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

Hormones : International Journal of Endocrinology and Metabolism
J G Timmons, B Mukhopadhyay

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.

References

Nov 28, 2013·Best Practice & Research. Clinical Endocrinology & Metabolism·Olympia KoulouriMark Gurnell
Dec 23, 2015·Pituitary·Alice AzzalinAdriana G Ioachimescu
Jan 23, 2016·Endocrine·Fatemeh G Amlashi, Nicholas A Tritos
Oct 13, 2017·Journal of Endocrinological Investigation·D M Nazato, J Abucham
Jun 2, 2018·Clinica Chimica Acta; International Journal of Clinical Chemistry·Viktoria F KoehlerW A Mann
Apr 13, 2019·Molecular Diagnosis & Therapy·Paola ConcolinoRosa Maria Paragliola
Jun 9, 2019·Journal of Endocrinological Investigation·P Beck-PeccozA Lania
Oct 8, 2019·Experientia. Supplementum·Luca Persani, Irene Campi
Oct 31, 2019·Journal of Thyroid Research·Salman RazviSanaa Mrabeti

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Methods Mentioned

BETA
equilibrium dialysis

Software Mentioned

Vignette

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