Thyroid Stimulating Hormone

Thyroid Stimulating Hormone

Sarah Davis

Importance of tsh analysis

TSH testing is used to evaluate thyroid gland function as it pertains to the primary cause of hypothyroidism.

It is also used to check for congenital disorders, tumors, cancer, and inflammation.

Normal values

Age	Conventional Units	SI Units
Neonate-3 days	<40 micro-international units/mL	< 40 milli-international units/L
2 weeks-5 months	1.7-9.1 micro-international units/mL	1.7-9.1 milli-international units/L
6 months-1 year	0.7-6.4 micro-international units/mL	0.7-6.4 milli-international units/L
2 years-19 years	0.5-4.5 micro-international units/mL	0.5-4.5 milli-international units/L
20 years +	0.4-4.2 micro-international units/mL	0.4-4.2 milli-international units/L

Abnormal values and indications

An increase in thyroid hormone levels activates the feedback loop to decrease production of TSH.

Excess thyroid hormone replacement.

Grave’s disease

Primary hyperthyroidism.

Secondary hyperthyroidism r/t pituitary involvement, decreasing production of TSH.

Tertiary hypothyroidism r/t hypothalamic involvement, decreasing production of TSH.

A decrease in thyroid hormone levels activates the feed- back loop to increase production of TSH.

Congenital hypothyroidism in the neonate (filter paper test).

Ectopic TSH-producing tumors (lungs and breasts).

Primary hypothyroidism related to dysfunction of the thyroid gland.

Secondary hypothyroidism r/t pituitary hyperactivity.

Thyroid hormone resistance.

Hashimoto autoimmune disease (thyroiditis).

Patient care and teaching

Before

Explain that there may be some discomfort during the venipuncture.

Explain the reason for the test and answer any questions to alleviate anxiety.

Determine if any medications are being taken that could potentially alter test results (e.g: amiodarone, iodides, lithium, corticosteroids, t3, t4, and certain multivitamins).

No fasting is required.

During

Watch for vasovagal responses to venipuncture. Patients prone to syncope are at risk for falling and injury.

After

Inform the patient of potential side effects such as bruising, phlebitis, and cellulitis.

Discuss expected outcomes including maintenance of a healthy weight, agreeing to a weight reduction program to achieve a healthy BMI, and having an absence of bradycardia with a pulse greater than 60 bpm.

Nursing diagnoses

Risk for falls

Risk for decrease cardiac output

Fatigue

Risk for impaired tissue integrity

Knowledge deficit

Follow-up testing

Related tests include adrenocorticotropin hormone, albumin, antibodies antithyroglobulin, biopsy thyroid, copper, follicle-stimulating hormone, growth hormone, luteinizing hormone, newborn screening, PTH, protein total, RAIU, thyroglobulin, TSI, TBII, thyroid scan, T4, free T4, T3, free T3, and US thyroid.

Ethical considerations

One ethical issue to take into consideration when it comes to TSH testing is over-testing, which has become more and more commonplace in our health-conscious society. It is important to perform diagnostic testing only when it is deemed truly necessary.

As is the case with all testing, autonomy, consent, and confidentiality are crucial when it comes to providing quality patient care. Ensuring privacy and providing adequate information in order for patients to make informed decisions about their care is vital.

Sources

Van Leeuwen, A. M., & Bladh, M. L. (2016). Textbook of laboratory and diagnostic testing: Practical application at the bedside. Philadelphia, PA: F. A. Davis Company.

 

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