Interpreting Thyroid Function Tests in Difficult Clinical Contexts: A Practical Approach to Avoiding Diagnostic Pitfalls and Accurately Diagnosing Thyroid Dysfunction
Abstract
Background: Thyroid function tests (TFTs) are essential for diagnosing thyroid disease, but their interpretation is problematic during pregnancy, critical illness, and biotin interference due to physiological changes and analytic interference. Aim: To provide a practical manual for clinicians to circumvent diagnostic pitfalls and correctly interpret TFTs in these scenarios. Methods: A narrative review (PubMed, Scopus, Web of Science; 2000–2025) of English peer-reviewed studies on TFT interpretation in pregnancy, non-thyroidal illness syndrome (NTIS), and biotin interference. Data were summarized to highlight physiological processes, diagnostic challenges, and management strategies. Results: Pregnancy requires trimester-specific TFT ranges because of hormonal change, NTIS needs distinction between adaptive responses and true hypothyroidism, and biotin interference needs assay awareness and supplement withdrawal. Trimester-specific ranges, conservative NTIS management, and non-biotin-based assays improve diagnostic accuracy. Conclusion: Understanding of physiological and analytical aspects, use of good-quality assays, and adherence to guidelines are crucial for the accurate interpretation of TFT, which results in improved patient outcomes in difficult clinical circumstances.
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Authors
Copyright (c) 2024 Faheed Mothib Almutairi, Faisal Naji Alsahabi, Fahdah Ateeq Alboanen, Tahani Othman Baharthi, Nawal Nasser Albishi, Moteb Attalh Almotery, Yahya Ibrahim Hassan Khurmi, Bader Abdulqader Joumah, Ashwaq Ibrahim Altehini, Wadha Abdulaziz Alsumayt
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