Medical needs in the evaluation of thyroid dysfunction

The clinical examination has low sensitivity and specificity for the diagnosis of thyroid dysfunction. There is still, however, no consensus as regards the cost-effectiveness of biochemical screening for thyroid dysfunction; of possible target groups women post partum might be of particular interest. Current methodological developments center around thyrotropin (TSH), free thyroxine (T4), anti-thyroperoxidase antibodies and indicators of thyroid hormone action, and topics of main concern are the precision at low TSH concentration, the calibration of free T4 assays, and the precision of those assays of free T4 which claim higher accuracy compared with "one-step" methods. Thyroid function indices in non-thyroidal illness continue to confuse assayists. The clinical spectrum of conditions which lead to low serum TSH concentration is insufficiently explored.