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Journal of Thyroid Research
Volume 2012, Article ID 438037, 9 pages
Review Article

TSH Measurement and Its Implications for Personalised Clinical Decision-Making

1Department of Nuclear Medicine, Klinikum Luedenscheid, Paulmannshoeherstraße 14, 58515 Luedenscheid, Germany
2Consultancy Division, North Lakes Clinical, 6 High Wheatley, Ilkley, West Yorkshire LS29 8RX, UK

Received 5 October 2012; Accepted 15 November 2012

Academic Editor: Johannes W. Dietrich

Copyright © 2012 Rudolf Hoermann and John E. M. Midgley. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Advances in assay technology have promoted thyrotropin (TSH) measurements from participation in a multi-analyte assessment of thyroid function to a statistically defined screening parameter in its own right. While this approach has been successful in many ways, it has some grave limitations. This includes the basic question of what constitutes an agreed reference range and the fact that the population-based reference range by far exceeds the variation of the intraindividual set point. Both problems result in a potential misdiagnosis of normal and pathological thyroid function in a substantial proportion of patients. From a physiological perspective, TSH plays an integrated role in thyroid homeostasis. Few attempts have been made to adopt physiological insights into thyroid homeostasis for medical decision-making. Some emerging novel findings question the widely assumed log-linear TSH-FT4 relationship over the entire thyroid function spectrum. This data favours more complex hierarchically structured models. With a better understanding of its role in thyroid homeostasis in thyroid health and disease, TSH can be revisited in the context of thyroid regulation. This, in turn, could help overcome some of the limitations arising from its isolated statistical use and offer new prospects towards a more personalised interpretation of thyroid test results.