TSH is a poor measure of severity of tissue hypothyroidism

Thyroid stimulating hormone (TSH) tests are not useful for estimating the clinical and metabolic severity of primary overt thyroid failure. Meier and colleagues (p 311) found that, in contrast with the accuracy of serum TSH measurement in the early diagnosis of hypothyroidism, clinical markers and circulating thyroid hormones much more accurately reflect the degree of tissue hypothyroidism. Initiation of replacement therapy should be guided by clinical presentation and circulating thyroid hormones and not by TSH concentrations, a point discussed in an editorial by Toft and Beckett (p 295).

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