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Clinical use of sensitive assays for thyroid-stimulating hormone

Journal of General Internal Medicine volume 11, pages 115–127 (1996)Cite this article

Abstract

OBJECTIVE: To review the optimal use of sensitive assays for thyroid-stimulating hormone (TSH) by clinicians.

METHODS: The available literature pertinent to the clinical application of sensitive TSH testing was identified through a systematic MEDLINE search and reviewed. Selection of materials for inclusion was based on clinical validity of the data and relevance to the study question.

SYNOPSIS: Sensitive TSH assays have contributed greatly to our basic knowledge of thyroid axis physiology and are a powerful clinical tool in the diagnosis and treatment of thyroid disease. The clinical applicability of these assays, as is our understanding of their appropriate use, is rapidly expanding. Based upon the best evidence and current understanding of thyroid physiology, strategies are presented for appropriate use of sensitive TSH assays in healthy outpatients, in patients who are likely to have a disturbed hypothalmic-pituitary-thyroid axis, and in patients on levothyroxane therapy.

CONCLUSIONS: Although many clinical questions regarding the use of sensitive TSH assays remain to be studied, it has emerged as a powerful tool for the diagnosis and management of thyroid disease. Optimal use of sensitive TSH assays requires an understanding of TSH physiology and measurement, coupled with appropriate application and interpretation in specific clinical settings.

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References

  1. Greenspan SL, Klibanski A, Schoenfeld D, Ridgway EC. Pulsatile secretion of thyrotropin in man. J Clin Endocrinol Metab. 1986;63:661–8.

    PubMed  CAS  Google Scholar 

  2. Vanhaelst L. Van Cauter E, Degaule JP, Golstein J. Circadian variations of serum thyrotropin levels in man. J Clin Endocrinol Metab. 1972;35:479–82.

    PubMed  CAS  Google Scholar 

  3. Nickoloff JT, Spencer CA. The use and misuse of the sensitive thyrotropin assays. J Clin Endocrinol Metab. 1990;71:553–8.

    Google Scholar 

  4. Ridgway EC. Thyrotropin radioimmunoassays: birth, life, and demise. Mayo Clin Proc. 1988;63:1028–34.

    PubMed  CAS  Google Scholar 

  5. Spencer CA, Schwarzbein D, Guttler RB, LoPresti JS, Nickoloff JT. Thyrotropin (TSH)-releasing hormone stimulation test responses employing third and fourth generation TSH assays. J Clin Endocrinol Metab. 1993;76:494–8.

    PubMed  Article  CAS  Google Scholar 

  6. Larsen PR, Alexander NM, Chopra IJ. et al. Revised nomenclature for tests of thyroid hormones and thyroid-related proteins in serum. Clin Chem. 1987;33:2114–7.

    Google Scholar 

  7. Hay ID, Bayer MF, Kaplan MM, et al. American Thyroid Association assessment of current thyroid hormone and thyrotropin measurements and guidelines for future clinical assays. Clin Chem. 1991;37:2002–8.

    PubMed  CAS  Google Scholar 

  8. Spencer CA. Thyroid profiling for the 1990’s: free T4 estimate or sensitive TSH measurement? J Clin Immunoassay. 1989;12:82–9.

    Google Scholar 

  9. Spencer CA. Takeuchi M. Kazarosyan M, MacKenzie F, Beckett GJ, Wilkinson E. Interlaboratory/intermethod differences in functional sensitivity of immunometric assays of thyrotropin (TSH) and impact on reliability of measurement of subnormal concentrations of TSH. Clin Chem. 1995;41:367–74.

    PubMed  CAS  Google Scholar 

  10. Simoni M, Velardo A, Montanini V, et al. Circannual rhythm of plasma thyrotropin in middle-aged and old euthyroid subjects. Horm Res. 1990;33:184–9.

    PubMed  CAS  Google Scholar 

  11. Olsson T, Viitanen M, Hagg E, et al. Hormone in ‘young’ and old’ elderly: pituitary-thyroid and pituitary-adrenal axes. Gerontology. 1989;35:144–52.

    PubMed  CAS  Google Scholar 

  12. Hershman JM, Pekary AE, Berg L. Solomon DH, Sawin CT. Serum thyrotropin and thyroid hormone levels in elderly and middle-aged euthyroid persons. J Am Geriatr Soc. 1993;41:823–8.

    PubMed  CAS  Google Scholar 

  13. van Coevorden A, Laurent E, Decoster C, et al. Decreased basal and stimulated thyrotropin secretion in healthy elderly men. J Clin Endocrinol Metab. 1989;69:177–85.

    PubMed  Google Scholar 

  14. Runnels BL, Garry PJ, Hunt WC, Standefer JC. Thyroid function in a healthy elderly population: implications for clinical evaluation. J Gerontol. 1991;46:B39–44.

    PubMed  CAS  Google Scholar 

  15. Szabolcs I, Ploenes C, Beyer M, Bernard W, Herrman J. Reference intervals for serum thyrotropin: dependence on the population investigated. Exp Clin Endocrinol. 1991;98:23–31.

    PubMed  CAS  Google Scholar 

  16. Schectman JM, Kallenberg GA, Schumacher RJ, Hirsch RP. Yield of hypothyroidism in symptomatic primary care patients. Arch Intern Med. 1989;149:861–4.

    PubMed  Article  CAS  Google Scholar 

  17. Schectman JM, Kallenberg GA, Hirsch RP, Schumacher RJ. Report of an association between race and thyroid stimulating hormone level. Am J Public Health. 1991;81:505–6.

    PubMed  CAS  Google Scholar 

  18. Bagchi N, Brown TR, Parish RF. Thyroid dysfunction in adults over age 55 years. Arch Intern Med. 1990;150:785–7.

    PubMed  Article  CAS  Google Scholar 

  19. Chan BY, Swaminathan R. Serum thyrotropin concentration measured by sensitive assays in normal pregnancy. Br J Obstet Gynaecol. 1988;95:1332–6.

    PubMed  CAS  Google Scholar 

  20. Glinoer D, DeNayer P, Bourdoux P, et al. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab. 1990;71:276–85.

    PubMed  CAS  Google Scholar 

  21. Ballabio M, Poshyachinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab. 1991;73:824–31.

    PubMed  CAS  Google Scholar 

  22. Burrow GN. Thyroid function and hyperfunction during gestation. Endocr Rev. 1993;14:194–202.

    PubMed  Article  CAS  Google Scholar 

  23. Busnardo I, Bui F, Glrelli ME. Different rates of thyrotropin suppression after total body scan in patients with thyroid cancer: effect of regular doses of thyroxine and triiodothyronine. J Endocrinol Invest. 1983;6:35–40.

    PubMed  CAS  Google Scholar 

  24. Spencer CA, LoPresti JS, Patel S, et al. Applications of a new chemiluminescent thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab. 1990;70:453–60.

    PubMed  CAS  Google Scholar 

  25. Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyroid disease. Ann Intern Med. 1993;119:491–502.

    Google Scholar 

  26. Helfand M, Crapo LM. Monitoring therapy in patients taking levothyroxine. Ann Intern Med. 1990;113:450–4.

    PubMed  CAS  Google Scholar 

  27. Kaptein EM, Spencer CA, Kamiel MB, Nickoloff JT. Prolonged dopamine administration and thyroid hormone economy in normal and critically ill subjects. J Clin Endocrinol Metab. 1980;51:387–93.

    PubMed  CAS  Google Scholar 

  28. Re RN, Kourides IA, Ridgway EC, Weintraub BD, Maloof F. The effect of glucocorticoid administration on human pituitary secretion of thyrotropin and prolactin. J Clin Endocrinol Metab. 1976;43:338–46.

    PubMed  CAS  Google Scholar 

  29. Spencer CA, Schwarzbein D, Nickoloff JT. Acute and chronic T4, dexamethasone (DEX) and dopamine (DA) suppression of TSH in man. Clin Res. 1990;38:100A.

    Google Scholar 

  30. Davies PH, Franklyn JA. The effects of drugs on tests of thyroid function. Eur J Clin Pharmacol. 1991;40:439–51.

    PubMed  Article  CAS  Google Scholar 

  31. Fradkin JE, Wolff J. Iodine-induced thyrotoxicosis. Medicine. 1983;62:1–14.

    PubMed  Article  CAS  Google Scholar 

  32. Braverman LE, Woeber KA, Ingbar SH. Induction of myxedema by iodine in patients euthyroid after radioiodine or surgical treatment of diffuse toxic goitre. N Engl J Med. 1969;281:816–21.

    PubMed  CAS  Article  Google Scholar 

  33. Braverman LE, Ingbar SH, Vagenakis AG, Adams L, Maloof F. Enhanced susceptibility to iodide myxedema in particular with Hashimoto’s disease. J Clin Endocrinol Metab. 1971;32:515–21.

    PubMed  CAS  Google Scholar 

  34. Trip MD, Wiersinga W, Plomp TA. Incidence, predictability, and pathogenesis of amiodarone-induced thyrotoxicosis and hypothyroidism. Am J Med. 1991;91:507–11.

    PubMed  Article  CAS  Google Scholar 

  35. Figge HL, Figge J. The effects of amiodarone on thyroid hormone function: a review of the physiology and clinical manifestations. J Clin Pharmacol. 1990;30:580–95.

    Google Scholar 

  36. Nademanee K, Singh BN, Callahan B, Hendrickson JA, Hershman JM. Amiodarone, thyroid hormone indexes, and altered thyroid function: long term serial effects in patients with cardiac arrhythmias. Am J Cardiol. 1986;58:981–6.

    PubMed  Article  CAS  Google Scholar 

  37. Singh BN, Nademanee K. Amiodarone and thyroid function: clinical implications during antiarrhythmic therapy. Am Heart J. 1983;106:857–69.

    PubMed  Article  CAS  Google Scholar 

  38. Melmed S, Nademanee K, Reed AW, Hendrickson JA, Singh BN, Hershman JM. Hyperthyroxinemia with bradycardia and normal thyrotropin secretion after chronic amiodarone administration. J Clin Endocrinol Metab. 1981;53:997–1001.

    PubMed  CAS  Google Scholar 

  39. Wiersinga WM, Endert E, Trip MD, Verhaest-deJong N. Immunoradiometric assay of thyrotropin in plasma: its value in predicting response to thyroliberin stimulation and assessing thyroid function in amiodarone-treated patients. Clin Chem. 1986;32:433–6.

    PubMed  CAS  Google Scholar 

  40. Burman P, Totterman TH, Karlsson FA. Thyroid autoimmunity in patients on long term therapy with leukocyte-derived interferon. J Clin Endocrinol Metab. 1986;63:1086–90.

    PubMed  CAS  Google Scholar 

  41. Schultz M, Muller R, von zur Muhlen A, Brabent G. Induction of hypothyroidism by interferon alpha-2-b. Lancet. 1989;1:1452.

    PubMed  Article  CAS  Google Scholar 

  42. Ronnblom LE, Aim GV, Oberg KE. Autoimmunity after alpha-interferon therapy for malignant carcinoid tumors. Ann Intern Med. 1991;115:178–83.

    PubMed  CAS  Google Scholar 

  43. Lisker-Melman M, DiBisceglie AM, Usala SJ, Weintraub B, Murray LM, Hoofnagle JH. Development of thyroid disease during therapy of chronic viral hepatitis with interferon alpha. Gastroenterology. 1993;102:2155–60.

    Google Scholar 

  44. Kamikubo K, Takami R, Suwa T, et al. Case report: silent thyroiditis developed during alpha-interferon therapy. Am J Med Sci. 1993;306:174–6.

    PubMed  Article  CAS  Google Scholar 

  45. Watanabe U, Hashimoto E, Hisamitsu T, Obata H, Hayashi N. The risk factor for development of thyroid disease during interferon-alpha therapy for chronic hepatitis C. Am J Gastroenterol. 1994;89:399–403.

    PubMed  CAS  Google Scholar 

  46. DuBuis JM, Burger AG. Thyroid-stimulating hormone measurements by immunoradiometric assay in severely ill patients. Lancet. 1986;2:1036–7.

    PubMed  Article  CAS  Google Scholar 

  47. Bayer MF, Macoviak JA, McDougal IR. Diagnostic performance of sensitive measurements of serum thyrotropin during severe non-thyroidal illness: the role in the diagnosis of hyperthyroidism. Clin Chem. 1987;33:2178–84.

    PubMed  CAS  Google Scholar 

  48. Spencer CA, Eigen A, Shen D, et al. Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem. 1987;33:1391–6.

    PubMed  CAS  Google Scholar 

  49. Chopra I, Solomon DH, Huang T-S. Serum thyrotropin in hospitalized psychiatric patients: evidence for hyperthyrotropinemia as measured by an ultrasensitive thyrotropin assay. Metabolism. 1990;5:538–43.

    Article  Google Scholar 

  50. Hein MD, Jackson IMD. Review: thyroid function in psychiatric illness. Gen Hosp Psychiatry. 1990;12:232–44.

    PubMed  Article  CAS  Google Scholar 

  51. Dobs AS, Dempsey MA, Ladenson PW, Polk BF. Endocrine disorders in men infected with human immunodeficiency virus. Am J Med. 1987;84:611–6.

    Article  Google Scholar 

  52. Merenich JA, McDermott MT, Asp AA, Harrison SM, Kidd GS. Evidence of endocrine involvement early in the course of human immunodeficiency virus infection. J Clin Endocrinol Metab. 1990;70:566–71.

    PubMed  CAS  Google Scholar 

  53. Tang WW, Kaptein EM. Thyroid hormone levels in the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. West J Med. 1989;151:627–31.

    PubMed  CAS  Google Scholar 

  54. LoPresti JS, Fried JC, Spencer CA, Nickoloff JT. Unique alterations of thyroid hormone indices in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1989;110:970–5.

    PubMed  CAS  Google Scholar 

  55. Olivieri A, Sorcini M, Battisti P, et al. Thyroid hypofunction related with the progression of human immunodeficency virus infection. J Endocrinol Invest. 1993;16:407–13.

    PubMed  CAS  Google Scholar 

  56. Aizawa T, Koizumi Y, Yamada T, et al. Difference in pituitary-thyroid feedback regulation in hypothyroid patients, depending on the severity of hypothyroidism. J. Clin Endocrinol Metab. 1978;47:560–5.

    CAS  Google Scholar 

  57. Brajkovich IE, Mashiter K, Joplin GF, Cassar J. Serum T4, T3, and TSH levels in primary hypothyroidism during replacement therapy with thyroxine. Metabolism. 1983;32:745–7.

    PubMed  Article  CAS  Google Scholar 

  58. Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP, Oppenheimer JH. Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. N Engl J Med. 1987;316:764–70.

    PubMed  CAS  Article  Google Scholar 

  59. Maeda M, Kuzuya N, Masuyama Y, et al. Changes in serum tri-iodothyronine, thyroxine, and thyrotropin during treatment with thyroxine in severe primary hypothyroidism. J Clin Endocrinol Metab. 1976;43:10–7.

    PubMed  CAS  Google Scholar 

  60. England ML, Hershman JM. Serum TSH as an aid to monitoring compliance with thyroid hormone therapy in hypothyroidism. Am J Med Sci. 1986;292:264–6.

    PubMed  Article  CAS  Google Scholar 

  61. Kabadi UM. “Subclinical hypothyroidism”-natural course of the syndrome during a prolonged follow-up study. Arch Intern Med. 1993;153:957–61.

    PubMed  Article  CAS  Google Scholar 

  62. Parle JV, Franklyn JA, Cross KW, Jones SC, Parle JV. Prevalence and follow-up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol. 1991;34:77–83.

    CAS  Google Scholar 

  63. Tunbridge WM, Brewis M, French JM, et al. Natural history of autoimmune thyroiditis. Br Med J. 1981;282:258–62.

    CAS  Google Scholar 

  64. Rosenthal MJ, Hunt WC, Garry PJ, Goodwin JS. Thyroid failure in the elderly: microsomal antibodies as discriminant for therapy. JAMA. 1987;258:209–13.

    PubMed  Article  CAS  Google Scholar 

  65. Lazarus JH, Burr ML, McGregor AM, et al. The prevalence and progression of autoimmune thyroid disease in the elderly. Acta Endocrinol. 1984;106:199–202.

    PubMed  CAS  Google Scholar 

  66. Brochmann H, Bjoro T, Gaarder PI, Hanson F, Frey HM. Prevalence of thyroid dysfunction in elderly subjects. A randomized study in a Norwegian rural community. Acta Endocrinol. 1988;117:7–12.

    PubMed  CAS  Google Scholar 

  67. Davies PH, Franklyn JA, Daykin J, Sheppard MC. The significance of TSH values measured in a sensitive assay in the follow-up of hyperthyroid patients treated with iodine. J Clin Endocrinol Metab. 1992;74:1189–94.

    PubMed  Article  CAS  Google Scholar 

  68. Toft AD, Irvine WU, Seth J, Cameron EHD. How often should patients be reviewed after treatment with iodine-131 for thyrotoxicosis? BMJ. 1978;2:1115–7.

    PubMed  CAS  Google Scholar 

  69. Toft AD, Irvine WJ, Hunter WM, Seth J. Plasma TSH and serum T4 levels in long-term follow-up of patients treated with I131 for thyrotoxicosis. BMJ. 1974;3:152–3.

    PubMed  CAS  Google Scholar 

  70. Hamblin PS, Dyer SA, Mohr VS, et al. Relationship between thyrotropin and thyroxine changes during recovery from severe hypothyroxlnemia of critical illness. J Clin Endocrinol Metab. 1986;62:717–22.

    PubMed  CAS  Google Scholar 

  71. Spencer CA. Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Mayo Clin Proc. 1988;63:1214–22.

    PubMed  CAS  Google Scholar 

  72. Kaptein EM, Weiner JM, Robinson WJ, Wheeler WS, Nickoloff JT. Relationship of altered thyroid hormone indices to survival in nonthyroidal illness. Clin Endocrinol. 1982;16:565–74.

    CAS  Google Scholar 

  73. Faber J, Kirkegaard C, Rasmussen B, Westh H, Busch-Sorensen M, Jensen IW. Pituitary-thyroid axis in critical illness. J Clin Endocrinol Metab. 1987;65:315–20.

    PubMed  CAS  Google Scholar 

  74. Topliss DJ. White EL, Stockigt JR. Significance of thyrotropin excess in untreated primary adrenal insufficiency. J Clin Endocrinol Metab. 1980;50:52–6.

    PubMed  CAS  Google Scholar 

  75. Wynne AG, Gharib H, Scheithauer BW, Davis DH, Freeman SL, Horvath E. Hyperthyroidism due to inappropriate secretion of thyrotropin in 10 patients. Am J Med. 1992;92:15–24.

    PubMed  Article  CAS  Google Scholar 

  76. Faglia G. Beck-Peccoz P. Piscitelli G. Medri G. Inappropriate secretion of thyrotropin by the pituitary. Horm Res. 1987;26:79–99.

    PubMed  CAS  Article  Google Scholar 

  77. Refetoff S. Weiss RE, Usala SJ. The syndromes of resistance to thyroid hormone. Endocr Rev. 1993;14:348–99.

    PubMed  Article  CAS  Google Scholar 

  78. Faglia G. Bitensky L, Pinchera A, et al. Thyrotropin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979;48:989–98.

    PubMed  CAS  Google Scholar 

  79. Sunthornthepvarakul T, Gottschalk ME, Hayashi Y, Refetoff S. Brief report: resistance to thyrotropin caused by mutations in the thyrotropin receptor gene. N Engl J Med. 1995;332:155–60.

    Article  CAS  Google Scholar 

  80. Franklyn JA, Black EG, Betteridge J. Sheppard MC. Comparison of second and third generation methods for measurement of serum thyrotropin in patients with overt hyperthyroidism, patients receiving thyroxine therapy, and those with non-thyroidal illness. J Clin Endocrinol Metab. 1994;78:1368–71.

    PubMed  Article  CAS  Google Scholar 

  81. Ross DS. Ardisson LJ, Meskell MJ. Measurement of thyrotropin in clinical and subclinical hyperthyroidism using a new chemiluminescent assay. J Clin Endocrinol Metab. 1989;68:684–8.

    Google Scholar 

  82. Figge J. Leinung M, Goodman AD, et al. The clinical evaluation of patients with subclinical hyperthyroidism and free triidothyro-nine (free T3) toxicosis. Am J Med. 1994;96:229–34.

    PubMed  Article  CAS  Google Scholar 

  83. Bitton RE, Wexler C. Free triidothyronine thyrotoxicosis: a distinct entity. Am J Med. 1990;88:531–3.

    PubMed  Article  CAS  Google Scholar 

  84. Simons RJ, Manni A, Fang S-H, Braverman L. Free triidothyronine toxicosis in a patient with multtaodular goiter. Am J Med. 1990;88:689–92.

    PubMed  Article  CAS  Google Scholar 

  85. Eggertsen R, Petersen K, Lundberg P-A, Nystrom E, Lindstedt G. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. BMJ. 1988;297:1586–92.

    PubMed  CAS  Google Scholar 

  86. Sawin CT. Geller A, Kaplan M, Bacharach P. Wilson PWF, Hershman JM. Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism. Arch Intern Med. 1991;151:165–8.

    PubMed  Article  CAS  Google Scholar 

  87. Sundbeck G, Jagenburg R, Johansson P-M, Eden S, Lindstedt G. Clinical significance of low serum thyrotropin concentration by chemiluminetric assay in 85-year-old women and men. Arch Intern Med. 1991;151:549–56.

    PubMed  Article  CAS  Google Scholar 

  88. Stott DJ, McLellen AR, Finlayson J. Alexander WD. Elderly patients with suppressed serum TSH but normal free thyroid hormone levels usually have mild thyroid overactivity and are at increased risk of developing overt hyperthyroidism. QJM. 1991;78:77–84.

    PubMed  CAS  Google Scholar 

  89. Sawin CT. Geller A, Wolf PA. et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249–52.

    PubMed  Article  CAS  Google Scholar 

  90. Fischer HRA. Hackeng WHL, Schopman W. Silberbusch J. Analysis of factors in hyperthyroidism, which determine the duration of suppressive treatment before recovery of thyroid stimulating hormone secretion. Clin Endocrinol. 1982;16:575–85.

    CAS  Google Scholar 

  91. Toft AD, Irvine WJ, Hunter WM, Ratcliffe JG, Seth J. Anomalous plasma TSH levels in patients developing hypothyroidism in the early months after I131 therapy for thyrotoxicosis. J Clin Endocrinol Metab. 1974;39:607–9.

    PubMed  CAS  Article  Google Scholar 

  92. Nagai K, Tamai H, Mukuta T, et al. A follow-up of 85 patients with Graves’ disease in remission who develop undetectable serum thyroid-stimulating hormone concentrations using sensitive TSH assays. Horm Res. 1991;35:185–9.

    PubMed  CAS  Article  Google Scholar 

  93. Ross DS. Subclinical hyperthyroidism: possible danger of over-zealous thyroxine replacement therapy. Mayo Clin Proc. 1988;63:1223–9.

    PubMed  CAS  Google Scholar 

  94. Toft AD. Thyroxine therapy. N Engl J Med. 1994;331:174–80.

    PubMed  Article  CAS  Google Scholar 

  95. Pacchiarotti A, Martino E, Bartalena L, et al. Serum thyrotropin by ultrasensitive immunoradiometric assay and serum free thyroid hormones in pregnancy. J Endocrinol Invest. 1986;9:185–9.

    PubMed  CAS  Google Scholar 

  96. Ball R, Freedman DB, Holmes JC, Midgley JEM. Sheehan CP. Low-normal concentrations of free thyroxine in serum in late pregnancy: physiological fact, not technical artifact. Clin Chem. 1989;35:1891–6.

    PubMed  CAS  Google Scholar 

  97. Taimela E, Tahtela R, Koskinen P, et al. Ability of two new thyrotropin (TSH) assays to separate hyperthyroid patients from euthyroid patients with low TSH. Clin Chem. 1994;40:101–5.

    PubMed  CAS  Google Scholar 

  98. Becker DV, Bigos ST, Gaitan E, et al. Optimal use of blood tests for assessment of thyroid function [letter]. JAMA. 1993;269:A2736.

    Google Scholar 

  99. Ross DS, Daniels GH, Goubeia D. The use and limitations of a chemiluminescent thryotropin assay as a single thyroid function test in an out-patient endocrine clinic. J Clin Endocrinol Metab. 1990;71:764–9.

    PubMed  CAS  Article  Google Scholar 

  100. Schectman JM, Pawlson LG. The cost-effectiveness of three thyroid function testing strategies for suspicion of hypothyroidism in a primary care setting. J Gen Intern Med. 1990;5:9–15.

    PubMed  CAS  Google Scholar 

  101. de los Santos ET, Stanch GH, Mazzaferri EL. Sensitivity, specificity, and cost-effectiveness of the sensitive thyrotropin assay in the diagnosis of thyroid disease in ambulatory patients. Arch Intern Med 1989;149:526–32.

    PubMed  Article  Google Scholar 

  102. Helfand M, Crapo LM. Screening for thyroid disease. Ann Intern Med. 1990;112:840–9.

    PubMed  CAS  Google Scholar 

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    Philip A. Masters MD

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  1. Philip A. Masters MD
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Received from the College of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania.

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Masters, P.A., Simons, R.J. Clinical use of sensitive assays for thyroid-stimulating hormone. J Gen Intern Med 11, 115–127 (1996). https://doi.org/10.1007/BF02599589

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Key words

  • thyrotropin
  • thyroid function tests
  • hyperthyroidism
  • hypothyroidism