Are the current TSH assays sensitive enough for accurate titration of levothyroxine therapy?
Ans. The more sensitive third generation TSH kits are obviously the best for monitoring patients with thyroid disease. Unfortunately, a number of commercial laboratories in India barely possess 1st generation TSH kits. Essentially, the issue in discussion is diagnosis of hyperthyroidism, for which third generation TSH kits are good. In patients on thyroxine therapy, the worry is in some cases- are we over treating these patients and precipitating iatrogenic hyperthyroidism. This iatrogenic hyperthyroidism is subclinical in some cases and concern is as to whether one may precipitate arrhythmias in the elderly and osteoporosis with long-term treatment. From a clinical and practical perspective however, 2nd generation assays that are available with reasonable freedom are good enough to delineate early subclinical iatrogenic hyperthyroidism. The treating physician should ensure that the laboratory where he checks his thyroid function tests is part of a well-recognized quality control progr
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