Journal
HORMONES-INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM
Volume 19, Issue 3, Pages 311-315Publisher
SPRINGER INTERNATIONAL PUBLISHING AG
DOI: 10.1007/s42000-020-00180-3
Keywords
Discordant thyroid function tests; Resistance to thyroid hormone (RTH); TSH-secreting pituitary adenoma; TSHoma; Central hyperthyroidism
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Disorders of thyroid function are among the commonest referrals to endocrinology. While interpretation of thyroid function testing is usually straightforward, accurate interpretation becomes significantly more challenging when the parameters do not behave as would be expected in normal negative feedback. In such cases, uncertainty regarding further investigation and management arises. An important abnormal pattern encountered in clinical practice is that of high normal or raised free thyroxine (fT4) with inappropriately non-suppressed or elevated thyroid-stimulating hormone (TSH). In this short review using two clinical vignettes, we examine the diagnostic approach in such cases. A diagnostic algorithm is proposed to ensure that a definitive diagnosis is reached in these challenging cases.
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