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Related Concept Videos

Hyperthyroidism I: Introduction01:25

Hyperthyroidism I: Introduction

Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
Hyperthyroidism II: Pathophysiology01:27

Hyperthyroidism II: Pathophysiology

Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...
Synthesis and Regulation of Thyroid Hormones01:20

Synthesis and Regulation of Thyroid Hormones

Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The iodine is then...
Hypothyroidism II: Pathophysiology01:23

Hypothyroidism II: Pathophysiology

Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...
Graves Disease II: Pathophysiology01:24

Graves Disease II: Pathophysiology

Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor, and heat...
Graves' Disease I: Introduction01:28

Graves' Disease I: Introduction

Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence in...

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Related Experiment Video

Updated: Jun 24, 2026

Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model
04:39

Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model

Published on: March 17, 2023

Falsely elevated thyroid-stimulating hormone (TSH) level due to macro-TSH.

Hiroyuki Sakai1, Gen Fukuda, Naoko Suzuki

  • 1Division of Diabetology, Metabolism and Endocrinology, The Third Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.

Endocrine Journal
|April 2, 2009
PubMed
Summary

Macro-TSH, a complex of thyroid-stimulating hormone (TSH) and autoantibodies, can cause falsely high TSH levels. This case highlights the importance of considering macro-TSH in unexplained high TSH results, particularly in autoimmune thyroid disease.

Related Experiment Videos

Last Updated: Jun 24, 2026

Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model
04:39

Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model

Published on: March 17, 2023

Area of Science:

  • Clinical Chemistry
  • Endocrinology
  • Immunology

Background:

  • Thyroid-stimulating hormone (TSH) is a key regulator of thyroid function.
  • Elevated TSH levels typically indicate hypothyroidism.
  • Assays for TSH measurement can be subject to interference.

Observation:

  • A 60-year-old woman presented with markedly elevated TSH levels by electrochemiluminescent immunoassay (ECLIA) but asymptomatic with normal free T3 and T4.
  • Polyethylene glycol (PEG) precipitation showed low TSH recovery (4%), and human antimouse IgG antibody (HAMA) interference was absent.
  • Multiple chemiluminescent immunoassay (CLIA) instruments also yielded varied high TSH values.

Findings:

  • Gel filtration chromatography (GFC) revealed a TSH immunoreactivity peak larger than IgG at pH 7.2.
  • Further GFC at pH 3.0 demonstrated the disappearance of the large complex and the appearance of TSH monomer.
  • Protein G-Agarose gel effectively removed the TSH complex, confirming its nature.

Implications:

  • The patient's elevated TSH was attributed to macro-TSH, a complex of TSH and anti-TSH IgG autoantibodies.
  • Macro-TSH can lead to misdiagnosis of hyperthyroidism.
  • Consider macro-TSH in patients with unexpectedly high TSH levels, especially those with autoimmune thyroid disorders.