Therapeutic Letter

Thyroid testing in primary hypothyroidism

Anshula Ambasta, Guillaume Grenet, Jessica Otte, Wade Thompson, Kenneth Bassett, Thomas Perry
African Journal of Primary Health Care & Family Medicine | Vol 17, No 1 | a5043 | DOI: https://doi.org/10.4102/phcfm.v17i1.5043 | © 2025 Anshula Ambasta, Guillaume Grenet, Jessica Otte, Wade Thompson, Kenneth Bassett, Thomas Perry | This work is licensed under CC Attribution 4.0
Submitted: 12 May 2025 | Published: 30 June 2025

About the author(s)

Anshula Ambasta, Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
Guillaume Grenet, Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
Jessica Otte, Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
Wade Thompson, Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
Kenneth Bassett, Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
Thomas Perry, Department of Anaesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada

Abstract

Thyroid hormones regulate essential metabolic processes and development. The hypothalamic–pituitary–thyroid axis regulates hormone production, with thyroid-stimulating hormone (TSH) levels being a key indicator of thyroid function in primary hypothyroidism. This therapeutics letter emphasises a TSH-centred approach to the diagnosis and management of primary hypothyroidism (dysfunction at the level of the thyroid gland) in adults. It discourages routine thyroid function screening in asymptomatic individuals due to a lack of demonstrated benefit and potential harm from overdiagnosis and overtreatment. It outlines appropriate diagnostic strategies, including when to use TSH, free T4 (thyroxine), and free T3 (triiodothyronine) tests, and outlines indications for antibody testing. Special considerations are provided for subclinical hypothyroidism and hypothyroidism during pregnancy.

Keywords

diagnostic tests; hypothyroidism; mass screening; overdiagnosis; thyroid function tests; pregnancy; thyroid diseases.

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