The genetic basis of thyroid function: Novel findings and new approaches

Context: Genetic factors are major determinants of thyroid function. Over the last two decades,multiple genetic variants have been associated with variations in normal range thyroid functiontests. Most recently, a large-scale genome-wide association study (GWAS) doubled the number ofknown variants associated with normal range thyrotropin (TSH) and free thyroxine (FT4) levels.Evidence Acquisition: This review summarizes the results of genetic association studies onnormal range thyroid function and explores how these genetic variants can be used in futurestudies to improve our understanding of thyroid hormone regulation and disease.Evidence Synthesis: Serum TSH and FT4 levels are determined by multiple genetic variantson virtually all levels of the hypothalamus-pituitary-thyroid (HPT) axis. Functional followup studies on top of GWAS hits has the potential to discover new key players in thyroidhormone regulation, as exemplified by the identification of the thyroid hormone transporterSLC17A4 and the metabolizing enzyme AADAT. Translational studies may use these geneticvariants to investigate causal associations between thyroid function and various outcomes inMendelian Randomization (MR) studies, to identify individuals with an increased risk of thyroiddysfunction, and to predict the individual HPT axis setpoint.Conclusions: Recent genetic studies have greatl