[Thyroid diagnosis in general practice].

The selection of appropriate diagnostic procedures in presumptive thyroid diseases should be based on clinical signs and symptoms. To exclude primary thyroid dysfunction, basal TSH levels measured by a sensitive system should be employed. Further hormonal analyses are indicated in patients with suppressed TSH levels (fT4J, fT4 or the T4/TBG ratio and total T3) and in those with elevated TSH (fT4J, T4/TBG ratio without total T3). When TSH levels are partially suppressed thyroid autonomy must be excluded. Thyroid antibodies may be employed in patients with spontaneous hypothyroidism and hyperthyroidism, homogeneous technetium uptake with no eye signs. In patients with thyroid enlargement, ultrasound investigation including volumetry is the first line investigation. Nodular abnormalities must be investigated by technetium uptake in euthyroid and hyperthyroid individuals. Cytological investigations are indicated in cold nodules, especially in those showing reduced echogenicity.