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Thyroid function tests in thyroid and nonthyroid disease.

Modern day evaluation of thyroid disorders requires a combination of accurate clinical judgement and reliable, sensitive, and specific thyroid functions tests. Principle among the latter are thyroxine (T4) 3, 5, 3'-triiodothyronine (T3), and thyroid-stimulating hormone (TSH). Also playing an important role in special situations are free thyroxine, an assessment of bound and unbound thyroid-binding globulin, TRH stimulation, long-acting thyroid stimulator (LATS), antibodies to thyroid hormone and to thyroid receptors. Basic to interpretation of these tests in the clinical setting is a comprehension of the relationship of the hypothalamus, the pituitary, and the thyroid gland as well as a knowledge of the peripheral metabolism of thyroxine and triiodothyronine. The role of each of these laboratory tests in the evaluation of hyper- and hypometabolic states, their alteration in nonthyroid and other endocrine disorders, and the effects of environmental and physiological factors on these tests are reviewed.