Hyperthyroxinemia with a non-suppressed TSH: how to confidently reach a diagnosis in this clinical conundrum

[helvella]

We see quite a few cases with discordant thyroid tests - where TSH, FT4 and FT3 do not reflect each other in the way that a simplistic interpretation would suggest.

(I suspect we would see a lot more if more patients had TSH, FT4 AND FT3 tested - every time.)

This article discusses one particular situation - TSH not suppressed despite high thyroid hormone levels.

Let us hope the authors' confident is not misplaced and doesn't actually reflect over-confidence or arrogance!

• Review Article

• Open Access

• Published: 03 March 2020

Hyperthyroxinemia with a non-suppressed TSH: how to confidently reach a diagnosis in this clinical conundrum

• J. G. Timmons &

• B. Mukhopadhyay

Hormones (2020)

Abstract

Disorders of thyroid function are among the commonest referrals to endocrinology. While interpretation of thyroid function testing is usually straightforward, accurate interpretation becomes significantly more challenging when the parameters do not behave as would be expected in normal negative feedback. In such cases, uncertainty regarding further investigation and management arises. An important abnormal pattern encountered in clinical practice is that of high normal or raised free thyroxine (fT4) with inappropriately non-suppressed or elevated thyroid-stimulating hormone (TSH). In this short review using two clinical vignettes, we examine the diagnostic approach in such cases. A diagnostic algorithm is proposed to ensure that a definitive diagnosis is reached in these challenging cases.

Full review article freely available here:

link.springer.com/article/1...

[london81]

my daughters ft4 and ft3 were high with high tsh. we are still waiting to see what happens next and she has high antibodies so i’m assuming the next stage is high tsh and falling ft4 and ft3 once thyroid destruction increases. will read this study with interest, thank you