Approach to the Patient With Raised Thyroid Hormones and Nonsuppressed TSH

Carla Moran, Nadia Schoenmakers, David Halsall, Susan Oddy, Greta Lyons, Sjoerd van den Berg, Mark Gurnell, Krishna Chatterjee*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Pages (from-to)1094-1108
Number of pages15
JournalThe Journal of clinical endocrinology and metabolism
Volume109
Issue number4
DOIs
Publication statusPublished - Apr 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.

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