Thyroid biomarker testing under the spotlight

Video presentation

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Thyroid biomarker testing under the spotlight

E-learning Modules

Launch: 31 May 2024


Best practice management of patients with thyroid disorders is evolving to allow point-of-care testing of thyroid biomarkers, most commonly thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), thyroglobulin (TG), antibodies to thyroid antigens including TG and thyroid peroxidase (TPO). Central to this process are laboratory test values, which are defined by analyte reference intervals for healthy subjects against which patient samples can be compared. Despite quality assurance processes, there are significant inter- and intra-laboratory differences over time that can limit the application of clinical practice guidelines and create challenges for patients and treating clinicians [ATA, 2019]. Establishment of reference ranges requires sampling of a “normal” population, i.e., a population without thyroid dysfunction. However, non-diagnosed thyroid disease is common (1–3% of the population in iodine-replete areas has hypothyroidism, with much higher prevalence in older persons and in women [Jonklaas, 2019]). This muddies the value of cut-offs for reference ranges for both sub-clinical and overt thyroid disease. For TSH, authoritative guidelines recommend targeting treatment TSH levels to within the lower half of the normal range, but TSH levels are subject to multiple factors that are patient-specific, including concomitant disease, medications, age, gender, ethnicity, time of day and time of year [Razvi, 2019], making one size fits all cut-off values a question for debate. This video presentation is closely linked to one of the podcasts in this 2024 series – TSH: The impact of increasing age and increasing weight, launched on 29 July 2024. It is highly recommended that you listen to both.

Learning Objectives

After this video presentation, participants will be able to:

Target Audience

Clinicians involved in endocrinology, particularly thyroid disorders and general practice; some content of interest to pediatricians, biochemists, clinical and research scientists, and those involved in pre-natal, pregnancy and post-natal care.


English with voice-over into Spanish and Chinese


Bernadette Biondi

Bernadette Biondi

Full Professor of Internal Medicine
Department of Clinical Medicine and Surgery
University of Naples Federico II Medical School
Naples, Italy

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· Bernadette Biondi ·

Bernadette Biondi is Full Professor of Internal Medicine at the University of Naples Federico II Medical School, Italy, where she teaches cardiovascular endocrinology and researches clinical thyroidology, with a special focus on subclinical thyroid dysfunction. She has recently been member of the Awards Committee Roster of the American Thyroid Association and chaired the European Thyroid Association’s task force for the development of clinical practice guidelines for the diagnosis and treatment of subclinical hyperthyroidism in 2015. She is also member of the editorial board of important scientific journals such as Clinical Thyroidology and Frontiers in Thyroid Endocrinology. Professor Biondi is author and co-author of numerous papers published in journals including the American Journal of Medicine, Annals of Internal Medicine, Circulation, Endocrine Reviews, The European Heart Journal, The European Journal of Endocrinology, Endocrinology Metabolic Clinics of North America, Journals of the American College of Cardiology, The Journal of Clinical Endocrinology and Metabolism, JAMA, Lancet, The New England Journal of Medicine and Thyroid.

· Martin O. Savage ·

Martin Savage is Emeritus Professor of Paediatric Endocrinology at William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London. He was head of the Paediatric Endocrine Unit at Barts and the London School of Medicine from 1982 to 2007. He has interests in growth disorders, specifically those with abnormalities in the GH-IGF-1 axis and in phenotype-genotype relationships of GH-IGF-1 axis defects, notably GH resistance. He published the first human case of an IGF-1 gene defect in the New England Journal of Medicine in 1996.  His other interests are Cushing’s syndrome and growth in chronic inflammatory diseases. He was General Secretary of the European Society for Paediatric Endocrinology (ESPE) from 1997 to 2004. He has lectured in 60 countries and has published 482 original articles, reviews, textbook chapters and books. In 2007, he was awarded the ESPE Andrea Prader Prize for contributions to paediatric endocrinology and in 2018 he received a Visionary Award from the American Human Growth Foundation. In 2022, he received a Research Excellence Award from the Dr Sulaiman Al Habib Medical Journal in Riyadh, and the British Society of Paediatric Endocrinology & Diabetes James M. Tanner Lifetime Achievement Award. He continues to lecture nationally and internationally.