• tiredness, lethargy
• menstrual dysfunction, e.g. amenorrhoea
• heart rate disturbances
• myocardial ischaemia
Blood pressure fluctuations
• postural hypotension
• hypothyroidism, myxoedema, acromegaly
Tests for thyroid disorders
Advances in technology have allowed the biochemical assessment of thyroid function to change dramatically in recent years with the introduction of the serum free thyroxine (T4) and the monoclonal TSH assays. With the highly sensitive TSH assays it is now possible to distinguish suppressed TSH levels (as in hyperthyroidism) from low but normal levels of TSH in the euthyroid state. However, the new assays are not foolproof and require interpretation in the context of the clinical picture. The serum TSH is the most sensitive index of thyroid function and is the preferred test for suspected thyroid dysfunction.
Serum tri-iodothyronine (T3) measurement and serum free thyroxine (T4) can be useful in suspected T3 toxicosis where serum T4 may be normal, and for monitoring patients with treated thyroid dysfunction. The relative values are summarised in Table 20.2 .
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