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Limitations to the Use of a Sensitive Assay for Serum Thyrotropin in the Assessment of Thyroid Status
David A. Ehrmann, MD;
Michael Weinberg;
David H. Same, MD
Arch Intern Med. 1989;149(2):369-372.
Abstract
• In the majority of clinical settings, a suppressed serum thyrotropin (s-TSH) level determined by the new sensitive assays is diagnostic of thyrotoxicosis. This has led to its proposed use as a screen for thyroid disease. However, s-TSH may be suppressed in conditions other than thyrotoxicosis. We retrospectively reviewed s-TSH measurements made in a large heterogeneous population to determine in which settings a suppressed value could potentially lead to misdiagnosis. We found that a suppressed s-TSH level was useful in making the diagnosis of autonomous thyroid function and in the assessment of thyroid hormone replacement therapy in patients with primary, but not central, hypothyroidism. Hyperthyroidism caused by either intrinsic thyroid disease or thyroid hormone administration accounted for 83% (111/134) of suppressed values; however, central hypothyroidism, nonthyroidal illness, acute psychiatric illness, or the administration of medication was responsible for this finding in 17% (23/134). While a suppressed s-TSH level is generally excellent in the diagnosis of pituitary suppression by thyroid hormone, in specific clinical settings, a suppressed s-TSH level may be seen in the absence of thyroid hormone excess. The limitations of its use as a first-line screen in those conditions must be recognized.
(Arch Intern Med 1989;149:369-372)
Author Affiliations
From the Thyroid Study Unit and the Thyroid Function Laboratory, Department of Medicine, The University of Chicago Pritzker School of Medicine. Dr Same is now with the University of Illinois at Chicago.
Footnotes
Accepted for publication Aug 5, 1988.
Presented in part at the 69th annual meeting of The Endocrine Society, Anaheim, Calif, June 11, 1987.
Reprint requests to University of Chicago, Thyroid Study Unit, Box 138, 5841 S Maryland Ave, Chicago, IL 60637 (Dr Ehrmann).
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