The biologic role of thyroid-stimulating hormone (TSH; thyrotropin) as an activator (agonist) of the TSH receptor (TSHR) in the hypothalamic-pituitary-thyroid axis is well known and activation of TSHR by recombinant human TSH is used clinically in patients with thyroid cancer. TSHR ligands other than TSH could be used to probe TSHR biology in thyroidal and extrathyroidal tissues, and potentially be employed in patients. A number of different TSHR ligands have been reported, including TSH analogs, antibodies and small-molecule, drug-like compounds. In this review, we will provide an update on all these classes of TSHR agonists and antagonists but place emphasis on smallmolecule ligands.Keywords small molecule; thyroid-stimulating hormone; thyrotropin; TSH analogs; TSHR antagonists; TSHR agonists; TSHR antibodies; TSH receptor; TSHR ligandsThe biologic role of thyroid-stimulating hormone (TSH; thyrotropin) as an activator (agonist) of the TSH receptor (TSHR) in the hypothalamic-pituitary-thyroid axis is well known [1]. TSH, which is produced in thyrotrophs of the anterior pituitary gland, is secreted into the circulation in response to thyrotropin-releasing hormone stimulation. Circulating TSH activates TSHR, thereby stimulating the function of thyroid follicular cells (thyrocytes) leading, in particular, to increases in size and number of thyrocytes, and biosynthesis and †Author for correspondence: Clinical Endocrinology Branch, NIDDK, NIH,