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Thyroid function tests: often justified in the acutely ill.
1Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, UK. edmund.lamb@kch-tr.sthames.nhs.uk
Annals of Clinical Biochemistry
|March 29, 2000
Summary
Thyroid function tests (TFTs) are often clinically justified in acutely ill patients, with 69% of requests deemed appropriate. Abnormal TFT results, even from unjustified requests, frequently indicate underlying thyroid issues requiring investigation.
Area of Science:
- Endocrinology
- Internal Medicine
- Clinical Pathology
Background:
- Inappropriate thyroid function test (TFT) ordering is suspected in acutely ill patients.
- Thyroid dysfunction can present with subtle or non-specific symptoms in hospitalized individuals.
Purpose of the Study:
- To evaluate the justification and yield of TFTs in acutely ill inpatients.
- To determine the proportion of abnormal TFT results and their correlation with clinical findings or underlying thyroid disease.
Main Methods:
- Prospective assessment of 129 consecutive inpatient TFTs.
- Correlation of TFT results with patient's clinical history, symptoms, and signs of thyroid disease.
Main Results:
- Requests were justified in 69% of cases, often due to atrial fibrillation/tachycardia.
- Abnormal TFT results were observed in patients with both justified and unjustified requests.
- Elevated TSH levels indicated hypothyroidism (newly diagnosed or pre-existing) in 11 patients, while non-thyroidal illness (NTI) accounted for 4.
- Reduced TSH levels were seen in 6 patients, with causes including thyrotoxicosis, NTI, and treatment for hypothyroidism.
Conclusions:
- TFTs are clinically justified in many unwell inpatients due to the subtle and varied manifestations of thyroid disease.
- While NTI can influence TFT results, a significant proportion of abnormalities suggest underlying thyroid conditions requiring further evaluation and management.