Investigation of Thyroid Dysfunction in Adults:

A summary of the Alberta CPG for the Investigation of Thyroid Dysfunction, April 1996
Symptoms of ♦ Weight gain ♦ Depression
hypothyroidism ♦ Lethargy ♦ Constipation
♦ Cold intolerance ♦ Dry skin
♦ Menstrual irregularities

Symptoms of ♦ Palpitations/Tachycardia ♦ Weight loss

hyperthyroidism ♦ Widened pulse pressure ♦ Muscular weakness
♦ Nervousness and tremor ♦ Usually goitre is present
♦ Heat intolerance

Investigations ♦ When patients are asymptomatic, seemingly healthy, having a periodic examination, no
testing required.
♦ When patients have non specific symptoms of thyroid disease, but do not belong to a
group at increased risk for thyroid disease, testing is not recommended.
♦ When patients have non-specific symptoms of thyroid disease and are in a group at
increased risk for thyroid disease: measure TSH and follow Category 1.
♦ When patients have definite clinical signs of thyroid disease: follow Category 1.
♦ When patients are taking thyroid hormone replacement and dosage needs monitoring:
follow Category 2.
♦ When patients are receiving thyroxine therapy for goitre and thyroid tumors: follow
Category 3.

Category 1 Suspected Hyper or Hypothyroidism

Patients with thyrotoxicosis usually have TSH values less than 0.1 U/L.

♦ TSH values between 0.1 and 0.2 mlU/L are rarely seen in primary thyrotoxic patients
and usually are the results of excess thyroxine therapy. If not undergoing thyroxin
treatment, repeat test in 1 month before proceeding to consultation.
♦ Thyroid antibodies are indicated in cases of hypothyroidism (TSH 6– 12 mlU/L) due to
suspected autoimmune thyroid disease. Serum antibody testing should only be
performed for diagnosis.

Category 2 TSH Use in Thyroxine Therapy For Treatment of Hypothyroidism

♦ Target: TSH in normal range.

♦ Thyroxine doses should be adjusted no more frequently than 8 - 10 week intervals.
♦ Once a stable dose is achieved, yearly TSH is sufficient.

Category 3 TSH Use In Monitoring ThyroxineTherapy In Goitre and Thyroid Tumours

Thyroid Cancer
♦ Target: Achieve suppressed TSH (< 0.2 mlU/L) to prevent regrowth of tumours.

Benign Goitre or Nodules

♦ Target: TSH: 0.1 - 1.0 mlU/L

For complete guideline refer to the Alberta Medical Association Website: www.albertadoctors.org
Administered by the Alberta
Revised May 1999 Medical Association
CATEGORY 1: Suspected Hyper or Hypothyroidism Note:
Values given are for adults - consult
laboratory for pediatric ranges.

TSH

> 6.0 <12

< 0.2 mlU/L 0.2 - 6.0 > 12 mlU/
mlU/L
Hyperthyroid mlU/L L
Hypothyroid

Measure T4
or equivalent
(FTI)

T4 T4
or equivalent or equivalnet
Consultation Normal (FTI) Normal (FTI) Low
recommended (Euthyroid)

Treatment decision Treat

should be based on
size of goitre present,
thyroid antibody status
and clinical state. If no
therapy is started
follow-up every 3 - 12
months is required.

CATEGORY 2: CATEGORY 3:

TSH Use in Thyroxine Therapy For TSH Use In Monitoring ThyroxineTherapy In

Treatment of Hypothyroidism Goitre and Thyroid Tumours

♦ Target: TSH in normal range. Thyroid Cancer

♦ Thyroxine doses should be adjusted no
more frequently than 8 - 10 week intervals.
♦ Once a stable dose is achieved, yearly
TSH is sufficient.
♦ Target: Achieve suppressed TSH (< 0.2 mlU/L) to
prevent regrowth of tumours.
Benign Goitre or Nodules
♦ Target: TSH: 0.1 - 1.0 mlU/L