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Ovim takoer potvrujem suglasnost za koautorstvo u ovom radu nakon uvida u kona nu verziju teksta prije tiskanja, uz mogunost odustajanja ili davanja izdvojenog dodatnog mialjenja. Zahvala: Zahvaljujemo svim lanovima Radne skupine za izradu Smjernica Hrvatskog druatva za atitnja u za racionalnu dijagnostiku poremeaja funkcije atitnja e kao i svima onima koji su svojim komentarima i prijedlozima doprinijeli izradi smjernica. Izrada smjernica financirana je dijelom iz sredstava Hrvatskog druatva za atitnja u HLZ-a a dijelom iz sredstava projekta Ministarstva znanosti, obrazovanja i aporta Republike Hrvatske  Karcinogeneza u atitnja i i guaavost u Hrvatskoj aifra projekta: 134-1342428-2430. LITERATURA Spencer CA, Takeuchi M, Kazarosyan M. Current status and performance goals for serum thyrotropin (TSH) assays. Clin Chem 1996; 42: 140-5. Kusi Z, Juki T, Dabeli N, Franceschi M. Dijagnosti ke i terapijske smjernice za diferencirani karcinom atitnja e Hrvatskog druatva za atitnja u. 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U: Bravermann LE, Utiger RD, ur. Werner and Ingbar's. The Thyroid  a Fundamental and Clinical Text, 8th edition. Philadelphia: Lippincott-Raven; 2000, str. 564-72. Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G. High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Danemark and Iceland. J Intern Med 1991; 229: 415-20. Farwell AP. Subacute thyroiditis and acute infectious thyroiditis. U: Bravermann LE, Utiger RD, ur. Werner and Ingbar's the thyroid: a fundamental and clinical text, 9th edition. Philadelphia: Lippincot Williams & Wilkins; 2005, str. 536-47. Lazarus JH. Sporadic and postpartum thyroiditis. U: Bravermann LE, Utiger RD, ur. Werner and Ingbar's the thyroid: a fundamental and clinical text, 9th edition. Philadelphia: Lippincot Williams & Wilkins; 2005, str. 524-35 Haddow JE, Palomaki GE, Allan WC i sur. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549-55. Allan WC, Haddow JE, Palomaki GE i sur. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000; 7: 127-30. Leung AS, Miller LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993; 81: 349-53. Lincoln SR, Ke RW, Kutteh WH. Screening for hypothyroidism in infertile women. J Reprod Med 1999; 44: 455-7. Tanis BC, Westendorp RGJ, Smelt AHM. Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hypothyroidism: A reanalysis of intervention studies. Clin Endocrinol (Oxf) 1996; 44: 643-9. Hak AE, Pols HAP, Visser TJ, Drexhage HA, Hofman A, Witteman JCM. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Inter Med 2000; 132: 270-87. Danese MD, Powe NR, Sawin CT, Ladenson PW. Screening for mild thyroid failure at the periodic health examination: a decision and cost effectiveness analysis. JAMA1996; 276: 285-92. American Association of Clinical Endocrinologists. Clinical practice guidelines for the evaluation and treatment of hyperthyroidism and hypothyroidism. Jacksonville, 1996: http://www.aace.com/clinguideindex.htm. Glenn GC. Laboratory Testing Task Force of the College of American Pathologists. Practice parameter on laboratory panel testing for screening and case finding in asymptomatic adults. Arch Pathol Lab Med 1996; 120: 929-43. Sarnavka V. Novoroena ki skrining. Paediatr Croat 2004; 48 (Suppl 1): 197-203. Tablica 1. Stanja koja uzrokuju promjenu koncentracije tiroksin  vezujueg globulina u krvotoku / Table 1. Conditions that alter concentration of thyroxine-binding globulin in the circulation Poveavaju / IncreaseSmanjuju / Decrease Oralni kontraceptivi / Oral contraceptivesTestosteron / TestosteroneTrudnoa / PregnancyKortikosteroidi / CorticosteroidsEstrogeni / EstrogensTeaka bolest / Severe illnessZarazni hepatitis/ Infectious hepatitisCiroza / CirrhosisKroni ni aktivni hepatitis / Chronic active hepatitisNefrotski sindrom / Nephrotic syndromeNasljedni / InheritedNasljedni / Inherited Tablica 2. Skupine bolesnika u kojih se primjenjuje algoritam za racionalnu dijagnostiku hipotireoze / Table 2. Groups of patients assigned to the algorithm for rational diagnosis of hypothyroidism Klini ki simpomi i znakovi hipotireoze / Clinical symptoms and signs of hypothyroidismRizi ne skupine - ispitanici i stanja / Risk groups  patients and conditions pozitivna protutijela na TPO / positive TPO antibodies prethodno lije enje Gravesove hipertireoze (operativno, jodom-131, tireostaticima) / prior treatment of Graves' hyperthyroidism (surgery, iodine-131, antithyroid drugs) prethodno vanjsko zra enje vrata / prior external beam radiotherapy of the neck lije enje amiodaronom/ treatment with amiodarone suspektan hipopituitarizam / suspected hypopituitarism guaa / goiter obiteljska anamneza autoimune bolesti atitnja e / positive family history of autoimmune thyroid disease osobna/obiteljska anamneza pridru~enih autoimunih bolesti / personal/family history of associated autoimmune disorders stariji bolesnici / elderly patients hiperkolesterolemija / hypercholesterolaemia  EMBED PowerPoint.Slide.12  Slika 1. Algoritam racionalne dijagnostike hipotireoze Prvi korak u obradi bolesnika sa sumnjom na hipotireozu je odreivanje TSH u serumu. Uredan nalaz TSH isklju uje hipotireozu, osim u slu aju centralne hipotireoze koja se javlja izuzetno rijetko. U slu aju nalaza TSH 5-10 mU/L, neophodno je ponoviti test za 2-3 mjeseca uz odreivanje FT4 (T4) kako bi se izbjegla mogua laboratorijska pogreaka ili prolazno poviaena vrijednost TSH. Ako je vrijednost TSH vea od 10 mU/L neophodno je odrediti FT4 (T4). Ako je FT4 (T4) sni~en, tada je bolesnik u primarnoj hipotireozi. Ako je FT4 (T4) uredan uz blago poviaen TSH tada se radi o supklini koj hipotireozi. U slu aju primarne, a osobito supklini ke hipotireoze korisno je odrediti protutijela na tireoidnu peroksidazu u serumu (TPO). Pozitivna TPO upuuju na kroni ni autoimuni (Hashimotov) tireoiditis. Ako su TPO negativna tada se vjerojatno radi o TPO negativnom kroni nom tireoiditisu, a izuzetno rijetko infiltraciji atitnja e. Potrebu za punkcijom u TPO negativnih bolesnika treba procijeniti na temelju klini ke slike. Ako postoji klini ka sumnja na centralnu hipotireozu potrebno je uz TSH odrediti FT4 (T4). Centralna hipotireoza je obilje~ena sni~enom razinom T4 (FT4) u serumu uz urednu ili sni~enu vrijednost TSH. Daljnja obrada je potrebna radi utvrivanja uzroka poremeaja (bolest hipofize ili hipotalamusa). Ako se tijekom obrade utvrdi sni~en TSH tada je potrebno odrediti FT4 (T4). Ako je vrijednost FT4 (T4) uredna ili poviaena, tada je potrebno slijediti algoritam tireotoksikoze. Figure 1. Algorithm for rational diagnosis of hypothyroidism The first step in the management of a patient suspected of hypothyroidism is serum TSH measurement. Normal serum TSH excludes hypothyroidism, except in the rare case of central hypothyroidism. If TSH value is 5-10 mU/L, repeated TSH testing after 2-3 months together with FT4 (T4) measurement is recommended to exclude laboratory error or transient elevation of TSH. If serum TSH level is greater than 10 mU/L, FT4 (T4) should be measured. If serum FT4 (T4) is low, the patient has primary hipothyroidism. Subclinical hypothyroidism is diagnosed if the patient has normal serum FT4 (T4) together with mildly elevated TSH. In the case of primary and especially subclinical hypothyroidism, the measurement of TPO antibodies (TPO) is useful to confirm chronic autoimmune (Hashimoto's) thyroiditis. If TPO are negative, TPO-negative chronic thyroiditis can be present, or rarely, infiltration of the thyroid tissue. Fine needle aspiration biopsy (FNAB) can be performed in these patients according to clinical findings. In the case of suspected central hypothyroidism, both TSH and FT4 (T4) should be measured. Central hypothyroidism is diagnosed when serum FT4 is low and TSH is low or normal. Further evaluation is necessary to confirm the cause of the disorder (pituitary or hypotalamic disease). If the finding is low serum TSH, the next step in the diagnostic evaluation is the measurement of FT4 (T4). If serum FT4 (T4) is normal or elevated, further evaluation shold be performed according to the diagnostic algorithym of thyrotoxicosis. Tablica 3 - Smjernice za praenje bolesnika s hipotireozom / Table 3. Guidelines for follow-up of patients with hypothyroidism Kod primarne hipotireoze kontrola FT4 (T4) i TSH 6-8 tjedana nakon uvoenja nadomjesnog lije enja L-T4 ili nakon promjene doze L-T4 / In primary hypothyroidism serum FT4 (T4) and TSH should be measured 6-8 weeks after the introduction of supstitution with L-T4 or a change of L-T4 doseNakon postizanja eutireoze kontrola TSH jednom godianje ili eae, ovisno o klini kim indikacijama / After reaching euthyroid state, serum TSH should be measured yearly or more often if there is clinical indicationU bolesnika u kojih se ne postigne adekvatan u inak supstitucijskim lije enjem L-T4 potrebno je odrediti FT4 (T4) i TSH / In patients without adequate L-T4 supstitution serum FT4 (T4) and TSH should be measuredPraenje supklini ke hipotireoze bez lije enja L-T4 / Follow-up of subclinical hypothyroidism without L-T4 treatment - u slu aju pozitivnih TPO protutijela kontrola FT4 (T4) i TSH svakih 6 mjeseci / in case of positive TPO antibodies: serum FT4 (T4) and TSH should be measured every 6 months - u slu aju negativnih TPO protutijela kontrola FT4 (T4) i TSH jednom godianje / in case of negative TPO antibodies: serum FT4 (T4) and TSH should be measured yearly Tablica 4. Skupine bolesnika u kojih se primjenjuju smjernice i algoritmi za racionalnu dijagnostiku tireotoksikoze / Table 4. Groups of patients assigned to the guidelines and algorithms for rational diagnosis of thyrotoxicosis Klini ki simptomi i znakovi tireotoksikoze / Clinical symptoms and signs of thyrotoxicosisRizi ne skupine / Risk groups - bolesnici s oftalmopatijom / patients with ophtalmopathy - anamneza autoimune bolesti atitnja e u obitelji / positive family history of autoimmune thyroid disease - lijekovi koji utje u na funkciju atitnja e (amiodaron, jod) / drugs that alter thyroid function (amiodarone, iodine) - kardiopati (bolesnici s aritmijama, sr anom dekompenzacijom, osobito stariji bolesnici / patients with cardiovascular diseases (arrithmias, heart failure, especially elderly patients)  EMBED PowerPoint.Slide.12  Slika 2. Algoritam racionalne dijagnostike tireotoksikoze: Prvi korak u obradi bolesnika sa sumnjom na tireotoksikozu (hipertireozu) je odreivanje tireotropina (TSH) u serumu jer je to najbolji test za isklju ivanje poremeaja funkcije atitnja e, osobito u ambulantnim uvjetima. Razvoj osjetljivih analiti kih metoda odreivanja TSH (III generacija) pojednostavnio je dijagnosti ki pristup tireotoksikozi i omoguio otkrivanje i supklini kih oblika bolesti. Tireotoksikoza bilo kojeg uzroka dovodi do supresije TSH (osim izrazito rijetkih stanja poput tireotropinoma i rezistencije na hormone atitnja e). Uredan nalaz TSH isklju uje tireotoksikozu. Preporu ljiva funkcionalna osjetljivost metode odreivanja TSH treba biti d" 0,02 mU/L. U slu aju nalaza sni~ene vrijednosti TSH neophodno je odrediti slobodni tiroksin (FT4) ili tiroksin (T4). Prednost odreivanja FT4 u odnosu na ukupni hormon je u izbjegavanju moguih greaaka zbog poviaene koncentracije tiroksin vezujueg globulina. Nalaz poviaene vrijednosti FT4 (T4) potvruje dijagnozu tireotoksikoze. Ako je nalaz FT4 (T4) u granicama normale tada je neophodno odrediti FT3 (T3) zbog isklju ivanja T3 tireotoksikoze. Poviaena vrijednost FT3 (T3) uz normalnu vrijednost FT4 (T4) i sni~enu vrijednost TSH potvruje T3 tireotoksikozu koja je esta na podru ju Europe. Ako su vrijednosti FT4 (T4) i FT3 (T3) uredne, a TSH suprimiran, tada se radi o supklini koj tireotoksikozi. U slu aju klini ke sumnje na tireotropinom ili rezistencije na hormone atitnja e uz TSH se mora odrediti FT4 (T4) jer uredan TSH u tim rijetkim stanjima ne isklju uje poremeaj. Serumski FT4 je kod tireotropinoma i rezistencije na hormone atitnja e poviaen uz uredan ili blago poviaen TSH. La~no poviaen FT4 mo~e se nai u bolesnika s obiteljskom disalbuminemi nom hipertiroksinemijom ili onih koji uzimaju neke lijekove (npr. amiodaron). U tih bolesnika vrijednost TSH je u granicama normale. U slu aju nalaza poviaene vrijednosti TSH potrebno je slijediti algoritam hipotireoze. Figure 2. Algorithm for the rational diagnosis of hyperthyroidism The first step in the management of patients suspected of thyrotoxicosis (hyperthyroidism) is serum TSH measurement. Serum TSH measurement is the single most reliable test to exclude thyroid dysfunction, particularly in the ambulatory settings. The development of ultrasensitive TSH assays (III generation) simplified clinical approach to the diagnosis of thyrotoxicosis and enabled the detection of subclinical forms of the disease. All types of thyrotoxicosis are accompanied by supressed serum TSH concentration (except rare clinical conditions such as TSH-secreting pituitary adenoma and selective resistance to thyroid hormones). Normal serum TSH level excludes thyrotoxicosis. TSH assay sensitivity must be d" 0,02 mU/L. In case od low serum TSH, serum FT4 (T4) should be measured. Free FT4 estimate instead of total T4 is recommended to avoid possible false elevation of T4 due to elevated thyroxine-binding globulin concentration. Elevated serum FT4 concentration confirms the diagnosis of thyrotoxicosis. If serum FT4 concentration is normal, serum FT3 (T3) should be measured to exclude T3 thyrotoxicosis. Elevated serum FT3 (T3) together with normal FT4 (T4) and low serum TSH concentration confirms the diagnosis of T3 thyrotoxicosis that is a common condition in Europe. If both serum FT4 (T4) and FT3 (T3) are normal, and serum TSH is suppressed, the diagnosis is subclinical thyrotoxicosis. In case of clinical suspicion for TSH-producing pituitary adenoma or resistance to thyroid hormones, serum FT4 (T4) should also be measured because normal serum TSH does not exclude these rare conditions. In TSH-producing pituitary adenoma and resistance to thyroid hormones serum FT4 (T4) concentration is elevated while serum TSH concentration is normal or mildly elevated. Falsely elevated serum FT4 can be found in patients with familial dysalbuminemic hyperthyroxinemia or in patients taking certain drugs (like amiodarone). Serum TSH is normal in these patients. If serum TSH is elevated, further evaluaton should be performed according to the diagnostic algorithm of hypothyroidism.  EMBED PowerPoint.Slide.12  Slika 3. Algoritam za utvrivanje uzroka tireotoksikoze Kada se laboratorijskom obradom utvrdi tireotoksikoza, potrebna je daljnja obrada radi utvrivanja uzroka poremeaja. Daljnje usmjeravanje obrade ovisi o nalazu palpacije i ultrazvuka (UZV) atitnja e. Ako se palpacijom i ultrazvukom atitnja e ne nau vorovi, tada je klini ka dijagnoza vjerojatno Gravesova hipertireoza. Nalaz oftalmopatije (egzoftalmus), dodatno govori u prilog Gravesove bolesti. Kod Gravesove hipertireoze ultrazvu no nalazimo difuzne promjene parenhima atitnja e, poja anu prokrvljenost parenhima atitnja e na obojenom doppleru (kratica CD, od anglosaksonski Color Doppler) i poja ane brzine protoka kroz tireoidne arterije. U diferencijalnoj dijagnozi tireotoksikoze potrebno je razmotriti mogunost tireoiditisa. Subakutni tireoiditis ima karakteristi nu klini ku sliku. Uzimanje antiaritmika amiodarona takoer mo~e uzrokovati tireoiditis (amiodaronom potaknuta tireotoksikoza tip II). U slu aju klini ke sumnje na tiroiditis, scintigrafija atitnja e s 99mTc pertehnetatom ili mjerenje nakupljanja radioaktivnog joda (131I) u atitnja i e isklju iti ili potvrditi dijagnozu. Scintigrafsko obilje~je svih tiroiditisa je izrazito oslabljen prikaz funkcionalnog parenhima atitnja e i izrazito sni~en test nakupljanja radioaktivnog joda u atitnja i. Ultrazvuk atitnja e s obojenim dopplerom (CD) je korisna dijagnosti ka metoda za razlikovanje amiodaronom potaknute tireotoksikoze tipa I i II. Kod amiodaronom potaknute tireotoksikoze tipa I (AIT tip I), ije je obilje~je poja ana funkcija atitnja e, nalazimo poja anu prokrvljenost parenhima atitnja e na CD-u i poveane brzine protoka kroz tireoidne arterije. Kod amiodaronom potaknutog tireoiditisa (AIT tip II) nema poja ane prokrvljernosti parenhima atitnja e na CD-u, a brzine protoka kroz tireoidne arterije nisu poviaene. U slu aju palpatornog i/ili ultrazvu nog nalaza veeg vora/ vorova u atitnja i, scintigrafija atitnja e je neophodna radi postavljanja dijagnoze uzroka tireotoksikoze. U slu aju nalaza funkcionalnog vora na scintigramu, obi no bez prikaza ostatka parenhima atitnja e, dijagnoza je toksi ni adenom. U slu aju nalaza viae funkcionalnih vorova na scintigramu, dijagnoza je multinodularna toksi na guaa. Kod Gravesove hipertireoze atitnja a je na scintigramu difuzno, intenzivno prikazana, a test nakupljanja radioaktivnog joda u atitnja i je poviaen. U slu aju nalaza nefunkcionalnog vora/ vorova neophodno je slijediti algoritam dijagnostike vor(ova) u atitnja i. Uz navedene dijagnosti ke postupke va~no je napomenuti da razina poviaenih vrijednosti FT3 (T3) i FT4 (T4), ali i njihov relativni odnos takoer imaju zna aj u dijagnostici uzroka tireotoksikoze. Izrazito visoke vrijednosti hormona atitnja e su obi no obilje~je Gravesove hipertireoze, rjee toksi nog adenoma i multinodularne toksi ne guae. T3 tireotoksikozu eae nalazimo kod Gravesove hipertireoze, ali je mo~emo nai i kod toksi nog adenoma i multonodularne toksi ne guae. Blaga tireotoksikoza uz predominantni porast FT4 (T4) je obi no obilje~je tiroiditisa. Figure 3. Algorithm for the determination of the etiology of thyrotoxicosis If laboratory testing confirms thyrotoxicosis, further diagnostic evaluation is mandatory to determine the etiology of the disorder. The next step in the diagnostic evaluation depends on the finding of thyroid palpation and ultrasound (US). If there are no nodules according to findings of thyroid palpation and US, clinical diagnosis is probably Graves' hyperthyroidism. In addition, clinical finding of ophtalmopathy leads to the diagnosis of Graves' disease. Ultrasound of the thyroid gland in Graves' hyperthyroidism demonstrates diffuse pattern of the thyroid parenchyma. Color Doppler in Graves hyperthyroidism demonstrates increased vascularity of the thyroid parenchyma and increased vascular flow through thyroid arteries. In a differential diagnosis of thyrotoxicosis thyroiditis should also be suspected. Subacute thyroiditis is characterized by specific clinical symptoms and signs. Furthermore, amiodarone can induce thyroiditis (amiodarone induced thyrotoxicosis type II, AIT type II). If thyroiditis is suspected according to the clinical findings, thyroid scan or radioactive iodine uptake test can exclude or confirm the diagnosis. Thyroiditis is characterized with poor thyroid gland imaging and very low radioioactive iodine uptake test. Thyroid ultrasound with Color Doppler (CD) is useful diagnostic tool in the differential diagnosis between amiodarone induced thyrotoxicosis type I and II. Amiodarone induced thyrotoxicosis type I (AIT type I) is characterized by increased thyroid function. Color Doppler in AIT type I demonstrates increased vascularity of the thyroid parenchyma and increased vascular flow through thyroid arteries. However, amiodarone induced thyroiditis (AIT type II) is characterized by the absence of increased vascularity of the thyroid parenchyma on CD and vascular flow through thyroid arteries is not increased. A thyroid scan is mandatory to determine the etiology of thyrotoxicosis if there is large nodule(s) according to finding of thyroid palpation and/or US. Toxic thyroid adenoma is diagnosed if the thyroid scan reveals a functioning nodule, usually with the supression of extranodular thyroid tissue. Multinodular toxic goiter is diagnosed if the thyroid scan reveals more than one functioning nodule. Graves' hyperthyroidism is characterized by intense, diffuse thyroid uptake and an elevated radioiodine uptake test. If the thyroid scan reveals nonfunctioning nodule, further diagnostic evaluation should be according to the algorithm for rational diagnostics of thyroid nodule(s). Furthermore, the level of elevated serum concentrations of FT3 (T3) and FT4 (T4), and the relative ratio of FT3 (T3) to FT4 (T4) are also important in the evaluation of the etiology of thyrotoxicosis. Very high serum concentrations of FT3 (T3) and FT4 (T4) are usually seen in Graves' hyperthyroidism, rarely in toxic thyroid adenoma and multinodular toxic goiter. T3 thyrotoxicosis is usually seen in Graves' hyperthyroidism, but can also be seen in toxic thyroid adenoma and multinodular toxic goiter. Mild thyrotoxicosis with predominant elevation of FT4 (T4) is usually seen in thyroiditis. Tablica 5. Smjernice za praenje bolesnika s hipertireozom / Table 5. Guidelines for follow-up of patients with hyperthyroidism Tijekom prva 2 do 3 mjeseca po uvoenju tireostatika odreivanje FT3 (T3) i FT4 (T4) svakih 4 - 6 tjedana / FT3 (T3) and FT4 (T4) should be measured every 4-6 weeks during the first 2-3 months following the introduction of antithyroid drugsNakon 2  3 mjeseca lije enja tireostaticima odreuje se FT4 (T4) i TSH / After 2-3 months of treatment with antithyroid drugs FT4 (T4) and TSH should be measuredNakon zavraetka lije enja Gravesove hipertireoze tireostaticima (nakon 12  18 mjeseci lije enja) mogu se odrediti TSH-receptor protutijela / After stopping antithyroid drugs (after 12 -18 months of treatment) TSH-receptor antibodies can be measured Nakon lije enja Gravesove hipertireoze jodom-131 prva kontrola FT4 (T4) i TSH nakon 2 mjeseca. Potrebno je do~ivotno praenje funkcije atitnja e / The first measurement of FT4 (T4) and TSH should be after 2 months following radioiodine therapy of Graves' hyperthyroidism. Life-long monitoring of thyroid function is mandatory. Nakon lije enja toksi nog adenoma ili multonodularne toksi ne guae jodom-131 prva kontrola FT4 (T4) i TSH i scintigrafija atitnja e s 99mTc nakon 3-4 mjeseca. Potrebno je do~ivotno praenje funkcije atitnja e / The first measurement of FT4 (T4) and TSH together with thyroid scan should be afer 3-4 months following radioiodine therapy for toxic thyroid adenoma or toxic multinodular goiter. Life-long monitoring of thyroid function is mandatoryNakon nekompletne tireoidektomije prva kontrola FT4 (T4) i TSH nakon 6 tjedana. Ultrazvuk atitnja e se preporu a u initi nakon 3 mjeseca po operativnom zahvatu. Potrebno je do~ivotno praenje funkcije atitnja e / After a subtotal thyroidectomy FT4 (T4) and TSH should be measured after 6 weeks. Thyroid ultrasound is recommended after 3 months following surgery. Life-long monitoring of thyroid function is mandatory. Supklini ka hipertireoza: Praenje odreivanjem FT3 (T3), FT4 (T4) i TSH svakih 6-12 mjeseci / Subclinical hyperthyroidism: Follow up with serum FT3 (T3), FT4 (T4) and TSH measurement every 6-12 months. Tablica 6. Preporuke za probir poremeaja funkcije atitnja e Hrvatskog druatva za atitnja u / Table 6. Screening for thyroid dysfunction  recommendations of the Croatian Thyroid Society Odreivanje TSH trudnicama na po etku trudnoe / Serum TSH measuremet in pregnant women at the beginning of pregnancyOdreivanje TSH ~enama starijim od 50 godina, ukoliko tra~e lije ni ku pomo / Serum TSH measurement in women older than 50 years if they seek medical help     PAGE  PAGE 1 L„ FԇևfhjЈ҈"f.JL:xޏ28:fJӴ풝wlaVh~hL0OJQJh~h! 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