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A more appropriate algorithm of thyroid function test in diagnosis of hyperthyroidism for Thai patients
Thiti Snabboon1, Vitaya Sridama, Sarat Sunthornyothin
1Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Patumwan, Bangkok 10330, Thailand.
Insights
For diagnosing hyperthyroidism, using free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) tests is most effective. This approach offers high sensitivity and specificity for identifying thyroid dysfunction in patients.
Area of Science:
- Endocrinology
- Internal Medicine
- Clinical Diagnostics
Background:
- Thyroid function tests are crucial for diagnosing thyroid dysfunction.
- Optimal diagnostic algorithms for clinical hyperthyroidism remain debated.
Purpose of the Study:
- To compare the effectiveness of various thyroid function test algorithms for diagnosing hyperthyroidism.
Main Methods:
- Evaluated thyroid function tests (T3, T4, FT3, FT4, TSH) in 452 patients.
- Defined hyperthyroidism as elevated FT3 or FT4 with suppressed TSH.
- Assessed algorithm effectiveness using sensitivity, specificity, positive predictive value, and negative predictive value.
Main Results:
- The combination of FT3 and TSH demonstrated the highest diagnostic performance (97.57% sensitivity, 100% specificity).
- FT3/TSH testing identified a significant incidence of T3 toxicosis (16.02%).
- FT4/TSH testing showed lower sensitivity (83.98%) but 100% specificity.
Conclusions:
- FT3 and TSH should be the initial diagnostic tests for hyperthyroidism in outpatient settings.
- Subsequent measurement of FT4 is recommended if T4 toxicosis is suspected.
Background:
Thyroid function test is an essential tool in the diagnosis of thyroid dysfunction. To date, it is still controversial which diagnostic algorithm is best applicable to clinically hyperthyroidism patients.
Objective:
To compare various algorithms of thyroid function tests in the diagnosis of hyperthyroidism.
Method:
Patients from the endocrine clinic, King Chulalongkorn Memorial Hospital were investigated for thyroid function tests (T3, T4, FT3, FT4 and TSH). Hyperthyroidism was defined as an elevated either FT3 or FT4 with suppressed TSH. The authors compared the effectiveness in hyperthyroidism diagnosis among algorithms by using sensitivity, specificity, positive predictive value and negative predictive value.
Results:
Of all 452 patients in the present study, 94.24 percent were women. There were 206 hyperthyroidism, 30 subclinical hyperthyroidism, 1 subclinical hypothyroidism, 8 primary hypothyroidism and 207 normal subjects. The incidence of T3 toxicosis was 16.02% while that of T4 toxicosis was 2.16%. After the effectiveness analysis of these algorithms, FT3 and TSH is the most optimal test with 97.57% sensitivity and 100% specificity. Compared to FT4 and TSH, it gave 83.98% sensitivity and 100% specificity.
Conclusion:
According to the high incidence of T3 toxicosis in the present study, FT3 and TSH should be the initial test for diagnosis of hyperthyroid patients in an outpatient setting and FT4 should be measured subsequently in case of suspected T4 toxicosis.
