Thyroid Disease
Course Objectives
- Connect thyroid disorders with relevant history and symptoms.
- Explain the purpose and limitations of common thyroid tests.
- Apply laboratory instructions to preparation, collection, and handling.
- Recognize concerns that require clarification or prompt clinical attention.
Course Content
Course Creator: Kirsten Hermens, NCMA-P
Total CE Hours: 1 Credit Hour
Pace Course #: 586-2806-26
Key Terms:
Hypothyroidism
Hyperthyroidism
Thyrotoxicosis
TSH
Free T4
Goiter
Assay Interference
Outline:
- Introduction
- Learning objectives and key terms
- The collector’s role in thyroid testing and patient safety
- Thyroid Function
- Thyroid anatomy and the endocrine system
- T3, T4, and TSH feedback
- Effects of thyroid hormones throughout the body
- Common Thyroid Disorders
- Hypothyroidism and Hashimoto disease
- Hyperthyroidism and Graves disease
- Thyroiditis
- Goiter, thyroid nodules, and thyroid cancer
- Blood Testing and Specimen Quality
- Common thyroid tests and result patterns
- Specimen types, collection volumes, and handling
- Biotin interference and preparation concerns
- Scenario: A patient taking high-dose biotin
- Clinical Assessment and Imaging
- Relevant patient history
- Thyroid ultrasound and nuclear medicine testing
- Fine needle aspiration and specimen coordination
- Urgent Concerns
- Recognizing thyroid emergencies
- Prioritizing clinical assessment and communicating concerns
- Scenario: A patient with Graves disease and severe symptoms
- Treatment and Follow-Up
- Medications, radioactive iodine, and surgery
- Thyroglobulin monitoring and stimulated testing
- Scenario: A change in the injection schedule
- Patient explanations, documentation, and handoffs
- Conclusion
- Review of patient preparation, specimen quality, and timely communication
References:
1. Nemours KidsHealth. (2023, September). Endocrine system. https://kidshealth.org/en/teens/endocrine.html
2. Cleveland Clinic. (2022, June 7). Thyroid. https://my.clevelandclinic.org/health/body/23188-thyroid
3. Cleveland Clinic. (2022, October 3). T4 (thyroxine) test. https://my.clevelandclinic.org/health/diagnostics/24235-thyroxine-t4-test
4. Cleveland Clinic. (2022, February 14). T3 (triiodothyronine) test. https://my.clevelandclinic.org/health/diagnostics/22425-triiodothyronine-t3
5. ARUP Consult. (2026, July). Thyroid disease testing. https://arupconsult.com/content/thyroid-disease
6. Cleveland Clinic. (2024, September 24). Hypothyroidism. https://my.clevelandclinic.org/health/diseases/12120-hypothyroidism
7. Lee, S. Y., & Pearce, E. N. (2023). Hyperthyroidism: A review. JAMA, 330(15), 1472–1483. https://doi.org/10.1001/jama.2023.19052
8. Mayo Clinic. (2025, April 30). Hashimoto’s disease: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
9. Cleveland Clinic. (2026, September 14). Hashimoto’s disease. https://my.clevelandclinic.org/health/diseases/17665-hashimotos-disease
10. Endocrine Society. (2022, January 24). Graves’ disease. https://www.endocrine.org/patient-engagement/endocrine-library/graves-disease
11. Mayo Clinic. (2026, September 4). Hyperthyroidism: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/diagnosis-treatment/drc-20373665
12. Cleveland Clinic. (2022, June 7). Thyroiditis. https://my.clevelandclinic.org/health/diseases/15455-thyroiditis
13. ARUP Consult. (2025, April). Thyroid nodules. https://www.arupconsult.com/content/thyroid-nodules
14. American College of Radiology & Radiological Society of North America. (2023, May 1). Ultrasound: Thyroid. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/us-thyroid
15. Cleveland Clinic. (2025, November 11). Thyroid cancer. https://my.clevelandclinic.org/health/diseases/12210-thyroid-cancer
16. ARUP Consult. (2025, April). Thyroid cancer molecular assessment. https://arupconsult.com/content/thyroid-cancer
17. ARUP Consult. (2025, May). Hypothyroidism. https://arupconsult.com/content/hypothyroidism
18. Labcorp. (n.d.). Thyroid-stimulating hormone (TSH), test 004259 [Current test catalog]. Retrieved October 8, 2026, from https://www.labcorp.com/tests/004259/thyroid-stimulating-hormone-tsh
19. Labcorp. (n.d.). Thyroid antibodies, test 006684 [Current test catalog]. Retrieved October 8, 2026, from https://www.labcorp.com/tests/006684/thyroid-antibodies
20. Labcorp. (n.d.). Thyroid-stimulating immunoglobulin (TSI), test 140749 [Current test catalog]. Retrieved October 8, 2026, from https://www.labcorp.com/tests/140749/thyroid-stimulating-immunoglobulin-tsi
21. ARUP Consult. (2024, August). Analytical considerations in the evaluation of thyroid function. https://arupconsult.com/content/analytical-considerations-evaluation-thyroid-function
22. American College of Radiology & Radiological Society of North America. (2026, June 1). Thyroid scan and uptake. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/thyroiduptake
23. American College of Radiology & Radiological Society of North America. (2026, July 1). Ultrasound-guided thyroid biopsy. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/thyroidbiopsy
24. Cleveland Clinic. (2022, June 8). Thyroid storm. https://my.clevelandclinic.org/health/diseases/23203-thyroid-storm
25. Cleveland Clinic. (2025, June 16). Myxedema coma. https://my.clevelandclinic.org/health/diseases/myxedema-coma
26. Mayo Clinic. (2026, September 10). Hypothyroidism: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289
27. Endocrine Society. (2022, January 24). Hashimoto disease. https://www.endocrine.org/patient-engagement/endocrine-library/hashimoto-disease
28. Hoang, T. D., Stocker, D. J., Chou, E. L., & Burch, H. B. (2022). 2022 update on clinical management of Graves’ disease and thyroid eye disease. Endocrinology and Metabolism Clinics of North America, 51(2), 287–304. https://doi.org/10.1016/j.ecl.2021.12.004
29. Ringel, M. D., et al. (2025). 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid, 35(8), 841–985. https://doi.org/10.1177/10507256251363120
30. Memorial Sloan Kettering Cancer Center. (2026, May 15). Recombinant human TSH stimulation test. https://www.mskcc.org/cancer-care/patient-education/recombinant-human-tsh-stimulation-test
1. Nemours KidsHealth. (2023, September). Endocrine system. https://kidshealth.org/en/teens/endocrine.html
2. Cleveland Clinic. (2022, June 7). Thyroid. https://my.clevelandclinic.org/health/body/23188-thyroid
3. Cleveland Clinic. (2022, October 3). T4 (thyroxine) test. https://my.clevelandclinic.org/health/diagnostics/24235-thyroxine-t4-test
4. Cleveland Clinic. (2022, February 14). T3 (triiodothyronine) test. https://my.clevelandclinic.org/health/diagnostics/22425-triiodothyronine-t3
5. ARUP Consult. (2026, July). Thyroid disease testing. https://arupconsult.com/content/thyroid-disease
6. Cleveland Clinic. (2024, September 24). Hypothyroidism. https://my.clevelandclinic.org/health/diseases/12120-hypothyroidism
7. Lee, S. Y., & Pearce, E. N. (2023). Hyperthyroidism: A review. JAMA, 330(15), 1472–1483. https://doi.org/10.1001/jama.2023.19052
8. Mayo Clinic. (2025, April 30). Hashimoto’s disease: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
9. Cleveland Clinic. (2026, September 14). Hashimoto’s disease. https://my.clevelandclinic.org/health/diseases/17665-hashimotos-disease
10. Endocrine Society. (2022, January 24). Graves’ disease. https://www.endocrine.org/patient-engagement/endocrine-library/graves-disease
11. Mayo Clinic. (2026, September 4). Hyperthyroidism: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/diagnosis-treatment/drc-20373665
12. Cleveland Clinic. (2022, June 7). Thyroiditis. https://my.clevelandclinic.org/health/diseases/15455-thyroiditis
13. ARUP Consult. (2025, April). Thyroid nodules. https://www.arupconsult.com/content/thyroid-nodules
14. American College of Radiology & Radiological Society of North America. (2023, May 1). Ultrasound: Thyroid. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/us-thyroid
15. Cleveland Clinic. (2025, November 11). Thyroid cancer. https://my.clevelandclinic.org/health/diseases/12210-thyroid-cancer
16. ARUP Consult. (2025, April). Thyroid cancer molecular assessment. https://arupconsult.com/content/thyroid-cancer
17. ARUP Consult. (2025, May). Hypothyroidism. https://arupconsult.com/content/hypothyroidism
18. Labcorp. (n.d.). Thyroid-stimulating hormone (TSH), test 004259 [Current test catalog]. Retrieved October 8, 2026, from https://www.labcorp.com/tests/004259/thyroid-stimulating-hormone-tsh
19. Labcorp. (n.d.). Thyroid antibodies, test 006684 [Current test catalog]. Retrieved October 8, 2026, from https://www.labcorp.com/tests/006684/thyroid-antibodies
20. Labcorp. (n.d.). Thyroid-stimulating immunoglobulin (TSI), test 140749 [Current test catalog]. Retrieved October 8, 2026, from https://www.labcorp.com/tests/140749/thyroid-stimulating-immunoglobulin-tsi
21. ARUP Consult. (2024, August). Analytical considerations in the evaluation of thyroid function. https://arupconsult.com/content/analytical-considerations-evaluation-thyroid-function
22. American College of Radiology & Radiological Society of North America. (2026, June 1). Thyroid scan and uptake. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/thyroiduptake
23. American College of Radiology & Radiological Society of North America. (2026, July 1). Ultrasound-guided thyroid biopsy. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/thyroidbiopsy
24. Cleveland Clinic. (2022, June 8). Thyroid storm. https://my.clevelandclinic.org/health/diseases/23203-thyroid-storm
25. Cleveland Clinic. (2025, June 16). Myxedema coma. https://my.clevelandclinic.org/health/diseases/myxedema-coma
26. Mayo Clinic. (2026, September 10). Hypothyroidism: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289
27. Endocrine Society. (2022, January 24). Hashimoto disease. https://www.endocrine.org/patient-engagement/endocrine-library/hashimoto-disease
28. Hoang, T. D., Stocker, D. J., Chou, E. L., & Burch, H. B. (2022). 2022 update on clinical management of Graves’ disease and thyroid eye disease. Endocrinology and Metabolism Clinics of North America, 51(2), 287–304. https://doi.org/10.1016/j.ecl.2021.12.004
29. Ringel, M. D., et al. (2025). 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid, 35(8), 841–985. https://doi.org/10.1177/10507256251363120
30. Memorial Sloan Kettering Cancer Center. (2026, May 15). Recombinant human TSH stimulation test. https://www.mskcc.org/cancer-care/patient-education/recombinant-human-tsh-stimulation-test
