sup>108</sup></a></td><td>8.67<a class="footnote-ref" id="fnref:109" href="#fn:109"><sup>109</sup></a></td><td>pmol/s</td></tr></tbody></table> <h3>Sum activity of peripheral deiodinases (<i>GD</i>)</h3> <p class="note">Main article: <a href="/facts/Sum_activity_of_peripheral_deiodinases/rb04hlcr">Sum activity of peripheral deiodinases</a></p> <p>The <a href="/facts/Sum_activity_of_peripheral_deiodinases/rb04hlcr">sum activity of peripheral deiodinases</a> (<i>GD</i>, also referred to as SPINA-GD) is reduced in nonthyroidal illness with hypodeiodination.<a class="footnote-ref" id="fnref:110" href="#fn:110"><sup>110</sup></a><a class="footnote-ref" id="fnref:111" href="#fn:111"><sup>111</sup></a><a class="footnote-ref" id="fnref:112" href="#fn:112"><sup>112</sup></a> </p><p><i>GD</i> is obtained with </p><p> G ^ D = β 31 ( K M 1 + [ F T 4 ] ) ( 1 + K 30 [ T B G ] ) [ F T 3 ] α 31 [ F T 4 ] {\displaystyle {\hat {G}}_{D}={{\beta _{31}(K_{M1}+[FT_{4}])(1+K_{30}[TBG])[FT_{3}]} \over {\alpha _{31}[FT_{4}]}}} </p><p>or </p><p> G ^ D = β 31 ( K M 1 + [ F T 4 ] ) [ T T 3 ] α 31 [ F T 4 ] {\displaystyle {\hat {G}}_{D}={{\beta _{31}(K_{M1}+[FT_{4}])[TT_{3}]} \over {\alpha _{31}[FT_{4}]}}} </p><p> α 31 {\displaystyle \alpha _{31}} : Dilution factor for T3 (reciprocal of apparent volume of distribution, 0.026 L−1) β 31 {\displaystyle \beta _{31}} : Clearance exponent for T3 (8e-6 sec−1) <i>K</i><i>M</i>1: Dissociation constant of type-1-deiodinase (5e-7 mol/L) <i>K</i>30: Dissociation constant T3-TBG (2e9 L/mol)<a class="footnote-ref" id="fnref:113" href="#fn:113"><sup>113</sup></a> </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>20<a class="footnote-ref" id="fnref:114" href="#fn:114"><sup>114</sup></a></td><td>40<a class="footnote-ref" id="fnref:115" href="#fn:115"><sup>115</sup></a></td><td>nmol/s</td></tr></tbody></table> <h3>TSH index</h3> <p class="note">Main article: <a href="/facts/Jostel%2527s_TSH_index/8cDsf5f8">Jostel's TSH index</a></p> <p><a href="/facts/Jostel%2527s_TSH_index/8cDsf5f8">Jostel's TSH index</a> (JTI or TSHI) helps to determine thyrotropic function of anterior <a href="/facts/Pituitary/gdrQyldF">pituitary</a> on a quantitative level.<a class="footnote-ref" id="fnref:116" href="#fn:116"><sup>116</sup></a> It is reduced in thyrotropic insufficiency<a class="footnote-ref" id="fnref:117" href="#fn:117"><sup>117</sup></a> and in certain cases of non-thyroidal illness syndrome.<a class="footnote-ref" id="fnref:118" href="#fn:118"><sup>118</sup></a> </p><p>It is calculated with </p><p> T S H I = L N ( T S H ) + 0.1345 ∗ F T 4 {\displaystyle TSHI=LN(TSH)+0.1345*FT4} . </p><p>Additionally, a standardized form of TSH index may be calculated with </p><p> s T S H I = ( T S H I − 2.7 ) / 0.676 {\displaystyle sTSHI=(TSHI-2.7)/0.676} .<a class="footnote-ref" id="fnref:119" href="#fn:119"><sup>119</sup></a> </p> <table><tbody><tr><td>Parameter</td><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>TSHI</td><td>1.3<a class="footnote-ref" id="fnref:120" href="#fn:120"><sup>120</sup></a></td><td>4.1<a class="footnote-ref" id="fnref:121" href="#fn:121"><sup>121</sup></a></td><td></td></tr><tr><td>sTSHI</td><td>-2<a class="footnote-ref" id="fnref:122" href="#fn:122"><sup>122</sup></a></td><td>2<a class="footnote-ref" id="fnref:123" href="#fn:123"><sup>123</sup></a></td><td></td></tr></tbody></table> <h3>TTSI</h3> <p class="note">Main article: <a href="/facts/Thyrotroph_Thyroid_Hormone_Sensitivity_Index/09vcowmy">Thyrotroph Thyroid Hormone Sensitivity Index</a></p> <p>The <i><a href="/facts/Thyrotroph_Thyroid_Hormone_Sensitivity_Index/09vcowmy">Thyrotroph Thyroid Hormone Sensitivity Index</a></i> (TTSI, also referred to as <i>Thyrotroph T4 Resistance Index</i> or TT4RI) was developed to enable fast screening for <a href="/facts/Thyroid_hormone_resistance/B4E6KvDq">resistance to thyroid hormone</a>.<a class="footnote-ref" id="fnref:124" href="#fn:124"><sup>124</sup></a><a class="footnote-ref" id="fnref:125" href="#fn:125"><sup>125</sup></a> Somewhat similar to the TSH Index it is calculated from equilibrium values for TSH and FT4, however with a different equation. </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>100</td><td>150</td><td></td></tr></tbody></table> <h3>TFQI</h3> <p class="note">Main article: <a href="/facts/Thyroid_Feedback_Quantile-based_Index/cH8tXAHz">Thyroid Feedback Quantile-based Index</a></p> <p>The <i><a href="/facts/Thyroid_Feedback_Quantile-based_Index/cH8tXAHz">Thyroid Feedback Quantile-based Index</a></i> (TFQI) is another parameter for thyrotropic pituitary function. It was defined to be more robust to distorted data than JTI and TTSI. It is calculated with </p><p> T F Q I = F F T 4 ( F T 4 ) − ( 1 − F T S H ( T S H ) ) {\displaystyle TFQI=F_{FT4}(FT4)-(1-F_{TSH}(TSH))} </p><p>from quantiles of FT4 and TSH concentration (as determined based on <a href="/facts/Cumulative_distribution_function/WaKU8tp4">cumulative distribution functions</a>).<a class="footnote-ref" id="fnref:126" href="#fn:126"><sup>126</sup></a> Per definition the TFQI has a <a href="/facts/Mean_(Statistics)/swcEd4Pg">mean</a> of 0 and a <a href="/facts/Standard_deviation/qSug9BRl">standard deviation</a> of 0.37 in a reference population.<a class="footnote-ref" id="fnref:127" href="#fn:127"><sup>127</sup></a> Higher values of TFQI are associated with <a href="/facts/Obesity/RBF9y5Vl">obesity</a>, <a href="/facts/Metabolic_syndrome/jI70tRBv">metabolic syndrome</a>, impaired <a href="/facts/Kidney/HBspPrv9">renal</a> function, <a href="/facts/Diabetes/2xeHXbsI">diabetes</a>, and diabetes-related <a href="/facts/Mortality_rate/s4gmxyFV">mortality</a>.<a class="footnote-ref" id="fnref:128" href="#fn:128"><sup>128</sup></a><a class="footnote-ref" id="fnref:129" href="#fn:129"><sup>129</sup></a><a class="footnote-ref" id="fnref:130" href="#fn:130"><sup>130</sup></a><a class="footnote-ref" id="fnref:131" href="#fn:131"><sup>131</sup></a><a class="footnote-ref" id="fnref:132" href="#fn:132"><sup>132</sup></a><a class="footnote-ref" id="fnref:133" href="#fn:133"><sup>133</sup></a><a class="footnote-ref" id="fnref:134" href="#fn:134"><sup>134</sup></a> TFQI results are also elevated in <a href="/facts/Takotsubo_syndrome/hlYVnzNC">takotsubo syndrome</a>,<a class="footnote-ref" id="fnref:135" href="#fn:135"><sup>135</sup></a> potentially reflecting type 2 <a href="/facts/Allostatic_load/dMEjop9E">allostatic load</a> in the situation of <a href="/facts/Psychosocial_stressor/cx6b084w">psychosocial stress</a>. Reductions have been observed in subjects with <a href="/facts/Schizophrenia/FMP4lQ57">schizophrenia</a> after initiation of therapy with <a href="/facts/Oxcarbazepine/jstz7RYM">oxcarbazepine</a>, potentially reflecting declining allostatic load.<a class="footnote-ref" id="fnref:136" href="#fn:136"><sup>136</sup></a> </p> <table><tbody><tr><td>Lower limit</td><td>Upper limit</td><td>Unit</td></tr><tr><td>–0,74</td><td>+0.74</td><td></td></tr></tbody></table> <h3>Reconstructed set point</h3> <p>In healthy persons, the intra-individual variation of TSH and thyroid hormones is considerably smaller than the inter-individual variation.<a class="footnote-ref" id="fnref:137" href="#fn:137"><sup>137</sup></a><a class="footnote-ref" id="fnref:138" href="#fn:138"><sup>138</sup></a><a class="footnote-ref" id="fnref:139" href="#fn:139"><sup>139</sup></a> This results from a personal <a href="/facts/Setpoint_(control_system)/UqfThpJu">set point</a> of thyroid homeostasis.<a class="footnote-ref" id="fnref:140" href="#fn:140"><sup>140</sup></a> In hypothyroidism, it is impossible to directly access the set point,<a class="footnote-ref" id="fnref:141" href="#fn:141"><sup>141</sup></a> but it can be reconstructed with methods of systems theory.<a class="footnote-ref" id="fnref:142" href="#fn:142"><sup>142</sup></a><a class="footnote-ref" id="fnref:143" href="#fn:143"><sup>143</sup></a><a class="footnote-ref" id="fnref:144" href="#fn:144"><sup>144</sup></a> </p><p>A computerised algorithm, called Thyroid-SPOT, which is based on this mathematical theory, has been implemented in software applications.<a class="footnote-ref" id="fnref:145" href="#fn:145"><sup>145</sup></a> In patients undergoing thyroidectomy it could be demonstrated that this algorithm can be used to reconstruct the personal set point with sufficient precision.<a class="footnote-ref" id="fnref:146" href="#fn:146"><sup>146</sup></a> </p> <h2 id="effects-of-drugs">Effects of drugs</h2> <p>Drugs can profoundly affect thyroid function tests. Listed below is a selection of important effects. </p> Effects of some drugs on Tests of Thyroid function<a class="footnote-ref" id="fnref:147" href="#fn:147"><sup>147</sup></a><a class="footnote-ref" id="fnref:148" href="#fn:148"><sup>148</sup></a><a class="footnote-ref" id="fnref:149" href="#fn:149"><sup>149</sup></a><table><tbody><tr><th>Cause</th><th>Drug</th><th>Effect on hormone concentrations</th><th>Effect on structure parameters</th></tr><tr><td>Inhibited TSH secretion</td><td><a href="/facts/Dopamine/5gNy8Xkd">Dopamine</a>, <a href="/facts/L-DOPA/4R7qahlh">L-DOPA</a>, <a href="/facts/Glucocorticoids/2P91Aj3S">glucocorticoids</a>, <a href="/facts/Somatostatin/GAD2utoz">somatostatin</a></td><td>↓T4; ↓T3; ↓TSH</td><td>↔SPINA-GT; ↓JTI</td></tr><tr><td>Inhibited synthesis or release of thyroid hormone</td><td><a href="/facts/Iodine/JlfMecMf">Iodine</a>, <a href="/facts/Lithium/7vXX6BWA">lithium</a></td><td>↓T4; ↓T3; ↑TSH</td><td>↓SPINA-GT; ↔JTI</td></tr><tr><td>Inhibited conversion of T4 to T3 (Step-up hypodeiodination)</td><td><a href="/facts/Amiodarone/rywCcA6L">Amiodarone</a>, <a href="/facts/Glucocorticoids/2P91Aj3S">glucocorticoids</a>, <a href="/facts/Propranolol/QvH2XYt1">propranolol</a>, <a href="/facts/Propylthiouracil/zRId5hqt">propylthiouracil</a>, <a href="/facts/Radiographic_contrast_agents/JefNS98C">radiographic contrast agents</a></td><td>↓T3; ↑rT3; ↓, ↔, ↑T4 and fT4; ↔, ↑TSH</td><td>↓SPINA-GD</td></tr><tr><td>Inhibited binding of T4/T3 to serum proteins</td><td><a href="/facts/Salicylates/qz7RRQCR">Salicylates</a>, <a href="/facts/Phenytoin/uFvxbwf2">phenytoin</a>, <a href="/facts/Carbamazepine/Hd1By1Mj">carbamazepine</a>, <a href="/facts/Furosemide/tq9Lx0u4">furosemide</a>, <a href="/facts/Nonsteroidal_anti-inflammatory_agents/coIkzl4s">nonsteroidal anti-inflammatory agents</a>, <a href="/facts/Heparin/4lxSm2pB">heparin</a> (in vitro effect)</td><td>↓T4; ↓T3; ↓fT4E, ↔, ↑fT4; ↔TSH</td><td>↓T4/fT4 ratio</td></tr><tr><td>Stimulated metabolism of iodothyronines</td><td><a href="/facts/Phenobarbital/G236GSuW">Phenobarbital</a>, <a href="/facts/Phenytoin/uFvxbwf2">phenytoin</a>, <a href="/facts/Carbamazepine/Hd1By1Mj">carbamazepine</a>, <a href="/facts/Rifampicin/9naa8C5l">rifampicin</a></td><td>↓T4; ↓fT4; ↔TSH</td><td></td></tr><tr><td>Inhibited absorption of ingested T4</td><td><a href="/facts/Aluminium_hydroxide/e0pXvDGr">Aluminium hydroxide</a>, <a href="/facts/Ferrous_sulfate/zyc7Fukb">ferrous sulfate</a>, <a href="/facts/Cholestyramine/BtL6h9hv">cholestyramine</a>, <a href="/facts/Colestipol/b7bvRUmr">colestipol</a>, iron <a href="/facts/Sucralfate/jJ4BLDJ6">sucralfate</a>, <a href="/facts/Soybean/reNwxvo2">soybean</a> preparations, <a href="/facts/Kayexalate/wfgeTdAh">kayexalate</a></td><td>↓T4; ↓fT4; ↑TSH</td><td></td></tr><tr><td>Increase in concentration of T4-binding proteins</td><td><a href="/facts/Estrogen/dPEewnDV">Estrogen</a>, <a href="/facts/Clofibrate/5tyjpuQY">clofibrate</a>, <a href="/facts/Opiates/IHfQkMkU">opiates</a> (<a href="/facts/Heroin/rYwrKHPk">heroin</a>, <a href="/facts/Methadone/Gz6231sT">methadone</a>), <a href="/facts/5-fluorouracil/6xH4uUaf">5-fluorouracil</a>, <a href="/facts/Perphenazine/rf2wAucn">perphenazine</a></td><td>↑T4; ↑T3; ↔fT4; ↔TSH</td><td>↔SPINA-GT; ↔SPINA-GD; ↔JTI; ↑T4/fT4 ratio</td></tr><tr><td>Decrease in concentration of T4-binding proteins</td><td><a href="/facts/Androgens/Rxey0HxX">Androgens</a>, <a href="/facts/Glucocorticoids/2P91Aj3S">glucocorticoids</a></td><td>↓T4; ↓T3; ↔fT4; ↔TSH</td><td>↔SPINA-GT; ↔SPINA-GD; ↔JTI; ↓T4/fT4 ratio</td></tr></tbody></table> <p>↓: reduced serum concentration or structure parameter; ↑: increased serum concentration or structure parameter; ↔: no change; TSH: Thyroid-stimulating hormone; T3: Total triiodothyronine; T4: Total thyroxine; fT4: Free thyroxine; fT3: Free triiodothyronine; rT3: Reverse triiodothyronine </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Reference_ranges_for_blood_tests/Fls5Gbtb">Reference ranges for thyroid hormones</a></li></ul> <ul><li><a href="/facts/Long-acting_thyroid_stimulator/6CjnWNdE">Long-acting thyroid stimulator</a> (LATS)</li></ul> <h2 id="further-reading">Further reading</h2> <ul><li>American Thyroid Association: <a href="http://www.thyroid.org/blood-test-for-thyroid/">Thyroid Function Tests</a>. Posted on June 4, 2012, seen on January 9, 2013.</li> <li><a href="http://labtestsonline.org/understanding/analytes/thyroid-panel/tab/test">Thyroid function panel - Lab Tests Online</a></li></ul> <h2 id="external-links">External links</h2> <ul><li><a href="http://spina.sf.net">SPINA Thyr: Open source software for calculating GT and GD</a></li> <li><a href="https://web.archive.org/web/20170212093006/https://pdfs.semanticscholar.org/5fe5/97829d6859a84190cf47e71310426588b72c.pdf">Interpretation of thyroid function tests</a> by Dayan, Colin M. 2001. The Lancet, Vol. 357.</li></ul> <h3>CDC laboratory procedure manuals</h3> <p>The <a href="/facts/Centers_for_Disease_Control_and_Prevention/NmoJNDV5">Centers for Disease Control and Prevention</a> has published the following laboratory procedure manuals for measuring thyroid-stimulating hormone: </p> <ul><li><a href="https://www.cdc.gov/NCHS/data/nhanes/nhanes_09_10/THYROD_F_met_TSH.pdf">Thyroid Stimulating Hormone (TSH) (University of Washington Medical Center)</a>. September 2011. Method: Access 2 (<a href="/facts/Beckman_Coulter/As0jIHkP">Beckman Coulter</a>).</li> <li><a href="https://www.cdc.gov/NCHS/data/nhanes/nhanes_09_10/THYROD_F_met_TSH_CLS.pdf">Thyroid Stimulating Hormone (TSH) (Collaborative Laboratory Services)</a>. September 2011. Method: Access 2 (<a href="/facts/Beckman_Coulter/As0jIHkP">Beckman Coulter</a>).</li> <li><a href="https://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/THYROD_e_met_Thyroid_Stimulating_Hormone.pdf">Thyroid Stimulating Hormone (TSH)</a>. September 2009. Method: Access 2 (<a href="/facts/Beckman_Coulter/As0jIHkP">Beckman Coulter</a>).</li> <li><a href="https://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/l18t4_b_met_b_tsh.pdf">Lab 18 Thyroid Stimulating Hormone</a>. 2001-2002. Method: Microparticle Enzyme Immunoassay.</li> <li><a href="https://www.cdc.gov/nchs/data/nhanes/nhanes_99_00/lab18_met_tsh.pdf">Lab 18 TSH - Thyroid Stimulating Hormone</a>. 1999-2000. Method: Microparticle Enzyme Immunoassay.</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Dayan CM (February 2001). "Interpretation of thyroid function tests". Lancet. 357 (9256): 619–24. doi:10.1016/S0140-6736(00)04060-5. PMID 11558500. S2CID 3278073. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Hoermann, Rudolf; Midgley, John E. M.; Larisch, Rolf; Dietrich, Johannes W. (22 December 2017). "Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment". Frontiers in Endocrinology. 8: 364. doi:10.3389/fendo.2017.00364. PMC 5763098. PMID 29375474. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763098" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763098</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Midgley, JEM; Toft, AD; Larisch, R; Dietrich, JW; Hoermann, R (18 April 2019). "Time for a reassessment of the treatment of hypothyroidism". BMC Endocrine Disorders. 19 (1): 37. doi:10.1186/s12902-019-0365-4. PMC 6471951. PMID 30999905. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471951" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471951</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Spencer, Carole; Takeuchi, Michael; Kazarosyan, Margarita (1996). "Current status and performance goals for serum thyrotropin (TSH) assays". Clinical Chemistry. 42 (1): 141–145. PMID 8565217. Retrieved 5 November 2013. <a href="http://www.clinchem.org/content/42/1/140.long" target="_blank">http://www.clinchem.org/content/42/1/140.long</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337. <a href="/wiki/PMID_(identifier)" target="_blank">/wiki/PMID_(identifier)</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07. <a href="978-0-7817-5047-9" target="_blank">978-0-7817-5047-9</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Hoermann, Rudolf; Midgley, John E. M.; Larisch, Rolf; Dietrich, Johannes W. (2015). "Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment". Frontiers in Endocrinology. 6: 177. doi:10.3389/fendo.2015.00177. PMC 4653296. PMID 26635726. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653296" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653296</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>Leow, Melvin Khee-Shing (2016). "A Review of the Phenomenon of Hysteresis in the Hypothalamus–Pituitary–Thyroid Axis". Frontiers in Endocrinology. 7: 64. doi:10.3389/fendo.2016.00064. PMC 4905968. PMID 27379016. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905968" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905968</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Dayan, Colin (24 February 2001). "Interpretation of thyroid function tests" (PDF). The Lancet. 357 (9256): 619–624. doi:10.1016/s0140-6736(00)04060-5. PMID 11558500. S2CID 3278073. Archived from the original (PDF) on 25 June 2013. Retrieved 5 November 2013. <a href="https://web.archive.org/web/20130625181731/http://keck.usc.edu/en/Education/Academic_Department_and_Divisions/Department_of_Medicine/Education_and_Training/Internal_Medicine_Residency/Resources/Articles/~/media/Docs/Departments/Medicine/Chief%20Resident/Articles/Endocrinology/TFTs.pdf" target="_blank">https://web.archive.org/web/20130625181731/http://keck.usc.edu/en/Education/Academic_Department_and_Divisions/Department_of_Medicine/Education_and_Training/Internal_Medicine_Residency/Resources/Articles/~/media/Docs/Departments/Medicine/Chief%20Resident/Articles/Endocrinology/TFTs.pdf</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>van der Watt G, Haarburger D, Berman P (July 2008). "Euthyroid patient with elevated serum free thyroxine". Clin. Chem. 54 (7): 1239–41. doi:10.1373/clinchem.2007.101428. PMID 18593963. <a href="https://doi.org/10.1373%2Fclinchem.2007.101428" target="_blank">https://doi.org/10.1373%2Fclinchem.2007.101428</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>van der Watt G, Haarburger D, Berman P (July 2008). "Euthyroid patient with elevated serum free thyroxine". Clin. Chem. 54 (7): 1239–41. doi:10.1373/clinchem.2007.101428. PMID 18593963. <a href="https://doi.org/10.1373%2Fclinchem.2007.101428" target="_blank">https://doi.org/10.1373%2Fclinchem.2007.101428</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>Derived from molar values using molar mass of 776.87 g/mol <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>Reference range list from Uppsala University Hospital ("Laborationslista"). Artnr 40284 Sj74a. Issued on April 22, 2008 <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>van der Watt G, Haarburger D, Berman P (July 2008). "Euthyroid patient with elevated serum free thyroxine". Clin. Chem. 54 (7): 1239–41. doi:10.1373/clinchem.2007.101428. PMID 18593963. <a href="https://doi.org/10.1373%2Fclinchem.2007.101428" target="_blank">https://doi.org/10.1373%2Fclinchem.2007.101428</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Reference range list from Uppsala University Hospital ("Laborationslista"). Artnr 40284 Sj74a. Issued on April 22, 2008 <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> <li id="fn:45"><p>van der Watt G, Haarburger D, Berman P (July 2008). "Euthyroid patient with elevated serum free thyroxine". Clin. Chem. 54 (7): 1239–41. doi:10.1373/clinchem.2007.101428. PMID 18593963. <a href="https://doi.org/10.1373%2Fclinchem.2007.101428" target="_blank">https://doi.org/10.1373%2Fclinchem.2007.101428</a> <a href="#fnref:45" class="footnote-back-ref">↩</a></p></li> <li id="fn:46"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:46" class="footnote-back-ref">↩</a></p></li> <li id="fn:47"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></p></li> <li id="fn:48"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:48" class="footnote-back-ref">↩</a></p></li> <li id="fn:49"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:49" class="footnote-back-ref">↩</a></p></li> <li id="fn:50"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></p></li> <li id="fn:51"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></p></li> <li id="fn:52"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:52" class="footnote-back-ref">↩</a></p></li> <li id="fn:53"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:53" class="footnote-back-ref">↩</a></p></li> <li id="fn:54"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:54" class="footnote-back-ref">↩</a></p></li> <li id="fn:55"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:55" class="footnote-back-ref">↩</a></p></li> <li id="fn:56"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:56" class="footnote-back-ref">↩</a></p></li> <li id="fn:57"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:57" class="footnote-back-ref">↩</a></p></li> <li id="fn:58"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:58" class="footnote-back-ref">↩</a></p></li> <li id="fn:59"><p>Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System <a href="http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm" target="_blank">http://labs.unchealthcare.org/labstestinfo/f_tests/free_t4.htm</a> <a href="#fnref:59" class="footnote-back-ref">↩</a></p></li> <li id="fn:60"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:60" class="footnote-back-ref">↩</a></p></li> <li id="fn:61"><p>Derived from mass values using molar mass of 776.87 g/mol <a href="#fnref:61" class="footnote-back-ref">↩</a></p></li> <li id="fn:62"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:62" class="footnote-back-ref">↩</a></p></li> <li id="fn:63"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:63" class="footnote-back-ref">↩</a></p></li> <li id="fn:64"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:64" class="footnote-back-ref">↩</a></p></li> <li id="fn:65"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:65" class="footnote-back-ref">↩</a></p></li> <li id="fn:66"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:66" class="footnote-back-ref">↩</a></p></li> <li id="fn:67"><p>Reference range list from Uppsala University Hospital ("Laborationslista"). Artnr 40284 Sj74a. Issued on April 22, 2008 <a href="#fnref:67" class="footnote-back-ref">↩</a></p></li> <li id="fn:68"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:68" class="footnote-back-ref">↩</a></p></li> <li id="fn:69"><p>Reference range list from Uppsala University Hospital ("Laborationslista"). Artnr 40284 Sj74a. Issued on April 22, 2008 <a href="#fnref:69" class="footnote-back-ref">↩</a></p></li> <li id="fn:70"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:70" class="footnote-back-ref">↩</a></p></li> <li id="fn:71"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:71" class="footnote-back-ref">↩</a></p></li> <li id="fn:72"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:72" class="footnote-back-ref">↩</a></p></li> <li id="fn:73"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:73" class="footnote-back-ref">↩</a></p></li> <li id="fn:74"><p>Derived from mass values using molar mass of 650.98 g/mol <a href="#fnref:74" class="footnote-back-ref">↩</a></p></li> <li id="fn:75"><p>Derived from mass values using molar mass of 650.98 g/mol <a href="#fnref:75" class="footnote-back-ref">↩</a></p></li> <li id="fn:76"><p>Cioffi M, Gazzerro P, Vietri MT, et al. (2001). "Serum concentration of free T3, free T4 and TSH in healthy children". J. Pediatr. Endocrinol. Metab. 14 (9): 1635–9. doi:10.1515/JPEM.2001.14.9.1635. PMID 11795654. S2CID 34910563. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:76" class="footnote-back-ref">↩</a></p></li> <li id="fn:77"><p>Cioffi M, Gazzerro P, Vietri MT, et al. (2001). "Serum concentration of free T3, free T4 and TSH in healthy children". J. Pediatr. Endocrinol. Metab. 14 (9): 1635–9. doi:10.1515/JPEM.2001.14.9.1635. PMID 11795654. S2CID 34910563. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:77" class="footnote-back-ref">↩</a></p></li> <li id="fn:78"><p>Derived from mass values using molar mass of 650.98 g/mol <a href="#fnref:78" class="footnote-back-ref">↩</a></p></li> <li id="fn:79"><p>Derived from mass values using molar mass of 650.98 g/mol <a href="#fnref:79" class="footnote-back-ref">↩</a></p></li> <li id="fn:80"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:80" class="footnote-back-ref">↩</a></p></li> <li id="fn:81"><p>Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease. <a href="http://pathcuric1.swmed.edu/PathDemo/nrrt.htm" target="_blank">http://pathcuric1.swmed.edu/PathDemo/nrrt.htm</a> <a href="#fnref:81" class="footnote-back-ref">↩</a></p></li> <li id="fn:82"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:82" class="footnote-back-ref">↩</a></p></li> <li id="fn:83"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:83" class="footnote-back-ref">↩</a></p></li> <li id="fn:84"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:84" class="footnote-back-ref">↩</a></p></li> <li id="fn:85"><p>Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager <a href="http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm" target="_blank">http://www.thyroidmanager.org/chapter6/Ch-6b-2.htm</a> <a href="#fnref:85" class="footnote-back-ref">↩</a></p></li> <li id="fn:86"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:86" class="footnote-back-ref">↩</a></p></li> <li id="fn:87"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:87" class="footnote-back-ref">↩</a></p></li> <li id="fn:88"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:88" class="footnote-back-ref">↩</a></p></li> <li id="fn:89"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:89" class="footnote-back-ref">↩</a></p></li> <li id="fn:90"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:90" class="footnote-back-ref">↩</a></p></li> <li id="fn:91"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:91" class="footnote-back-ref">↩</a></p></li> <li id="fn:92"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:92" class="footnote-back-ref">↩</a></p></li> <li id="fn:93"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:93" class="footnote-back-ref">↩</a></p></li> <li id="fn:94"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:94" class="footnote-back-ref">↩</a></p></li> <li id="fn:95"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:95" class="footnote-back-ref">↩</a></p></li> <li id="fn:96"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:96" class="footnote-back-ref">↩</a></p></li> <li id="fn:97"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:97" class="footnote-back-ref">↩</a></p></li> <li id="fn:98"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:98" class="footnote-back-ref">↩</a></p></li> <li id="fn:99"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:99" class="footnote-back-ref">↩</a></p></li> <li id="fn:100"><p>Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25. <a href="http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm" target="_blank">http://www.brooksidepress.org/Products/Military_OBGYN/Lab/ThyroidFunctionTests.htm</a> <a href="#fnref:100" class="footnote-back-ref">↩</a></p></li> <li id="fn:101"><p>Dietrich JW, Stachon A, Antic B, Klein HH, Hering S (2008). "The AQUA-FONTIS study: protocol of a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardized diagnostics and classification of non-thyroidal illness syndrome". BMC Endocr Disord. 8: 13. doi:10.1186/1472-6823-8-13. PMC 2576461. PMID 18851740. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576461" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576461</a> <a href="#fnref:101" class="footnote-back-ref">↩</a></p></li> <li id="fn:102"><p>Rosolowska-Huszcz D, Kozlowska L, Rydzewski A (August 2005). "Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure". Endocrine. 27 (3): 283–8. doi:10.1385/ENDO:27:3:283. PMID 16230785. S2CID 25630198. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:102" class="footnote-back-ref">↩</a></p></li> <li id="fn:103"><p>Liu S, Ren J, Zhao Y, Han G, Hong Z, Yan D, Chen J, Gu G, Wang G, Wang X, Fan C, Li J (2012). "Nonthyroidal Illness Syndrome: Is it Far Away From Crohn's Disease?". J Clin Gastroenterol. 47 (2): 153–9. doi:10.1097/MCG.0b013e318254ea8a. PMID 22874844. S2CID 35344744. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:103" class="footnote-back-ref">↩</a></p></li> <li id="fn:104"><p>Dietrich, Johannes W.; Landgrafe-Mende, Gabi; Wiora, Evelin; Chatzitomaris, Apostolos; Klein, Harald H.; Midgley, John E. M.; Hoermann, Rudolf (9 June 2016). "Calculated Parameters of Thyroid Homeostasis: Emerging Tools for Differential Diagnosis and Clinical Research". Frontiers in Endocrinology. 7: 57. doi:10.3389/fendo.2016.00057. PMC 4899439. PMID 27375554. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899439" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899439</a> <a href="#fnref:104" class="footnote-back-ref">↩</a></p></li> <li id="fn:105"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:105" class="footnote-back-ref">↩</a></p></li> <li id="fn:106"><p>Dietrich, J., M. Fischer, J. Jauch, E. Pantke, R. Gärtner und C. R. Pickardt (1999). "SPINA-THYR: A Novel Systems Theoretic Approach to Determine the Secretion Capacity of the Thyroid Gland." European Journal of Internal Medicine 10, Suppl. 1 (5/1999): S34. <a href="#fnref:106" class="footnote-back-ref">↩</a></p></li> <li id="fn:107"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:107" class="footnote-back-ref">↩</a></p></li> <li id="fn:108"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:108" class="footnote-back-ref">↩</a></p></li> <li id="fn:109"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:109" class="footnote-back-ref">↩</a></p></li> <li id="fn:110"><p>Rosolowska-Huszcz D, Kozlowska L, Rydzewski A (August 2005). "Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure". Endocrine. 27 (3): 283–8. doi:10.1385/ENDO:27:3:283. PMID 16230785. S2CID 25630198. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:110" class="footnote-back-ref">↩</a></p></li> <li id="fn:111"><p>Liu S, Ren J, Zhao Y, Han G, Hong Z, Yan D, Chen J, Gu G, Wang G, Wang X, Fan C, Li J (2012). "Nonthyroidal Illness Syndrome: Is it Far Away From Crohn's Disease?". J Clin Gastroenterol. 47 (2): 153–9. doi:10.1097/MCG.0b013e318254ea8a. PMID 22874844. S2CID 35344744. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:111" class="footnote-back-ref">↩</a></p></li> <li id="fn:112"><p>Fan, S; Ni, X; Wang, J; Zhang, Y; Tao, S; Chen, M; Li, Y; Li, J (February 2016). "Low Triiodothyronine Syndrome in Patients With Radiation Enteritis: Risk Factors and Clinical Outcomes an Observational Study". Medicine. 95 (6): e2640. doi:10.1097/MD.0000000000002640. PMC 4753882. PMID 26871787. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753882" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753882</a> <a href="#fnref:112" class="footnote-back-ref">↩</a></p></li> <li id="fn:113"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:113" class="footnote-back-ref">↩</a></p></li> <li id="fn:114"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:114" class="footnote-back-ref">↩</a></p></li> <li id="fn:115"><p>Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505. <a href="978-3-89722-850-4" target="_blank">978-3-89722-850-4</a> <a href="#fnref:115" class="footnote-back-ref">↩</a></p></li> <li id="fn:116"><p>Jostel A, Ryder WD, Shalet SM (October 2009). "The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH Index". Clin. Endocrinol. 71 (4): 529–34. doi:10.1111/j.1365-2265.2009.03534.x. PMID 19226261. S2CID 10827131. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:116" class="footnote-back-ref">↩</a></p></li> <li id="fn:117"><p>Jostel A, Ryder WD, Shalet SM (October 2009). "The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH Index". Clin. Endocrinol. 71 (4): 529–34. doi:10.1111/j.1365-2265.2009.03534.x. PMID 19226261. S2CID 10827131. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:117" class="footnote-back-ref">↩</a></p></li> <li id="fn:118"><p>Fan, S; Ni, X; Wang, J; Zhang, Y; Tao, S; Chen, M; Li, Y; Li, J (February 2016). "Low Triiodothyronine Syndrome in Patients With Radiation Enteritis: Risk Factors and Clinical Outcomes an Observational Study". Medicine. 95 (6): e2640. doi:10.1097/MD.0000000000002640. PMC 4753882. 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