Routine TSH Testing Adds Little Value in Primary Subjective Tinnitus Evaluation, Case-Control Study Finds

Routine measurement of serum thyroid-stimulating hormone (TSH) is unlikely to provide clinically useful information when evaluating patients with primary subjective tinnitus who have no known thyroid disease, according to a case-control study published in Frontiers in Neurology. The research team, led by Aphrodite Mavrogenis of Bajcsy-Zsilinszky Hospital in Budapest and colleagues in Hungary and Cyprus, recruited 557 patients with primary subjective tinnitus and 431 tinnitus-free controls, all without known thyroid disorders. Every participant underwent a full otorhinolaryngological examination and a serum TSH measurement.

The central comparison produced a strikingly flat result. Median TSH levels were 1.80 mIU/L (interquartile range 1.23–2.56) in the tinnitus group and 1.73 mIU/L (interquartile range 1.21–2.50) in the control group. The difference was not statistically significant (p = 0.63), and a Bayesian analysis actually provided moderate evidence in favour of the null hypothesis, with a Bayes factor of 4.459.

In plain terms, the data were roughly four and a half times more likely under the assumption that TSH levels do not differ between the groups than under the assumption that they do. The authors then asked whether TSH, even if it did not distinguish tinnitus patients from controls, might track the severity or character of the condition within the tinnitus group. Linear regression analyses found no significant association between TSH and total THI score, hearing level, tinnitus intensity, age, or symptom onset.

Bayesian regression analyses likewise returned evidence against a meaningful contribution of TSH to any of these tinnitus-related parameters, reinforcing the impression that the hormone carries little signal relevant to this patient population. TSH performed essentially at chance: the area under the curve was 0.509 (95% confidence interval 0.471–0.547, p = 0.640). The authors were careful to draw a precise boundary around their conclusion.

The findings apply to patients without known thyroid disorders and should not be extrapolated to people with confirmed thyroid dysfunction. Nor should the results be read as a recommendation against thyroid function testing when clinical signs, symptoms, or other findings suggest underlying thyroid disease. The study measured TSH alone; it did not assess free thyroxine (FT4), free triiodothyronine (FT3), or thyroid autoantibodies, so subtle or autoimmune thyroid pathology could theoretically have been missed in some participants.

That limitation points to the study's main open question. The authors call for further research incorporating comprehensive thyroid function assessment, including FT4, FT3, and thyroid autoantibodies, to clarify whether specific aspects of thyroid dysfunction may be relevant to selected tinnitus populations. Until such data exist, the safest reading is narrow but actionable: a normal-range TSH value, ordered reflexively in the tinnitus workup, tells the clinician essentially nothing about the tinnitus.

The study's design also deserves note.

Subject of Research: Association between serum TSH levels and primary subjective tinnitus

Article Title: Is routine serum TSH testing useful in the evaluation of primary subjective tinnitus? A case–control study

Article References: Mavrogenis, A., Maihoub, S., Mavrogeni, P., & Molnár, A. (2026). Is routine serum TSH testing useful in the evaluation of primary subjective tinnitus? A case–control study. Frontiers in Neurology, 17, Article 1973811. https://doi.org/10.3389/fneur.2026.1973811

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1973811

Keywords: tinnitus, TSH, thyroid-stimulating hormone, case-control study, audiology, Tinnitus Handicap Inventory, ROC analysis, Bayesian analysis, ENT, thyroid dysfunction, diagnostic testing, neuro-otology