Endocrine Abstracts (2011) 26 MTE18

Weird thyroid function tests

Mark Gurnell & Krish Chatterjee

Metabolic Research Laboratories, Addenbrooke’s Hospital, Cambridge, UK.

Although overt thyroid disease is easily recognised, lesser disturbances of thyroid function can prove difficult to diagnose and be mimicked by other endocrine and non-endocrine disorders. Establishing the correct diagnosis depends on accurate interpretation of thyroid function tests (TFTs), which is usually straightforward; however, in a minority of situations, the results of FT4, FT3 and TSH measurement either do not ‘fit’ with the clinical picture and/or appear discordant with each other (so-called ‘funny’ or ‘weird’ TFTs) (Figure). 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.

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