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sandwich technique. ",{"id":215,"name":216},1,"Course previews",[218,229,234],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},169,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Mastering TSH assays","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=PJV-DJ5gVAI",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},10.666666666666666,"\u003Cp>This video was taken from our \u003Ca href=\"https:\u002F\u002Fapp.medmastery.com\u002Fcourses\u002F3749\">Thyroid Disease Masterclass\u003C\u002Fa>. In it, you’ll learn why TSH is ideal for monitoring thyroid disease. You’ll also learn about the method by which TSH is commonly measured—the so-called sandwich technique.\u003C\u002Fp>\u003Cp>Enjoy, and don’t forget to \u003Ca href=\"https:\u002F\u002Fapp.medmastery.com\u002Fcourses\u002F3749\">check out the course\u003C\u002Fa>!\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},88,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-882896b8-7fff-ec2e-4c57-8551a9c8a11c\">[00:00:00] \u003C\u002Fb>Thyroid stimulating hormone or TSH is the best assay for assessing thyroid function, for a given individual. It's very sensitive to any changes in thyroid hormone levels. For instance, you can see here if your thyroid hormone level increases by 50%, your TSH level is actually going to decrease tenfold. So, small changes in thyroid hormone levels can lead to large changes in TSH. Current highly sensitive TSH assays \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-882896b8-7fff-ec2e-4c57-8551a9c8a11c\">[00:00:30] \u003C\u002Fb>utilize an immunometric assay, known as the sandwich assay. In this case, the captured antibody is bound to a plate, which binds to the patient's TSH. A second labeled antibody is added to the mix, which binds to a different portion of the TSH molecule creating a TSH sandwich. After you wash off the unbound antibody, another substrate is added, which reacts with the labeled antibody and emits a signal that can be measured, reflecting the amount of TSH in the patient's \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-882896b8-7fff-ec2e-4c57-8551a9c8a11c\">[00:01:00] \u003C\u002Fb>blood. TSH is a very good method for monitoring thyroid function, for a given individual, as it has very low intraindividual variability. So, what this means is you can measure the patient's TSH one month and then six months later, measure their levels again and they should be relatively similar. If there has been a significant change in their TSH levels over that time, even if still within the normal range, that may be an indication that that patient is developing thyroid dysfunction and should be followed more closely. There are some limitations \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-882896b8-7fff-ec2e-4c57-8551a9c8a11c\">[00:01:30]\u003C\u002Fb> to the TSH, however. TSH tends to lag behind changes in thyroid hormone. For instance, if a patient's thyroid hormone levels are dropping quickly following thyroid surgery for instance, your T4 levels will be in the abnormal range but the TSH has not yet started to increase. Similarly, if a patient is started on thyroid hormone replacement and their levels are returning back towards normal, the TSH takes a little bit longer to come back into the normal range. So, in times of rapid changes in thyroid hormone levels, the TSH may \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-882896b8-7fff-ec2e-4c57-8551a9c8a11c\">[00:02:00] \u003C\u002Fb>not be an accurate reflection of thyroid function. It is best used to monitor thyroid function in a steady state. There are also some variations in the normal range for TSH. Pregnant women tend to have a lower average TSH, whereas elderly patients tend to have a higher average TSH. Even if these values fall out of the normal range, they are normal for these individuals. 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Learn to recognize and report it with exercise stress ECG.",{"alt":277,"title":278,"size":279,"location":281},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":280,"height":280},1200,{"bucket":282,"key":283},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":285,"title":286,"relativeURL":287,"image":288,"professionLong":289,"profession":290,"weight":292},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":291},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":297,"updated":298,"published":299},1778115738,1778118425,1778118255,{"id":301,"title":302,"text":303,"image":304,"author":310,"path":312,"readDuration":313,"readDurationFormatted":314,"internal":315},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":305,"title":278,"size":306,"location":308},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":307,"height":307},600,{"bucket":282,"key":309},"\u002F2026-04\u002FC121_magazine image.png",{"id":285,"title":286,"relativeURL":287,"image":288,"professionLong":289,"profession":311,"weight":292},{"name":291},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":316,"updated":317,"published":318},1777403036,1777572381,1777412421,{"id":320,"title":321,"text":322,"image":323,"author":328,"path":337,"readDuration":338,"readDurationFormatted":339,"internal":340},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":324,"title":278,"size":325,"location":326},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":307,"height":307},{"bucket":282,"key":327},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":329,"title":330,"relativeURL":331,"image":332,"professionLong":333,"profession":334,"weight":336},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":335},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":341,"updated":342,"published":343},1776705362,1776710540,1776710541,{"seo":345,"og":347},{"title":346,"description":213},"TSH—why and how we measure it | Medmastery",{"title":346,"description":213,"image":348},{"alt":278,"title":278,"size":349,"location":352},{"width":350,"height":351},480,328,{"bucket":282,"key":353},"\u002Fmigrated-images\u002F170725-magazine.jpg",{"id":355,"created":356,"updated":357,"published":356},126,1501060148,1736534832]