title: Does fasting or postprandial state affect thyroid function testing?
abstract: BACKGROUND
  Thyroid stimulating hormone (TSH) levels vary with the time of the day and probably in relation to food. In this study, we addressed the question of whether a fasting or non-fasting sample would make a clinically significant difference in the interpretation of thyroid function tests.
  
  
  METHODS
  Fifty seven adult ambulatory patients were selected from our laboratory database and were divided into Group A [Normal free thyroxine (T4) and TSH], Group B (subclinical hypothyroid with increased TSH and normal free T4) and Group C (overt hypothyroid with low free T4 and high TSH). Thyroid functions (free T4 and TSH) were done in fasting state and 2 hours postprandially.
  
  
  RESULTS
  TSH was suppressed in all subjects after food irrespective of the fasting levels. Free T4 values did not change significantly. This resulted in reclassification of 15 out of 20 (75%) subjects as subclinical hypothyroidism (SCH) based on fasting values whose TSH values were otherwise within range in the postprandial sample. This may have an impact on the diagnosis and management of hypothyroidism especially where even marginal changes in TSH may be clinically relevant as in SCH and in pregnancy.
  
  
  CONCLUSIONS
  TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.
authors.affiliation: Department of General Medicine, Stanley Medical College, Chennai, Tamil Nadu, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Nair
authors.affiliation: Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
authors.forename: Shriraam
authors.initials: S
authors.lastname: Mahadevan
authors.affiliation: Department of General Medicine, Stanley Medical College, Chennai, Tamil Nadu, India.
authors.forename: R S
authors.initials: RS
authors.lastname: Muralidharan
authors.affiliation: Department of General Medicine, Stanley Medical College, Chennai, Tamil Nadu, India.
authors.forename: S
authors.initials: S
authors.lastname: Madhavan
keywords: Fasting; subclinical hypothyroidism; thyroid function test; thyroid stimulating hormone