Alterations of thyroid function, especially hypothyroidism, are
exceptionally common conditions. Studies from several developed
countries revealed the prevalence of subclinical and overt
hypothyroidism to be between 5 and 15 % and between 1 and 10%,
respectively. Diagnosis and treatment of (overt or subclinical)
hypothyroidism are considered to be easy tasks, since thyrotropin (TSH) concentration mirrors the supply with thyroid hormones and is therefore accepted as a biomarker for both diagnosis and dose calibration for substitution therapy.

Recently, however, a new debate on the width of the TSH reference range
has emerged. It questions if certain TSH levels in a subrange of the traditional reference interval still mirror euthyroidism or if it is
necessary to narrow the reference range to an upper limit of 2.5 mIU/L. Additionally, up to 15 % of hypothyroid patient on substitution therapy
suffer from reduced quality of life, even if normal TSH levels suggest
an adequate supply of thyroid hormones. The underlying cause for this
³syndrome T² is at present unclear but is now being elucidated by
current research. The situation is even more elusive in patients with non-thyroidal illness, since a large proportion of patients suffering
from critical illness, tumors, uremia or starvation demonstrate some
form of thyroid allostasis that interferes with diagnosis of thyroid dysfunction.

In the light of these uncertainties, It is therefore necessary to
revisit our current understanding of thyroid homeostasis. Recent
research suggested that the control of thyroid hormone concentrations is
a complex, dynamic system, which integrates central and peripheral
mechanisms to adjust for situation-dependent demand of thyroid
signaling. Combining mathematical modelling of integrative thyroid
control, molecular research on non-classical thyroid hormones, transport
and conversion mechanisms and clinical trials with advanced methodology promises new insights that may lay the foundation for improved diagnosis
and therapy of thyroid disorders. Additionally, this innovative approach
paves the way for personalized treatment of hypothyroid patients.

Articles in this research topic include basic research papers and review articles that give a comprehensive overview on state-of-the-art
methodology and recent results from the emerging new world of
thyroidology, which tries to rationalize a scenario of previously
unknown complexity.

Manuscript submission deadline: January 31st, 2016

See
http://journal.frontiersin.org/researchtopic/4262/homeostasis-and-allosta sis-of-thyroid-function for details.

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-- Dr. med. Johannes W. Dietrich
-- Oberarzt / Consultant Endocrinologist
-- Laboratory XU44, Endocrine Research
-- Medical Hospital I, Bergmannsheil University Hospitals
-- Ruhr University of Bochum
-- Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, NRW, Germany
-- http://www.thyreologie.com.de

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