title: What should be done when thyroid function tests do not make sense?
abstract: Interpretation of thyroid function tests (TFTs) is generally straightforward. However, in a minority of contexts the results of thyroid hormone and thyrotropin measurements either conflict with the clinical picture or form an unusual pattern. In many such cases, reassessment of the clinical context provides an explanation for the discrepant TFTs; in other instances, interference in one or other laboratory assays can be shown to account for divergent results; uncommonly, genetic defects in the hypothalamic-pituitary-thyroid axis are associated with anomalous TFTs. Failure to recognize these potential 'pitfalls' can lead to misdiagnosis and inappropriate management. Here, focusing particularly on the combination of hyperthyroxinaemia with nonsuppressed thyrotropin, we show how a structured approach to investigation can help make sense of atypical TFTs.
authors.affiliation: Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. mg299@medschl.cam.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Gurnell
authors.forename: David J
authors.initials: DJ
authors.lastname: Halsall
authors.forename: V Krishna
authors.initials: VK
authors.lastname: Chatterjee
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D006801:Humans; D006981:Hyperthyroxinemia / Q000097:blood* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013960:Thyroid Function Tests / Q000379:methods / Q000592:standards*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine