Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Elevated TSH levels

Are transient factors or hypothyroidism behind it?

    • Education
    • Endocrinology and Diabetology
    • General Internal Medicine
    • RX
  • 2 minute read

Hashimoto’s thyroiditis is the most common thyroiditis and the main cause of hypothyroidism. But elevated TSH levels can also be due to various other factors. Therefore, repeated measurements and differential assessment are advised before thyroxine administration is prescribed.

The hormone thyroxine (T4) produced by the thyroid gland is the most important thyroid hormone and is vital for numerous metabolic processes. The rate of T4 secretion is controlled by TSH (thyrotropin) secreted from the pituitary gland as part of the thyrotropic regulatory circuit. An elevated TSH level may mean that the thyroid gland is not producing enough thyroid hormone. But there are other explanations, such as seasonal variations [1]. According to a recent study, TSH levels tend to be higher in winter than in summer [2]. Acute sleep deprivation, physical exertion, infections, puberty, older age, or obesity should also be considered as underlying factors. If patients are otherwise symptom-free, the German Society for Endocrinology (DGE) recommends that a new TSH determination be performed before therapeutic administration of the thyroid hormone thyroxine [1]. And at least 2, better 6 months after the first test. In about half of the cases, a normal value is then measured, according to the DGE.

Are there antibodies against the patient’s own thyroid tissue?

“Formally, hypothyroidism is present when the TSH value is above the upper limit range of 4.2 mU/l,” explained Prof. Joachim Feldkamp, MD, Bielefeld Mitte Hospital [1]. “But individual measurements should be taken with great caution. They almost never justify a therapy decision,” says Prof. Feldkamp. Are there complaints such as overweight, disturbed weight regulation. Depression and high sleep need to be further clarified thyroid function. “These include determination of free thyroid hormones T3 and T4, detection of antibodies to the patient’s own thyroid tissue such as TPO-AK, TG-AK, and TRAK, and ultrasonography of the metabolic organ” [1]. If these tests are positive, the most common cause of high TSH levels is autoimmune hypothyroidism (Hashimoto’s syndrome). The therapy of choice is hormone replacement with L-thyroxine (Fig. 1) [3].

Literature:

  1. “Thyroid: When TSH is elevated: caution in diagnosis – context matters,” DGE, Aug. 29, 2023.
  2. Yamada S, et al: J Endocr Soc. 2022 Apr 6; 6(6): bvac054.
  3. “Elevated TSH in family practice,” S2k guideline, 2023, abridged version, AWMF registry no. 053-046.

HAUSARZT PRAXIS 2023; 18(9): 23

Autoren
  • Mirjam Peter, M.Sc.
Publikation
  • HAUSARZT PRAXIS
Related Topics
  • Hashimoto's syndrome
  • Hypothyroidism
  • Substitution
  • Thyrotropin
  • transient factors
  • TSH
Previous Article
  • Renal cell carcinoma

Therapy management from the point of view of improving prognosis

  • Education
  • Nephrology
  • Oncology
  • RX
View Post
Next Article
  • Mucosal injury

Colitis due to sevelamer crystals

  • Education
  • Gastroenterology and Hepatology
  • General Internal Medicine
  • Nephrology
  • RX
View Post
You May Also Like
View Post
  • 4 min
  • Case Report

Mycosis fungoides in an 11-year-old child

    • Allergology and clinical immunology
    • Cases
    • Dermatology and venereology
    • Education
    • Oncology
    • Pediatrics
    • RX
    • Studies
View Post
  • 6 min
  • EHA 2025

Progress in multiple myeloma

    • Congress Reports
    • Hematology
    • Oncology
    • RX
    • Studies
View Post
  • 6 min
  • Interstitial lung diseases

Artificial intelligence improves ILD diagnosis

    • Education
    • General Internal Medicine
    • Pneumology
    • Prevention and health care
    • RX
    • Studies
View Post
  • 7 min
  • Management of patients after alloHCST

ERS/EBMT guideline recommendations on pulmonary cGvHD

    • Education
    • General Internal Medicine
    • Genetics
    • Hematology
    • Pneumology
    • RX
    • Studies
View Post
  • 3 min
  • Pyoderma gangraenosum

New study data confirm the validity of the PARACELSUS score

    • Congress Reports
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Geriatrics
    • Orthopedics
    • Prevention and health care
    • RX
    • Studies
    • Surgery
View Post
  • 8 min
  • Progressive multiple sclerosis

New horizons: from BTK inhibitors to remyelination

    • Education
    • Genetics
    • Neurology
    • RX
    • Studies
View Post
  • 6 min
  • Cutaneous and especially facial metastases

Rare manifestations of esophageal carcinoma

    • Cases
    • Dermatology and venereology
    • Education
    • Gastroenterology and Hepatology
    • Oncology
    • RX
    • Surgery
View Post
  • 7 min
  • Rare pulmonary syndromes

Yellow nail and Swyer-James syndrome

    • CME continuing education
    • Dermatology and venereology
    • General Internal Medicine
    • Infectiology
    • Pneumology
    • RX
Top Partner Content
  • Herpes zoster

    Zum Thema
Top CME content
  • 1
    Colorectal cancer screening – an update
  • 2
    Yellow nail and Swyer-James syndrome
  • 3
    Individual therapy management for an optimized outcome – an update
  • 4
    Doing sport without fear or risk
  • 5
    UV protection and skin cancer screening – Update 2025

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.