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ANIK WIDIJANTI

Laboratory test The Thyroid gland. ANIK WIDIJANTI Clinical Pathology Department Saiful Anwar Hospital / Medical Faculty Brawijaya University MALANG. ROUTINE LABORATORY EVALUATION TSH : Thyroid stimulating hormone Thyroxine (T 4 ) and Triiodothyronine (T 3 ) (free / total)

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ANIK WIDIJANTI

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  1. Laboratory test The Thyroid gland ANIK WIDIJANTI Clinical Pathology Department Saiful Anwar Hospital / Medical Faculty Brawijaya University MALANG

  2. ROUTINE LABORATORY EVALUATION • TSH : Thyroid stimulating hormone • Thyroxine (T4) and Triiodothyronine (T3) (free / total) • ETIOLOGY TEST OF THYROID DYSFUNCTION • Autoimmune thyroid disease is detected by circulating antibodies against TPO and Tg. As antibodies to Tg alone is uncommon, it isreasonable to measure only TPO antibodies

  3. Characteristics of Circulating T4 and T 3

  4. Measure TSH Elevated Normal Measure unbound T4 Pituitary disease suspected Normal Low No yes Primary hypothyroidism No further test Measure unbound T4 Mild hypothyroidism TPO Ab (+) TPO Ab (-) Low Normal TPO Ab (+) or symptomatic TPO Ab (-) or no symptoms No further test Rule out other Causes of hypothyroidism Autoimmun hypothyroidism Rule out drug effects, sick Euthyroid syndrome, then Evaluate anterior pituitary function T4 treatment Annual follow up T4 treatment

  5. Aplication of TSH Examination • BIOASSAY • VARIATION OF SENSITIVITY : • INCONVINIENT • RIAs • SENSITIVITY 1mU/L • CROSS REACTION< 1 % • HYPOTHYROID • IRMAs • SENSITIVITY • 10 - 200 X RIAs • HYPO + EUTTHROID HYPERTIHYROID TSH 0.05 - 0. 11mU/L EUTHYROID 0.4 - 4.0 HYPOTHYROID 4 m U/L II I Detection • ICMAs • < 0.1 IMMUNOASSAY I : 5 – 7 m U/L IMMUNO ASSAY III: 0.01 – 0.02 II : O.1 – 0.2 IV : 0.001 – 0.002

  6. THYROID AUTOIMUN (AIT) • Anti Tg • Sitoplasma folikular • Complement activation(-) • Anti TPO • 105 kd, mikrosomal • Thyroid peroksidase enzyme • Korelasi (+) anti TPO & PPTD • Complement activation (+) • AntiTSH-R •  hypertiroid •  hypotiroid • !!inGD • Ab bispesifik :Ab TPO more frequent & higher thananti Tg, • Only Anti TPO (+) : rare • Anti TPO & anti Tg pd GD : not establish (discussion) RoutinDeteksion Ab tiroid : only anti TPO

  7. Prevalensi anti TPO • PPTD (post partum thyroiditis): 16 % • Grave disease: 34,6 % • Hasimoto thyroiditis : 40.5 % • Ab bispesifik • PPTD : 16 % • N population : 1,4 % • Anti TPO & AIT • Clinical relevancy : not clearly • Correlation with active clinical disease • Strong correlation with risk of PPTD

  8. Anti TPO for predictPPTD Variation of sensitivity& spesificity Depend on whenanti TPO examined PPTD (-) when anti TPO (-)  Screening anti TPO in early pregnancy

  9. Anti Tg • Jodium Defisiensi • DetectionAIT (Goiter +) • Monitoring jodiumTx IHA > 1 : 1000 T Hasimoto : 80 % GD : 60 % Tiroid carcinoma: 30 % IHA < 1 : 1000 Normal : 3-18 % Anemia Pernisiosa Syogren Syndrome • Tiroglobulin (Tg) • Prekursor thyroid H • Produced inthyroid gland • Secretion to colloid • Thyroid H reserved • Reseptor apical Tg for trafficTg intraselular • Early indikator PPTD • Rise in GD • Target anti Tg

  10. SERUM Tg EXAMINATION • Not distinguish :PPTD & GD • Interferens :serum anti Tg(reaction of anti Tg +anti Tg antibodi in immunoassay kit),  examination simultaneously Tg + anti Tg

  11. Thank you for your attention

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