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Updated: Mar 20, 2026

Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
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Two-step thyroid screening strategy in the critical patient.

Daniel Morell-Garcia1, Josep Miquel Bauça1, Miguel Angel Elorza2

  • 1Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain; Institut d'Investigació Sanitària de Palma (IdISPa), Palma, Balearic Islands, Spain.

Clinical Biochemistry
|May 22, 2016
PubMed
Summary

A two-step thyroid function test strategy in the ICU is effective for detecting thyroid dysfunction. This approach saves costs by reducing unnecessary biochemical tests while maintaining diagnostic accuracy.

Keywords:
Critical illnessScreeningThyroid profileThyrotropin

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Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Clinical Biochemistry

Background:

  • Thyroid function tests are crucial for prognosticating critically ill patients.
  • The role of free triiodothyronine and thyroxine as early prognostic markers in the ICU remains debated.
  • Early thyroid function assessment within 48 hours of ICU admission is critical.

Purpose of the Study:

  • To compare the diagnostic utility of two thyroid function testing strategies in the ICU.
  • To evaluate a two-step approach (TSH, then fT4/fT3 if needed) versus a comprehensive one-step profile (TSH+fT4+fT3).

Main Methods:

  • Prospective study comparing two thyroid function assessment strategies.
  • Strategy 1: Initial TSH, followed by free T4 (fT4) and free T3 (fT3) if indicated.
  • Strategy 2: Simultaneous TSH, fT4, and fT3 measurement.

Main Results:

  • No significant difference in thyroid dysfunction detection rates between the two strategies (2.8% vs. 2.4%, p=0.71).
  • The two-step strategy achieved 100% sensitivity and negative predictive value for TSH ≤ 2.5μUI/mL.
  • In patients with isolated altered fT3, mortality was significantly higher with TSH ≤ 2.5μUI/mL (14%) compared to TSH > 2.5μUI/mL (7%, p=0.008).

Conclusions:

  • An early two-step thyroid screening strategy (TSH first) is diagnostically equivalent to a comprehensive profile in the ICU.
  • This approach reduces fT4 and fT3 testing by 50%, with a low false-negative rate (1.3%).
  • The two-step strategy offers an improved, cost-effective diagnostic approach, minimizing unnecessary biochemical tests.