The Significance of an Isolated Elevated TSH Level in a Depressed Patient: A Clinical Commentary

Abstract

Objective: To discuss the approach to the isolated finding of an elevated thyrotropin (TSH) level on routine biochemical screening of a depressed patient. Method: A focused literature review as well as discussion of published clinical guidelines and the formulation of a rational clinical approach. Results: Screening for thyroid dysfunction is part of the routine assessment of the depressed patient. It is not uncommon for such patients to have an isolated elevation of TSH levels with nor laboratory or clinical features of thyroid disease. There is often misunderstanding about how to deal with this isolated laboratory finding which can lead to unnecessary investigation and treatment. Conclusions: A rational approach to evaluation and management of an isolated elevated TSH level is suggested.