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Thyroid function tests: often justified in the acutely ill.

E J Lamb1, J Martin

  • 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
PubMed
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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.

Related Experiment Videos

  • 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.