{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:54:02Z","timestamp":1777672442553,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>A 19-year-old male presented with mild fatigue and chronic constipation and was found to have an elevated thyroid-stimulating hormone (TSH) level of 85\u2009mIU\/L, normal free thyroxine, and normal total triiodothyronine. This presentation was concerning for Macro-TSH, which is rare and may suggest hypothyroidism. This patient\u2019s diagnosis of Macro-TSH was confirmed by TSH antibody testing and gel filtration chromatography. We present this case to highlight the need to further evaluate TSH results when thyroid function tests are incompatible with the clinical presentation. Assessment for TSH antibodies, a commercially available test, or gold-standard gel filtration chromatography testing, which is not commercially available, can be used to diagnose Macro-TSH.<\/jats:p>","DOI":"10.1177\/23247096261430087","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:54:08Z","timestamp":1773914048000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real or Not Real? An Elevated TSH"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6413-628X","authenticated-orcid":false,"given":"Marla E.","family":"Sevilla-Alsina","sequence":"first","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6099-7792","authenticated-orcid":false,"given":"Allison O.","family":"Dumitriu Carcoana","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, FL, USA"},{"name":"Case Western Reserve University, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0016-4589","authenticated-orcid":false,"given":"Jane Y.","family":"Yang","sequence":"additional","affiliation":[{"name":"Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4399-5733","authenticated-orcid":false,"given":"Michael J.","family":"McPhaul","sequence":"additional","affiliation":[{"name":"Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA"},{"name":"UT Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2435-8202","authenticated-orcid":false,"given":"Mohammad Saiful","family":"Islam","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3671-0621","authenticated-orcid":false,"given":"Roy E.","family":"Weiss","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-3490"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1210\/er.2018-00119"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2024.241048"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13101471"},{"issue":"11","key":"e_1_3_2_6_2","first-page":"1305","article-title":"TSH-assay interference: still with us","volume":"58","author":"Verdickt L","year":"2012","unstructured":"Verdickt L, Maiter D, Depraetere L, et al. TSH-assay interference: still with us. Clin Lab. 2012;58(11-12):1305-1307.","journal-title":"Clin Lab"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-243436"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2022.0457"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0442"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04023.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.9052"},{"issue":"2","key":"e_1_3_2_12_2","first-page":"229","article-title":"Hyperprolactinemia in association with subclinical hypothyroidism","volume":"2","author":"Bahar A","year":"2011","unstructured":"Bahar A, Akha O, Kashi Z, et al. Hyperprolactinemia in association with subclinical hypothyroidism. Caspian J Intern Med. 2011;2(2):229-233.","journal-title":"Caspian J Intern Med"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22063131"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.81.2.8636271"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1159\/000509184"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0883"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2013.05.011"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ21-0021"},{"issue":"4","key":"e_1_3_2_19_2","first-page":"317","article-title":"A macro-TSH: a clinical diagnostic dilemma","volume":"33","author":"Nkuna X","year":"2022","unstructured":"Nkuna X, Dire Z, Khoza S. A macro-TSH: a clinical diagnostic dilemma. EJIFCC. 2022;33(4):317-324","journal-title":"EJIFCC"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2023.010705"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.28.1.65-69.1990"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(82)80331-4"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12643"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.11312"}],"container-title":["Journal of Investigative Medicine High Impact Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096261430087","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23247096261430087","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096261430087","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:04:57Z","timestamp":1777449897000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23247096261430087"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":23,"alternative-id":["10.1177\/23247096261430087"],"URL":"https:\/\/doi.org\/10.1177\/23247096261430087","relation":{},"ISSN":["2324-7096","2324-7096"],"issn-type":[{"value":"2324-7096","type":"print"},{"value":"2324-7096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"23247096261430087"}}