Toxic Adenoma laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Measurement of serum TSH is considered as the best initial test in the evaluation of thyroid disorders. The serum free T4 and free or total T3 levels are elevated or in the upper part of the normal range. Findings of routine laboratory tests include elevated serum calcium, elevated alkaline phosphatase, elevated ferritin levels, low (LDL) cholesterol levels.

Laboratory Findings

Measurement of serum TSH is considered as the initial test in the evaluation of thyroid disorders.^[1]^[2]^[3]^[4]
It should be measured in all patients with a thyroid nodule or goiter.
The serum free T4 and free or total T3 levels are elevated or in the upper part of the normal range.
Toxic adenomas can be associated with overt or subclinical hyperthyroidism.
- In overt hyperthyroidism, usually both serum (free) T4 and T3 are elevated.
- Isolated T3 toxicosis, in which the serum T3 concentration is elevated but free T4 is normal, occurs in approximately 1% of patients with hyperthyroidism.
When the TSH is low, but both free T4 and T3 levels are normal, the patient has subclinical or mild hyperthyroidism, which is common in toxic multinodular goiter, especially in older patients.
Findings of routine laboratory tests include:
- Elevated serum calcium
- Elevated alkaline phosphatase
- Elevated ferritin levels
- Low (LDL) cholesterol levels.

Tests	Findings
TSH	Low
Free T4	Elevated
Total T3	Elevated
CMP	Hypercalcemia Elevated aminotransferases Elevated alkaline phosphatase
TSH receptor antibodies	Negative
Thyroid peroxidase antibodies	Negative

References

↑ Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, LiVosli VA, Niccoli-Sire P, John R, Ruf J, Smyth PP, Spencer CA, Stockigt JR (2003). “Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease”. Thyroid. 13 (1): 3–126. doi:10.1089/105072503321086962. PMID 12625976.
↑ Hegedüs L (2004). “Clinical practice. The thyroid nodule”. N. Engl. J. Med. 351 (17): 1764–71. doi:10.1056/NEJMcp031436. PMID 15496625.
↑ Cattaneo F, Bürgi U, Mueller B (1999). “[Goiter and nodular thyroid disease: clinical guidelines for diagnosis and treatment. (Waiting? Hormone therapy? Surgery? radioiodine?)]”. Ther Umsch (in German). 56 (7): 356–63. doi:10.1024/0040-5930.56.7.356. PMID 10434771.
↑ Hurley DL, Gharib H (1996). “Evaluation and management of multinodular goiter”. Otolaryngol. Clin. North Am. 29 (4): 527–40. PMID 8844728.

[pmid12625976-1] Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, LiVosli VA, Niccoli-Sire P, John R, Ruf J, Smyth PP, Spencer CA, Stockigt JR (2003). “Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease”. Thyroid. 13 (1): 3–126. doi:10.1089/105072503321086962. PMID 12625976.

[pmid15496625-2] Hegedüs L (2004). “Clinical practice. The thyroid nodule”. N. Engl. J. Med. 351 (17): 1764–71. doi:10.1056/NEJMcp031436. PMID 15496625.

[pmid10434771-3] Cattaneo F, Bürgi U, Mueller B (1999). “[Goiter and nodular thyroid disease: clinical guidelines for diagnosis and treatment. (Waiting? Hormone therapy? Surgery? radioiodine?)]”. Ther Umsch (in German). 56 (7): 356–63. doi:10.1024/0040-5930.56.7.356. PMID 10434771.

[pmid8844728-4] Hurley DL, Gharib H (1996). “Evaluation and management of multinodular goiter”. Otolaryngol. Clin. North Am. 29 (4): 527–40. PMID 8844728.

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