TSH measurement and AFTNs

Managing thyroid nodules is a common problem in adults. Whilst thyroid scan is the only technique that permits evaluation of the functional characteristics of a nodule, it is rarely used in the management of thyroid nodules. This non-use of the thyroid scan is based on the assumption that thyroid stimulating hormone (TSH) levels are always subnormal in the presence of autonomously functioning thyroid nodules (AFTNs). Although several guidelines have been published  in recent years on thyroid nodule management, there seems to be disagreement on deciding which patients, if any, with a thyroid nodule and a normal TSH deserve a thyroid scan.

Chami et al. therefore conducted a retrospective study on 368 patients to determine the proportion of AFTNs with a normal TSH level to ascertain whether a normal TSH really rules out an AFTN. They found that 71% of the patients included in their study for the assessment of a thyroid nodule had a normal TSH value. Their study shows that TSH alone is not an effective screening tool to diagnose AFTNs and that thyroid scan remains the gold standard for detecting AFTN.

Read full article at DOI: 10.1530/EJE-13-1003