1st order laboratory parameters – obligatory laboratory tests.
- TSH ↓ (thyroid-stimulating hormone).
- T3 ↑ (triiodothyronine) and T4 ↑ (thyroxine) (in manifest hyperthyroidism).
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- TRAK (TSH receptor antibody) – thyroid autoantibody, which may be present in the blood especially in hyperthyroidism of Graves’ type [detection frequency: 80-100%; TRAK level allows prognostic information on the course of the disease].
- Thyroid peroxidase antibodies (PAH) (also called: thyroperoxidase antibodies = TPO-Ak) – elevated levels occur in Graves’ disease [detection frequency: 60-80%]
- Note: This antibody is positive in five percent of the healthy population! A positive finding is therefore no proof of the presence of an autoimmune disease.
- TAK (thyroglobulin antibodies; thyroglobulin autoantibodies – TGAK) – elevated levels occur in Graves’ disease [detection frequency: 10-20%].
Further notes
- Small blood count [reduced hemoglobin and platelet (blood platelet) levels; 4.2% of Graves’ patients have mild thrombocytopenia (reduction of platelets (blood platelets) in the blood); normalization in euthyroidism (normal thyroid function)] Differential blood count [14.1% have mild neutropenia (decrease in neutrophil granulocytes in the blood: < 2,000 /µL) before starting therapy; normalization in euthyroidism]
Graves’ disease in pregnancy
- Normal: As a result of accelerated thyroid metabolism, there may be a nonpathologic increase in triiodothyronine (T3) and thyroxine (T4). The concentration of thyroid-stimulating hormone (TSH), on the other hand, is often reduced in pregnant women.Due to the fact that the alpha chain of HCG is identical to the alpha chain of LH, FSH, and TSH, it is explained that HCG has a thyrotropic effect. Therefore, physiologically, in the 1st trimester (third trimester), there is an increased synthesis of T4 with the consequence that the endogenous TSH level is somewhat suppressed. This thyroid function normalizes at the latest in the second trimester.
- Pathologies in pregnancy:
- FT3 + fT4 in the upper normal range = latent hyperthyroidism.
- FT3 + fT4 = manifest hyperthyroidism hyperthyroidism often accompanied by hyperemesis gravidarum
- As above, additionally TRAK (MAK) titers increased.
