Approach to the Patient With Raised Thyroid Hormones and Nonsuppressed TSH.

Measurement of free thyroid hormones (THs) and thyrotropin (TSH) using automated immunoassays is central to the diagnosis of thyroid dysfunction. Using illustrative cases, we describe a diagnostic approach to discordant thyroid function tests, focusing on entities causing elevated free thyroxine and/or free triiodothyronine measurements with nonsuppressed TSH levels. Different types of analytical interference (eg, abnormal thyroid hormone binding proteins, antibodies to iodothyronines or TSH, heterophile antibodies, biotin) or disorders (eg, resistance to thyroid hormone β or α, monocarboxylate transporter 8 or selenoprotein deficiency, TSH-secreting pituitary tumor) that can cause this biochemical pattern will be considered. We show that a structured approach, combining clinical assessment with additional laboratory investigations to exclude assay artifact, followed by genetic testing or specialized imaging, can establish a correct diagnosis, potentially preventing unnecessary investigation or inappropriate therapy. © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.

Citation

Carla Moran, Nadia Schoenmakers, David Halsall, Susan Oddy, Greta Lyons, Sjoerd van den Berg, Mark Gurnell, Krishna Chatterjee. Approach to the Patient With Raised Thyroid Hormones and Nonsuppressed TSH. The Journal of clinical endocrinology and metabolism. 2024 Mar 15;109(4):1094-1108

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PMID: 37988295

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