Thyroid-stimulating hormone measurement

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Measurement of thyroid-stimulating hormone from blood serum is regarded as the most important test for early detection of hyperthyroidism and hypothyroidism,[1] and is one of the thyroid function tests used to diagnose and treat thyroid disease.[2] The result of this assay is suggestive of the presence and cause of thyroid disease, since a measurement of elevated TSH generally indicates hypothyroidism, while a measurement of low TSH generally indicates hyperthyroidism.[3] However, when TSH is measured by itself, it can yield misleading results, so additional thyroid function tests must be compared with the result of this test for accurate diagnosis.[2]


First-generation TSH assays were done by radioimmunoassay and were introduced in 1965.[1] There were variations and improvements upon TSH radioimmunoassay, but their use declined as a new immunometric assay technique became available in the middle of the 1980s.[1][2] The new techniques were more accurate, leading to the second, third, and even fourth generations of TSH assay, with each generation possessing ten times greater functional sensitivity than the last.[4] Third generation immunometric assay methods are typically automated.[1] Fourth generation TSH immunometric assay has been developed for use in research.[2]

Current status[edit]

Third generation TSH assay is the current requirement for modern standards of care. At present, TSH testing in the United States is typically carried out with automated platforms using advanced forms of immunometric assay.[1] Nonetheless, there is currently no international standard for measurement of thyroid-stimulating hormone.[2]


Accurate interpretation takes a variety of factors into account, such as the thyroid hormones i.e. thyroxine (T4) and triiodothyronine (T3), current medical status (such as pregnancy[1]),[2] certain medications like propylthiouracil,[2] temporal effects including circadian rhythm[5] and hysteresis,[6] and other past medical history.[7]

See also[edit]


  1. ^ a b c d e f Spencer, Carole (1 January 2013). "Assay of Thyroid Hormones and Related Substances". Thyroid Disease Manager. Retrieved 5 November 2013. 
  2. ^ a b c d e f g Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar’s The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 0-7817-5047-4. 
  3. ^ Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300
  4. ^ Spencer, Carole; Takeuchi, Michael; Kazarosyan, Margarita (1996). "Current status and performance goals for serum thyrotropin (TSH) assays". Clinical Chemistry. Clinical Chemistry. 42 (1): 141–145. Retrieved 5 November 2013. 
  5. ^ Hoermann, Rudolf; Midgley, John E. M.; Larisch, Rolf; Dietrich, Johannes W. "Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment". Frontiers in Endocrinology. 6: 177. PMC 4653296Freely accessible. PMID 26635726. doi:10.3389/fendo.2015.00177. 
  6. ^ Leow, Melvin Khee-Shing. "A Review of the Phenomenon of Hysteresis in the Hypothalamus–Pituitary–Thyroid Axis". Frontiers in Endocrinology. 7: 64. PMC 4905968Freely accessible. PMID 27379016. doi:10.3389/fendo.2016.00064. 
  7. ^ Dayan, Colin (24 February 2001). "Interpretation of thyroid function tests" (PDF). The Lancet. Bristol: The Lancet Publishing Group. 357: 619–624. PMID 11558500. doi:10.1016/s0140-6736(00)04060-5. Retrieved 5 November 2013. 

External links[edit]

CDC laboratory procedure manuals[edit]

The Centers for Disease Control and Prevention has published the following laboratory procedure manuals for measuring thyroid-stimulating hormone:

Beckman Coulter procedure manuals[edit]

Beckman Coulter provides the equipment and reagents used in the 2009-2011 CDC manuals, and has published the following manuals for performing the procedure: