A practical approach towards the evaluation of aberrant thyroid function tests

ABSTRACT

Objective: To provide insight in patterns and causes of aberrant thyroid function tests (TFT) and to propose a practical approach for clinicians.

Methods: Starting from an illustrative case report, an extensive literature search was performed, resulting in a narrative literature review.

Results: TFT that cannot be explained by the negative feedback principle of the hypothalamo-pituitary-thyroid axis are a challenge for every clinician. Various alternative explanations for these TFT should be considered before drawing the conclusion of thyroid disorder, since incorrect diagnosis and treatment can have severe consequences for the patient.

For example, the combination of elevated or normal TSH with elevated free T4 or T3 levels may result from the use of certain drugs or lab interference, while low or normal TSH with low T3 or T4 can often be explained by non-thyroidal illness or central hypothyroidism due to pituitary failure. Correct identification of these clinical situations requires understanding thyroid hormone metabolism and action, knowledge of some laboratory techniques, and a multistep evaluation process.

Conclusion: To avoid incorrect diagnosis and thus treatment, clinicians should be aware of the existence of aberrant TFT and know how to decipher them.

Graphical Abstract

KEYWORDS:

• Thyroid function tests
• analytical interference
• non-suppressed serum TSH
• resistance to thyroid hormone
• non-thyroidal illness

Acknowledgments

We kindly thank the patient who consented with this report and also late Prof. Dr. T.J. Visser (Erasmus MC, Rotterdam) for genetic profiling of the patient’s DNA.

Disclosure statement

No potential conflict of interest was reported by the authors.