Approach to the Patient With Raised Thyroid Hormones and Nonsuppressed TSH.
assay interference
thyroid function tests
thyroid hormone action
Journal
The Journal of clinical endocrinology and metabolism
ISSN: 1945-7197
Titre abrégé: J Clin Endocrinol Metab
Pays: United States
ID NLM: 0375362
Informations de publication
Date de publication:
15 Mar 2024
15 Mar 2024
Historique:
received:
23
08
2023
medline:
18
3
2024
pubmed:
21
11
2023
entrez:
21
11
2023
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 37988295
pii: 7439666
doi: 10.1210/clinem/dgad681
pmc: PMC10940260
doi:
Substances chimiques
Thyroxine
Q51BO43MG4
Triiodothyronine
06LU7C9H1V
Thyroid Hormones
0
Thyrotropin
9002-71-5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1094-1108Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Medical Research Council
ID : MRC_MC_UU_00014/40
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 210755/Z/18/Z
Pays : United Kingdom
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.
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