A biopsy is a diagnostic procedure in which a little tissue is removed from any part of a person’s body and then it is studied under a microscope for determining the actual cause of a disease.

Types of Biopsies

The biopsy gives the greatest certainty of diagnosis. There are different modes depending on clinical circumstances:

  • Tissue biopsy
  • Lymph node biopsy
  • Percutaneous
  • Daniel biopsy or scalene node biopsy,
  • Biopsy of soft tissue mass,
  • Bone biopsy of an osteolytic lesion
  • Bone marrow biopsy
  • Pleural biopsy
  • Percutaneous lung biopsy or transmural or transpleural:
  • Late or preoperative biopsy

Other types of biopsies include:

Excision biopsy: it is the complete removal of an organ or a tumor, usually without margins, which is normally performed in the operating room under anesthesia. Excision biopsy is performed for:

  • The removal of lymph node isolation.
  • In small breast tumors: When it is a benign tumor, the biopsy itself is therapeutic.
  • In suspicious skin lesions, especially melanin: If they are benign, no further surgical treatment is required after the biopsy.
  • The spleen cannot be biopsied in case of lymphoma , taking a sample of the risk of bleeding , so it is completely removed ( splenectomy ).

Intraoperative biopsy: this is obtained during an exploratory laparotomy for example in ovarian cancer.

Perpendicular Cervical Biopsy: this is done in the cervical area to determine cervical cancer.

Incision biopsy: It is the biopsy that is done to surgically remove a tumor or obtain a piece of tissue from it. This type of biopsy is used most often used in soft tissue tumors of the brain , liver , lung or kidney.

Endoscopic Biopsy: biopsy is done through an endoscope inserted through a natural orifice or a small surgical incision.

It is a kind of scan which is performed to measure or evaluate the functioning of the thyroid gland of a person. This scan is mostly conducted in a laboratory or testing center of a hospital. This kind of scan falls under nuclear medicine as this test uses a certain amount of radioactive iodine or radioiodine. This scan is similar to Iodine uptake scan and its purpose is to determine the condition of the thyroid gland of an individual and to find out the root cause of any thyroid related disorder.

How is Thyroid Scan performed?

The patient is given a pill which contains radioiodine (radioactive iodine), the iodine is mixed with the blood, allowed to flow with the bloodstream and then to settle in the person’s thyroid. After about 4 – 6 hours, with the help of a camera, the testers then find out the amount of iodine that the thyroid gland has absorbed from the blood. This scan will then reveal the cause of different thyroid related problems.

The camera takes pictures of the person’s thyroid gland from three different angles. These images will help in determining over active & under active stages of thyroid gland. This test can also be performed with radioactive technetium instead of using radioiodine.

A complete body scan can also be performed for people who suffer from thyroid cancer. This scan helps in determining if the cancerous cells have spread across the patient’s body.

Why is Thyroid Scan required?

A thyroid scan could be required in order to:

  • Find the root cause of hyperthyroidism (when the thyroid gland is over active).
  • To determine if thyroid cancer have spread in areas, outside of the patient’s thyroid gland.

The thyroid scan is prescribed by the doctor based on the condition of the patient.

Iodine Uptake Scan is an examination of the thyroid function in which one is given a moderate amount of radioactive iodine to determine how much of it is absorbed by the thyroid gland in a given period of time.

How is the test conducted?

The person to be tested is given a capsule which contains radioactive iodine or radioiodine. After a little while period of time (generally which is 6 to 24 hours later), the patient than returns to the clinic for the measurement of radioactivity of the thyroid gland. It is completed using a certain device which is known as gamma probe.

This device is placed on the thyroid gland throughout the external part of the neck. After that, the patient normally lies down and then the scanner runs over the neck and scans the entire area. This process takes around 30 minutes.

Preparation for this test

The patient should not eat anything for 8 hours before the test is conducted. The doctor or the physician might advice the patient not to take certain drugs or medications that might interfere with this particular test.

Drugs that can increase result:

  • Barbiturates
  • Lithium
  • Estrogens
  • Thyroid stimulating hormones
  • Phenothiazines

Drugs that might decrease the result:

  • Corticotropina
  • Antihistamine
  • Antitiroideos drugs
  • Corticosteroids
  • Solution of Lugol
  • Nitrates
  • Potassium iodide saturated solution
  • Drugs for the thyroid
  • Tolbutamida

Thus, the patient must stay away from the above mentioned drugs unless the doctor advises otherwise.

The doctor must be informed if the patient has encountered any such situation:

  • Diarrhea (the absorbed radioactive iodine could fall off the body).
  • Recent radiological procedures in which means of resistance with iodine have been used (in the previous two weeks).
  • Very little or too much iodine in the diet.

Thyrotropin releasing hormone also known as thyrotropin releasing factor or TRF, protirelin or thyroliberin is a hormone which is responsible for stimulating the pituitary gland so that it can secrete Thyroid Stimulating Hormone or TSH, which in turn stimulates the thyroid gland to secrete T3 & T4 thyroid hormones.

TRH test is mostly required in case of thyroid related disorders like secondary hypothyroidism, when the doctor would like to determine the root cause of the disease.

The test

The TRH test generally involves administering a small portion or amount of TRH into the veins of a person.

Once the TRH enters the blood, the TSH level in the body is measured.

Stimulus: TRH (TRH-Ferring ELEA or HRT) intravenous bolus in 2 minutes.

Dosage: Adults: 200 ug.

Children: 9 ug / kg. Weight.

Preconditions for the patient:

The patient should come with an empty stomach for the test and should also take sufficient amount of rest before the test is conducted.

After intravenous injection, the patient should remain in the laboratory for subsequent blood draws to be conducted as prescribed.

If the patient needs to take any medication for hormonal function, it should only be taken after the test is completed.

Interpretation:

In normal individuals TSH concentration increases rapidly reaching maximal response between 20 and 30 minutes, then declines slowly returning to baseline within 2 to 3 hours. Overall the average increase in TSH is 15 UUI / ml.

The answer is classified as:

  • Plain: less than 3 UUI / ml.
  • Subnormal: between 3 and 4.7 UUI / ml.
  • Normal: 4.7- to 25 UUI / ml.
  • hyper responsiveness: over 25 UUI / ml

Based on the results of the test, the doctors determine the nature of the disease and the appropriate treatment for the same, which includes dosage of different drugs or medications.

TSH or Thyroid Stimulating Hormone is produced by the pituitary gland of the human body. This hormone helps in the stimulation of the thyroid gland so that it can produce thyroid hormones like T3 & T4. In the absence of TSH, the thyroid gland may reduce the production of the thyroid hormones resulting in many thyroid related disorders in the body. In certain scenarios when the thyroid gland has reduced the production of T3 and t$ hormones, the pituitary gland increases the production of TSH so that these hormones can stimulate the thyroid and help in resuming the production of thyroid hormones. However, sometimes the pituitary gland may not produce sufficient amount of TSH, which is when different thyroid disorders occur.

Measurement of Pituitary Production of TSH

It is an analysis that is done to measure the amount of hormone of pituitary origin present in the serum. Its determination serves to determine whether a thyroid problem is of primary origin (thyroid) or secondary origin (the hypothalamus).

Why This Analysis Is Done?

When thyroid hormone (T4 or T3) are low, the hypothalamus receives an order to produce more TSH, and thus be elevated to a primary thyroid problem.

If, however, because of hemorrhage, trauma or tumor hypothalamus can lower the secretion and therefore the thyroid is not stimulated and lower level of T3 and T4 are produced, resulting in a secondary goiter.

Their determination will help in administering treatment or hormonal regulator of thyroid function. If the TSH levels are normal then the treatment of the disease will focus on treating the thyroid gland, whereas if the TSH level is not normal then the treatment will focus on treating the pituitary gland.

This is why, this particular test is very important in the diagnosis and treatment of most thyroid related disorders.

Thyroid binding or Thyroid Binding Globulin helps in binding together the thyroid hormones that circulate in the human body. It is a protein, which along with albumin and transthytretin, help in carrying thyroxine (T4), which is a thyroid hormone. It is produced in the liver of a human being and it is primarily responsible for the transportation of the thyroid hormones T4 and T3 from the thyroid gland to the blood stream, so that they can mix with the blood and then spread to the other organs of the body. It is secreted in a very minimum amount and the deficiency of this hormone can cause many diseases.

What does it do?

The thyroxine-binding globulin (TBG) is a glycoprotein whose molecular mass is 1800 kDa , binds to the blood circulation to the thyroid hormones T4 and T3 with an affinity 100 times greater than that of thyroxine-binding prealbumin (TBPA) . In normal conditions TBG non-covalently fixes almost the entire concentration of T3 and T4. The portion of the thyroid hormone that is not fixed is in charge of producing biological activity.

The TBG is produced in the liver and its synthesis is increased by the action of estrogen .Its synthesis decreases after treatment with androgens or glucocorticoids and in some liver diseases, which are inherited. In such diseases the liver fails to produce the required amount of Thyroid Binding Globulin.

What is its importance?

It has a major role to play in the diagnosis of many thyroid related problems in the body. The Thyroid Binding Globulin or TGB level in the body is measured to determine the root cause of thyroid diseases like hypothyroidism, hyperthyroidism etc. Testing TGB levels can help in determining the reasons for decrease or increase in thyroid hormones, which in turn helps in the treatment of many thyroid diseases.

Serum is one of the components of our blood; it is not a blood cell and it doesn’t help blood clotting as well. It is a kind of blood plasma which does not contain the fibrinogens. It includes proteins, antibodies, electrolytes, hormones, antigens and different exogenous substances like drugs or microorganisms etc.

Many different illness or disorders in the human body related to the kidney, liver, thyroid gland, skin, heart, blood flow and even certain allergic reactions are dependent on different components of blood serum. Depending on the disease or disorder that the patient is suffering from, doctors may advice tests to measure the quantity of different components of the serum. These tests or measurements are called serum measurements.

Where is it conducted?

Most clinics or laboratories are equipped with instruments to conduct this test.

How is the test conducted?

When the doctor prescribes such a test, you can approach any clinic and they will take certain amount of blood from you and then conduct the test on the same. The blood is collected through a needle with the help of a syringe. The same blood is then sent for the serum measurement test.

How long does the test take?

The duration of the test depends on the clinic and the method they use for the test. In normal circumstances, it will not take more than 24 hours to obtain the result.

What is the next step?

Based on the result of the test, the doctor will determine if any component of the serum is in excessive quantity or there is a deficiency of the component in the serum. Depending on the result, the doctor will then decide the course of treatment which will include different drugs and medications which the patient will need to take. These medicines will help in curing the disease, the patient is suffering from.