How to detect hypothyroidism when screening tests are normal

Preview

Suppose a patient comes in complaining of the characteristic symptoms of hypothyroidism—or simply “looks hypothyroid”—but routine screening tests show no abnormalities in thyroid function. Could the patient still have hypothyroidism? Is thyroid replacement therapy indicated? The authors of this article make a strong case for use of the thyrotropin-releasing hormone test in this situation by describing how this sensitive stimulation test revealed borderline hypothyroidism in their series of more than 60 patients.