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The information in this booklet is given as a guideline only

and is not intended to be exhaustive.
It in no way binds bioMérieux S.A. to the diagnosis established
or the treatment prescribed by the physician.

Investigation ofof
theThyroid
Thyroid Function
the
Function
Printed in France / THERA Conseil / RCS Lyon B 398 160 242

bioMérieux S.A.
69280 Marcy l’Etoile
France
Tel. : 33 (0)4 78 87 20 00
Fax : 33 (0)4 78 87 20 90
www.biomerieux.com
 Who requires
a thyroid profile?
1 All patients with a combination of symptoms suggesting
a thyroid dysfunction, and/or with a morphological
anomaly of the thyroid gland.
N.B. Since the role of thyroid hormones is essential
for maturation and development, a profile is carried out
for all newborns and children with a growth disorder.

Significance Main general symptoms associated

of the thyroid profile with thyroid disfunction :
• asthenia (hypo),
Thyroid hormones affect the regulation of every body organ, mainly • apathy (hypo) or excitement (hyper),
through nuclear receptors (expression of genes through • slow (hypo) or rapid (hyper)
transcription), but also other receptors (membrane, mitochondria, pulse rate,
etc.) or actions linked with other hormones. • slow (hypo) or rapid (hyper)
Consequently, any dysfunctioning in the thyroid system results in heart rate,
a large number of general symptoms indicating: • weight gain (hypo) or loss (hyper),
• either excess synthesis of thyroid hormones • long (hypo) or short (hyper) intestinal
(hyperthyroidism) transit times,
• or insufficient production (hypothyroidism). • in children : growth disorders.

2 Patients treated for a thyroid pathology either using

synthetic anti-thyroid drugs (SAT), or thyroxin (T4).

3 Patients treated with drugs which may induce thyroid

pathologies (cordarone, interferon, lithium, etc.)

4 Patients with non-thyroid auto-immune diseases

(dominant role of autoimmunity in thyroid pathologies
and frequent associations with various auto-immune diseases).

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Biological aspects
Regulation of thyroid function
Serotonin
+

HYPOTHALAMUS
+
FT4 + FT3 TRH Noradrenalin
PERIPHERAL

FT3
T3 Nr D II Somatostatin Dopamine
TRH Mr
DI + Estrogens
Androgens
Glucocorticoids
D II
FT4 FT4 FT3 + +

PITUITARY
FT3
FT3 αTSH T3 Nr βTSH

FT3
TSH

TSH
HCG + Neuropeptides
The hormones Somatostatin

Growth TSH Mr
TSH factors
TSH is a pituitary hormone, which is

THYROID
the centerpoint of the thyroid profile, since it acts Cytokines Organification
T4 T3
Binding
as a "modulator" for variations in thyroxinemia
(T4, contrary to T3, being exclusively
produced by the thyroid).
Iodide Affinity
FT4 (Free T4 fraction). Carrier proteins Binding
FT4 Concentration
FT4 acts as an indicator of thyroid
production and is used to confirm
the diagnosis suggested by TSH. FT3

FT3 (Free T3 fraction).

In some cases, FT3 can be produced Mr = membrane receptor TRH = Thyrotropin-Releasing
by the thyroid gland, in preference over T4 Nr = nuclear receptor Hormone
(e.g. in cases of iodine deficiency). DI = Type I deiodase TSH = Thyroid-Stimulating
However, in most cases, FT3 is an indicator DII = Type II deiodase (5'deiodase) Hormone
of peripheral deiodination of T4. ● = main sites of interaction between FT4 = Free Thyroxine
drugs and non-thyroid illnesses (direct FT3 = Free Triiodothyronine
action or through agonists or antagonists
of physiological molecules)

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Main causes of discrepant profiles other than
thyroid pathologies : Specific cases :
- Presence of anti-hormone antibodies (anti-T3, anti-T4)
Decreased TSH
- Early stage of pregnancy (HCG) or mouse anti-gammaglobulins (HAMA), or abnormal
- Glucocorticoids, dopamine and dopaminergics albumin levels (dysalbuminemia).
(bromocriptine), serotonin, opiates, dextrogyral T4 (DT4), - Hypothalamo-pituitary disorders.
triiodoacetic acid. - Thyroid hormone resistance syndromes.
- Severe non-thyroid illnesses (NTI, psychiatric
disorders).
Moderate TSH increase
Dopamine antagonists and neuroleptics
(metoclopramide, chlorpromazide, haloperidol,
domperidone, sulpiride), lithium, amiodarone
Which tests
(especially at the beginning of treatment). to prescribe?
Increased FT4
Amiodarone, propanolol, active acute and chronic hepatitis,
DT4. TSH is always the first screening test to be performed.
Decreased FT4
The following approach could then be used :
Kidney disorders, diphenyl-hydantoin, phenobarbital,
carbamazepine. 1 Where there is little clinical context, eliminate a thyroid
Increased FT3 pathology from diagnosis using only the TSH assay,
Triiodoacetic acid, DT4.
2 In cases of a clinically suspected thyroid
Decreased FT3 dysfunction, confirm diagnosis by associating TSH-FT4
Fasting, cordarone, propanolol, severe non-thyroid (TSH may be affected by non-thyroid factors),
illnesses (NTI), hepatic cirrhosis.
3 When monitoring treated patients, an FT4 or FT3 assay
may be performed in addition to the TSH assay,
if necessary.
Situations inducing thyroid pathologies :
Treatment with lithium, interferon, amiodarone, When monitoring treated cases of secondary hypothyroidism,
ingestion of substances leading to excess iodine exposure. the TSH assay is of no significance. FT4 or FT3 assays should be
used for monitoring these patients.
Effect of age :
- TSH peak during first days of life
- FT4 levels higher in newborns than in adults Other parameters for investigation of the thyroid function
(with lower FT3) TSH anti-receptor antibody
- FT3 levels higher in children and adolescents than Anti-thyroglobulin antibody
in adults Anti-thyroperoxidase antibody
- FT3 levels reduced in the elderly Thyroglobulin
Thyrocalcitonin

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Profile interpretation
Initial biological investigation of thyroid disorders

Patient not receiving treatment

TSH

low
high normal

and and
FT4 FT4 FT4 or FT3 FT4 or FT3 FT4 and FT3

increased normal or increased normal decreased

decreased

Profile check See clinical examination

EUTHYROID SECONDARY
Further investigations (NTI*, therapeutic drugs,
HYPOTHYROIDISM (if confirmed by HYPERTHYROIDISM pregnancy...). Complete the HYPOTHYROIDISM
required
clinical examination) investigation by performing NTI*
an immunological profile, or
iodine profile,
or scintigraphy.

Investigation of the
hypothalamic-pituitary
axis (adenoma, Hyperthyroidism (nodular or diffuse goiter), case
resistance to history of hyperthyroidism, viral pathologies,
thyroid hormones...) profile modifications due to drugs or iodine,
early stage of a thyroid pathology...

* NTI = non-thyroid illness

Biological monitoring*

Patients treated with thyroxin as a substitute Patients treated with synthetic anti-thyroid drugs

TSH TSH

decreased normal increased decreased normal increased

Reduce dosage Hypothyroid state persists. Appropriate Reduce

FT4 Increase dosage FT4 treatment dosage

decreased normal increased decreased normal increased

Investigate Continue Consult time of Consider maintaining Continue Hypothyroid state persists.
possible interference same dosage last T4 administration or reducing dosage same dosage Increase dosage

* A considerable time period (at least 2 to 3 weeks) should separate the biological follow-up from the initiation or modification of treatment.

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Interpretation bioMérieux Thyroid Offer
difficulties Experience and Innovation
These difficulties are based on the following observations : bioMérieux is committed to maintaining a leading position in
in vitro diagnostics. In the early 1980’s, as an innovative RIA
1 The non-thyroid origin of TSH specialist, bioMérieux gained valuable know-how in the field
(physiological or pathological disorders
of the hypothalamo-pituitary axis), of hormonology.
Based on this extensive experience, bioMérieux has been able
2 Difficulty in determining the free fraction to develop tests for VIDAS® and VIDIA®.
of thyroid hormones,
3 Difficulty in defining a normal range, Investigation of the thyroid function on VIDIA
4 Repercussions possibly due to a deficiency or excess VIDIA TSH ref. 38 200 100 tests
of iodine (although no pathology is detected),
VIDIA FT4 ref. 38 210 100 tests
5 The inevitable possibility of interference due to VIDIA FT3 ref. 38 220 50 tests
analytical (in vitro), medicinal (in vivo and sometimes
in vitro) or biological (associated pathologies) factors.
Investigation of the thyroid function on VIDAS
VIDAS TSH ref. 30 400 60 tests
VIDAS TSH 3 ref. 30 441 60 tests

What should be done VIDAS FT4

VIDAS FT3
ref. 30 401
ref. 30 402
60 tests
60 tests
in the case of VIDAS T4
VIDAS T3
ref. 30 404
ref. 30 403
60 tests
60 tests
a discrepant profile?
Please contact your local bioMérieux representative
for further information and product availability
1 Check that results are valid (by controlling the assay
giving an apparently abnormal result).

2 Study the information given on treatments being taken

which may interfere with the parameters being tested
(see page 4).

3 Perform several simple tests to eliminate the possibility

of analytical interference (dilutions, spiking tests).
Ask your supplier for advice.
After these controls, it may be helpful to perform an immune
profile and/or an iodine profile.
Repeating a profile at a later date may often be useful in clarifying
the situation (return to normal or evolution).

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