Diagnostic methods of TSH in thyroid screening tests                 
More details
Hide details
Department of Endocrinology, Medical University, Lublin, Poland
Department of Health Informatics and Statistics, Institute of Rural Health, Lublin, Poland
Faculty of Pedagogy and Psychology, University of Economics and Innovation, Lublin, Poland
Corresponding author
Beata Matyjaszek-Matuszek   

Department of Endocrinology, Medical University, Lublin, Poland
Ann Agric Environ Med. 2013;20(4):731-735
Reliable and quick thyreologic diagnostics, as well as verification of the effectiveness of the therapy undertaken, is of great importance for the state of health of society. The measurement of plasma TSH is the commonly accepted and most sensitive screening test for primary thyroid disorders, which are the most frequent diseases related to the endocrine glands. At present, the available methods for the determination of TSH are characterized by high sensitivity ≤0.01 µIU/ml and lack of cross-reactivity. However, many drugs and substances, as well as pathological conditions, may affect the TSH level.

evaluation of contemporary laboratory methods for the determination of TSH and the principles of interpretation of screening tests.

State of knowledge:
In many countries, the TSH test is the only test performed in the diagnostics of thyroid function; nevertheless, it seems that for genuine and objective assessment of thyroid status the TSH level, together with FT4 level, should be absolutely determined, which allows the differentiation and assessment of the intensity of thyroid function disorders and foresee its consequences. The interpretation of TSH results in screening tests is different in such population groups as: children aged under 14, pregnant women, the elderly, and patients with non-thyroidal illnesses.

From among currently used laboratory methods for determination of TSH levels, third generation non-isotopic methods are most frequently recommended, especially the method of immunochemiluminescence.

Greenspan FS. The thyroid gland. W: Greenspan FS, Gardner DG (ed). Basic and Clinical Endocrinology. 7th ed. New York: Lange Medical Books/McGraw-Hill; 2004.p. 244–250.
Gietka-Czernel M. Postępy w laboratoryjnej diagnostyce czynności tarczycy. Post Nauk Med. 2008; 2: 83–91.
Ruchała M, Szczepanek E. Choroba guzkowa tarczycy. Fam Med Primary Care Rev. 2008; 10: 1383–1392.
Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003; 13: 3–126.
Rawlins ML, Roberts WL. Performance characteristics of six third-generation assays for thyroid-stimulating hormone. Clin Chem. 2004; 50: 2338–2344.
Lewiński A, Zygmunt A, Lewandowski K, Słowińska-Klencka D, Marcinkowska M, Makarewicz J, et al. Gruczoł tarczowy- czynność fizjologiczna i diagnostyka zaburzeń wydzielania hormonów tarczycy. W: Lewiński A, Zygmunt A (ed). Diagnostyka czynnościowa zaburzeń hormonalnych z elementami diagnostyki różnicowej. 1st ed. Lublin: Czelej; 2011.p.35–64.
Hepburn S, Farid S, Dawson J, Goodall S. Thyroid function testing. British Journal of Hospital Medicine. Br J Hosp Med (Lond). 2012; 73(8): 114–118.
Faglia G, Bitensky L, Pinchera A, Ferrari C, Paracchi A, Beck-Peccoz P, et al. Thyrotropin secretion in patients with central hypothyroidism: Evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979; 48: 989–998.
Ward G, McKinnon L, Badrick T, Hickman PE. Heterophilic antibodies remain a problem for the immunoassay laboratory. Am J Clin Pathol. 1997; 108: 417–421.
Smellie WS, Vanderpump MP, Fraser WD, Bowley R, Shaw N. Best practice in primary care pathology: review 11. J Clin Pathol. 2008; 61: 410–418.
Wartofsky L, Dickey RA. Controversy in Clinical Endocrinology. The evidence for a Narrower Thyrotropin Reference Range Is Compelling. J Clin Endocrinol Metab. 2005; 90(9): 5483–5488.
Dayan CM, Saravanan P, Bayly G. Whose normal thyroid function is better – yours or mine? Lancet 2002; 360; 9330: 353–354.
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol. 1995; 43: 55–68.
De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012, 97: 2543–2565.
Stricker R, Echenard M, Eberhart R, Chevailler MC, Perez V, Quinn FA, et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2007; 157: 509–514.
Sawin CT, Geller A, Kaplan MM, Bacharach P, Wilson PW, Hershman JM. Low serum thyrotropin (thyroid stimulating hormone) in elder persons without hyperthyroidism. Arch Intern Med. 1991; 151: 165–168.
Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly peoplefrom one low serum thyrotropin result: a 10-year study. Lancet 2001; 358: 861–865.
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008; 29: 76–131.
Singh S, Duggal J, Molnar J, Maldonado F, Barsano CP, Arora R. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: a meta-analysis. Int J Cardiol. 2008; 125: 41–48.
Sgarbi JA, Matsumura LK, Kasamatsu TS, Ferreira SR, Maciel RM. Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese-Brazilian thyroid study. Eur J Endocrinol. 2010; 162: 569–577.
Ittermann T, Haring R, Sauer S, Wallaschofski H, Dörr M, Nauck M, et al. Decreased serum TSH levels are not associated with mortality in the adult northeast German population. Eur J Endocrinol. 2010; 162: 579–585.
Zaidi M, Davies TF, Zallone A, Blair HC, Iqbal J, Moonga SS, et al. Thyroid-stimulating hormone, thyroid hormones, and bone loss. Curr Osteoporos Rep. 2009; 7: 47–52.
Faggiano A, Del Prete M, Marciello F, Marotta V, Ramundo V, Colao A. Thyroid diseases in elderly. Minerva Endocrinol. 2011; 36(3): 211–231.
De Groot LJ. Dangerous Dogmas in Medicine: The Nonthyroidal Illness Syndrome. J Clin Endocrinol Metab. 1999; 84: 151–164.
Warner MH, Beckett GJ. Mechanisms behind the non-thyroidal illness syndrome: an update. J Endocrinol. 2010; 205: 1–13.
Journals System - logo
Scroll to top