Thyroid testing paradigm switch from thyrotropin to thyroid hormones-Future directions and opportunities in clinical medicine and research
| Autor: | James V. Hennessey, Stephen P. Fitzgerald, Nigel G. Bean, Henrik Falhammar |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Thyroid function
endocrine system Thyroid Hormones endocrine system diseases Endocrinology Diabetes and Metabolism Thyroid Gland Physiology Thyrotropin Thyroid Function Tests Endocrinology Viewpoint Pregnancy Thyroid state Diabetes mellitus Endocrine system Medicine Humans Subclinical infection Aged business.industry Thyroid medicine.disease Thyrotropin (TSH) Thyroxine medicine.anatomical_structure Free triiodothyronine Thyroid hormones Triiodothyronine Female Clinical Medicine business hormones hormone substitutes and hormone antagonists Hormone |
| Zdroj: | Endocrine |
| ISSN: | 1559-0100 |
| Popis: | Purpose Recently published papers have demonstrated that particularly in untreated individuals, clinical parameters more often associate with thyroid hormone, particularly free thyroxine (FT4), levels than with thyrotropin (TSH) levels. Clinical and research assessments of the thyroid state of peripheral tissues would therefore be more precise if they were based on FT4 levels rather than on TSH levels. In this paper we describe implications of, and opportunities provided by, this discovery. Conclusions The FT4 level may be the best single test of thyroid function. The addition of free triiodothyronine (FT3) and TSH levels would further enhance test sensitivity and distinguish primary from secondary thyroid dysfunction respectively. There are opportunities to reconsider testing algorithms. Additional potential thyroidology research subjects include the peripheral differences between circulating FT4 and FT3 action, and outcomes in patients on thyroid replacement therapy in terms of thyroid hormone levels. Previously performed negative studies of therapy for subclinical thyroid dysfunction could be repeated using thyroid hormone levels rather than TSH levels for subject selection and the monitoring of treatment. Studies of outcomes in older individuals with treatment of high normal FT4 levels, and pregnant women with borderline high or low FT4 levels would appear to be the most likely to show positive results. There are fresh indications to critically re-analyse the physiological rationale for the current preference for TSH levels in the assessment of the thyroid state of the peripheral tissues. There may be opportunities to apply these research principles to analogous parameters in other endocrine systems. |
| Databáze: | OpenAIRE |
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