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Analysis of current thyroid function test ordering practices

JOURNAL OF EVALUATION IN CLINICAL PRACTICE 2018年第2期24卷 347-352页

作者： Kluesner, Joseph K. Beckman, Darrick J. Tate, Joshua M. Beauvais, Alexis A. Kravchenko, Maria I. Wardian, Jana L. Graybill, Sky D. Colburn, Jeffrey A. Folaron, Irene True, Mark W. San Antonio Mil Med Ctr Serv Endocrinol 3551 Roger Brooke Dr San Antonio TX 78234 USA Wilford Hall Ambulatory Surg Ctr Diabet Ctr Excellence San Antonio TX USA Uniformed Serv Univ Hlth Sci Bethesda MD USA

RationaleCurrent guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. ObjectiveTo evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing. MethodsA record of all TFTs obtained in the San Antonio Military Health System during a 3-month period was extracted from the electronic medical record. The TFTs of interest were TSH, FT4, thyroid panel (TSH+FT4), FT3, total thyroxine (T4), and total triiodothyronine (T3). These were categorized based on the presence or absence of hypothyroidism. ResultsBetween August 1 and October 31, 2016, there were 38 214 individual TFTs ordered via 28597 total laboratory requests;11486 of these requests were in patients with a history of hypothyroidism. The number (percent) of laboratory requests fell into these patterns: TSH alone 14919 (52.14%), TSH+FT4 7641 (26.72%), FT3 alone 3039 (10.63%), FT4 alone 1219 (4.26%), TSH+FT4+FT3 783 (2.74%), and others 996 (3.48%);36.0% of TFTs ordered were free thyroid hormones. Projected out to a year, using Department of Defense laboratory costs, $317429 worth of TFTs would be ordered, with free thyroid hormone testing accounting for $107720. ConclusionInappropriate ordering of free thyroid hormone tests is common. In an era of rising healthcare costs, inappropriate thyroid function testing is an ideal target for efforts to reduce laboratory overutilization, which in our system, could save up to $120000 per year. Further evaluation is needed to determine strategies that can reduce excessive thyroid hormone testing.

关键词： laboratory utilization resource stewardship thyroid function test

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Study of the Ideal Delay Period of Carbimazole for Hyperthyroidism Patients Using thyroid function test

Study of the Ideal Delay Period of Carbimazole for Hyperthyr...

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作者： Qurashi, Elaf Ahmed Abdullah Sudan University of Science and Technology

学位级别：硕士

This study consists of 51 hyperthyroid patients of different ages, gander, weight and heights whom were under different doses of medication (Carbimazole) and were referred to nuclear medicine department for thyroid scan to follow-up their response to medication by identifying the uptake of thyroid gland. These patients were divided into three groups (A, B and C) depending on their thyroid Hormone test (TFT) results while using medication. Each group been stopped from their medication for a specific period (3, 5 and 7days), to check whether patient’s thyroid hormone levels might elevate into a toxic level, and whether the accuracy of thyroid images would increase by increasing the delay period. To measure the thyroid hormone levels, (TFT) been made for patients. Two blood samples had been taken from each patient, the first while they were still under medication, and the second was according to their group (A, B and C) which is after 3, 5 and 7 days respectively. To check the accuracy of thyroid images, the patients underwent thyroid scan after a delay period of 3, 5 and 7 days respectively from medication. Images of thyroid uptake of the three groups were compared after the acquisition of thyroid scan has been made. The study been conducted at Khartoum Oncology Hospital in Sudan, between (Dec2018-Dec2019). The results showed that an elevation of thyroid hormones occurs as the patient stops the medication, and it increases as the delay time increases. In addition, it showed no significant increasing in the accuracy of thyroid scan as the delay time increased, TFT was quite enough for determining patient’s response to medication.

关键词： Medical Radiologic Sciences Nuclear Medicine Technology Ideal Delay Period Carbimazole for Hyperthyroidism Patients thyroid function test

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Age-and Gender-Specific Changes in thyroid Size and thyroid function test Values of Euthyroid Subjects

Age-and Gender-Specific Changes in Thyroid Size and Thyroid ...

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作者： Tika Ram Lamichhane Sandeep Prashad Pant Binod Lamichhane Chhabindra Gautam Sharma Paudel Binod Kumar Yadav Hari Prasad Lamichhane Central Department of Physics Tribhuvan University Department of Radiology & Imaging Tribhuvan University Teaching Hospital Department of Biochemistry Tribhuvan University Teaching Hospital

Background: The thyroid status is evaluated by two clinical diagnostic tests which are thyroid ultrasonography and thyroid function tests. The objective of this research is to critically analyze the age and gender based variations of thyroid volume and thyroid hormone levels in the hospital based euthyroid subjects. Methodology: A total of 221 euthyroid subjects aged 1-86 years were selected to observe the normal thyroid size by ultrasonography at Department of Radiology and the thyroid function test values(FT3, FT4 and TSH) of 2413 euthyroid subjects aged(<1)-93 years were observed at Department of Biochemistry, Tribhuvan University Teaching Hospital,Kathmandu, Nepal during January 2017 to February 2018. The observed data were analyzed graphically and statistically to check the cross-correlations among the variables. Results: The best fitted equations with significant correlation coefficients and p < 0.05 provide the empirical relations between any two of the observed variables: age, thyroid lobe volumes, FT3, FT4 and TSH. The mean ± SD(p < 0.0001) of thyroid volume, FT3, FT4 and TSH are 4.74 ± 2.30 mL, 5.46 ± 0.82 pmol/L, 14.09 ± 2.71 pmol/L and 2.30 ± 0.98 mI U/L, respectively. Conclusion: The thyroid size first increases and then decreases whereas the thyroxin level first decreases and then increases with aging. Left lobe volume is almost same for both genders and right lobe volume is higher in males. The thyroid size in menarche and menopause periods of females is larger than that of males. Such age-and gender-specific changes recommend the new reference ranges for the normal thyroid functions.

关键词： Euthyroid Subject thyroid function test thyroid Hormone Levels thyroid Ultrasonography Empirical Relation

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Effect of morning versus night-time administration of proton pump inhibitor (pantoprazole) on thyroid function test in levothyroxine-treated primary hypothyroidism: a prospective cross-over study

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thyroid RESEARCH 2023年第1期16卷 15-15页

作者： Awasthi, Avivar Chakraborty, Partha Pratim Agrawal, Neeti Sinha, Anirban Pandey, Anuj Kumar Maiti, Animesh Kasturba Med Coll & Hosp Dept Endocrinol Manipal Karnataka India Med Coll Dept Endocrinol & Metab MCH 4th Floor88 Coll St Kolkata 700073 West Bengal India King Georges Med Univ Dept Paediat Lucknow Uttar Pradesh India

BackgroundOne of the common causes of suboptimal control of thyroid stimulating hormone (TSH) in levothyroxine-treated hypothyroidism is coadministration of proton pump inhibitors (PPIs). Morning administration of pantoprazole has been shown to suppress intragastric pH to a greater extent. We therefore aimed to determine the effect of pantoprazole at different time points of the day on thyroid function test (TFT) in levothyroxine-treated overt primary *** this single centre, hospital based, prospective, two arm cross-over study (AB, BA), participants were randomized into 2 groups based on morning (6:00 am - 7:00 am simultaneously with the scheduled levothyroxine tablet) (group M) and evening (30 min before dinner) intake of 40 mg pantoprazole tablet (group N). After the initial 6 weeks (period 1), a washout period of 1 week for pantoprazole was given, and then both the groups crossed over for another 6 weeks (period 2). Patients were instructed to continue the same brand of levothyroxine tablet at empty stomach 1-hour before breakfast. Serum TSH was measured at baseline, week 6, and week *** from 30 patients, who completed the study with 100% compliance, were analysed. Mean TSH values of the study participants were significantly higher both at week 6 and week 13 compared to the baseline. Mean baseline serum TSH concentrations for groups M and N were 2.70 (+/- 1.36), and 2.20 (+/- 1.06) mu lU/mL, respectively. Mean serum TSH concentrations at the end periods 1 and 2 for group M were 3.78 (+/- 4.29), and 3.76 (+/- 2.77) while the levels in group N were 3.30 (+/- 1.90), and 4.53 (+/- 4.590) mu lU/mL, respectively. There was a significant rise in serum TSH concentration across periods 1 and 2 in both the groups (F-2,F- 58 = 3.87, p = 0.03). Within group changes in TSH across periods 1 and 2 were not statistically significant. Similarly difference in TSH between the groups, either at 6 weeks or at 13 weeks, were also not statistically sign

关键词： Primary hypothyroidism Levothyroxine Proton pump inhibitor Pantoprazole thyroid function test

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thyroid function tests: often justified in the acutely ill

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ANNALS OF CLINICAL BIOCHEMISTRY 2000年第2期37卷 158-164页

作者： Lamb, EJ Martin, J Kent & Canterbury Hosp E Kent Hosp NHS Trust Dept Clin Biochem Canterbury CT1 3NG Kent England Kent & Canterbury Hosp E Kent Hosp NHS Trust Dept Clin Audit Canterbury CT1 3NG Kent England

It is claimed that inappropriate requesting of thyroid function tests (TFTs) is common in acutely ill patients. Consecutive inpatient TFTs (n = 129) were assessed in relation to clinical history and common symptoms and signs of thyroid disease. Requests were justified in 69% of cases, most commonly on the basis of atrial fibrillation and/or tachycardia. There were no clear reasons for requesting TFTs in the remaining cases, although the yield of abnormal results in these patients was similar to that in those with justified requests. thyroid stimulating hormone (TSH) concentration was increased (median 7.5 mU/L, range 4.8-38.6 mU/L) in 22 patients, six of whom had biochemical and/or clinical evidence of hypothyroidism (previously undiagnosed) and five of whom had pre-existing hypothyroidism. Of the remaining 11 patients with increased TSH levels, three were confirmed to have compensated hypothyroidism;non-thyroidal illness (NTI) (including the effect of drags) accounted for four cases. In four patients tone of whom died during the admission) follow-up was not possible. Of six patients with reduced TSH concentration (range <0.05-0.35 mU/L), one was thyrotoxic on carbimazole, one was receiving thyroxine for hypothyroidism, one had NTI and three were lost to follow-up (two of whom died during their admission). Manifestations of thyroid disease are protean and often subtle, and TFTs are thus clinically justified in many unwell inpatients. Although NTI contributes to some cases of abnormal TSH levels, a significant number of TFT abnormalities are consistent with underlying thyroid abnormality requiring investigation/treatment.

关键词： Health Services Misuse thyroid function tests Thyrotropin 卫生服务滥用甲状腺功能试验 Thyrotropin Hypothyroidism thyroid function test Health Services Misuse Thin film transistors thyroid function thyroid Diseases

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thyroid function tests in newborns of mothers with hypothyroidism

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EUROPEAN JOURNAL OF PEDIATRICS 2021年第2期180卷 519-525页

作者： Haim, Alon Wainstock, Tamar Almashanu, Shlomo Loewenthal, Neta Sheiner, Eyal Hershkovitz, Eli Landau, Daniela Soroka Univ Med Ctr Pediat Endocrinol & Diabet Unit POB 151 IL-84101 Beer Sheva Israel Ben Gurion Univ Negev Fac Hlth Sci Beer Sheva Israel Minist Hlth Natl Newborn Screening Program Ramat Gan Israel Soroka Univ Med Ctr Dept Obstet & Gynecol Beer Sheva Israel Soroka Univ Med Ctr Dept Neonatol Beer Sheva Israel

Performing thyroid function tests (TFT) at 2 weeks of age in neonates of mothers with hypothyroidism, despite having a newborn screening program, is a debated approach. We examined whether there is an additional clinical benefit in TFT at 2 weeks of age in neonates born to mothers with hypothyroidism, in addition to the neonatal screening program. We performed a retrospective study which included all newborns of mothers with a diagnosis of hypothyroidism and gave birth in a single regional hospital between the years 2010 and 2016. Data were collected from a computerized medical record system of the hospital and the community clinics, and from Israel's national newborn screening program. Main outcome measure was results of serum TFT in comparison to the results of the neonatal screening test. There were 1392 newborns eligible according to the study criteria. Of these, 1033 underwent a newborn screening test, and serum TFT at least 2 weeks after birth. Eight babies with congenital hypothyroidism were detected independently by both the newborn screening program and at the TFT performed at 2 weeks of age. Conclusions: No added clinical benefit was found in retesting newborns of hypothyroid mothers for thyroid function in addition to the newborn screening program. What is Known Performing thyroid function test 2 weeks after birth is a common practice in newborn to a mother with hypothyroidism. Neonatal screening program for thyroid function is also done in these newborns. What is New No newborn was found to have a normal newborn screening test but abnormal serum thyroid function test. No added clinical benefit was found in retesting newborns of hypothyroid mothers for thyroid function in addition to the newborn screening program.

关键词： Congenital hypothyroidism Maternal hypothyroidism Newborn screening program thyroid function test

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thyroid function tests and Mortality in Aged Hospitalized Patients: A 7-Year Prospective Observational Study

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JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM 2013年第12期98卷 4683-4690页

作者： Iglesias, Pedro Ridruejo, Elena Munoz, Angelica Prado, Florentino Cruz Macias, Maria Teresa Guerrero, Maria Tajada, Pilar Garcia-Arevalo, Carmen Jose Diez, Juan Hosp Ramon & Cajal Dept Endocrinol E-28034 Madrid Spain Gen Hosp Dept Geriatr Segovia 28007 Spain Gen Hosp Dept Biochem Segovia 28007 Spain

Context: Several alterations in thyroid function test (TFT) results have been associated with mortality in elderly patients. Objective: Our aim was to investigate the relationship between TFT results and all-cause and cardiovascular (CV) mortality in aged hospitalized patients. Design: A 7-year prospective observational study was conducted. TFTs were performed at hospital admission, and mortality was registered in the follow-up period. Patients: Participants were 404 patients aged >65 years admitted to the Department of Geriatrics, Hospital General, Segovia, Spain, for any reason during 2005. Main Outcome Measures: The study evaluated the association between TFT results and mortality from all causes and CV diseases. Methods: TSH, free T-4, and free T-3 (FT3) were measured on the first day of admission. In-hospital and total survival times, number of deaths, and all-cause and CV mortality were registered until the census date on January 1, 2012. Results: During the study, 323 patients (80%) died. Kaplan-Meier analysis showed that median survival time for all-cause mortality was significantly lower in patients in the first tertile of serum FT3, in the first tertile of TSH, and in the first tertile of serum free T-4 concentrations. Multivariate adjusted Cox regression analysis showed that the history of cancer (hazard ratio, 1.60;95% confidence interval, 1.12-2.28;P = .009), age (1.03;1.01-1.06;P = .003), and FT3 levels (0.72;0.63-0.84;P < .001) were significant factors related to all-cause mortality. The cause of death was known in 202 patients. Of this group, 61 patients (30.2%) died of CV disease. Patients in the first tertile of TSH and FT3 exhibited a significant higher mortality due to CV disease. In the adjusted Cox regression analysis, FT3 was a significant predictor of CV mortality (0.76;0.63-0.91;P = .004). Conclusions: Alterations in TFT results during hospitalization are associated with long-term mortality in elderly patients. In particular, low FT3 levels

关键词： thyroid function test free thyroxine index Mortality Thin film transistors Thyrotropin Observational Study Patients

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thyroid function tests in End-Stage Renal Disease

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SEMINARS IN DIALYSIS 2014年第6期27卷 552-555页

作者： Kulkarni, Dhananjay P. Holley, Jean L. Univ Illinois Urbana Champaign Dept Internal Med Urbana IL 61801 USA Carle Phys Grp Urbana IL 61801 USA

The interaction between thyroid hormones (TH) and kidneys is complex (1,2). thyroid hormones are important for the growth and maturation of the kidneys and optimal kidney function is required for proper synthesis, secretion, metabolism, and elimination of TH. Thus, patients with ESRD can exhibit abnormal thyroid function. Indeed, there is epidemi-ologic evidence of an increased prevalence of subclin-ical hypothyroidism in advanced CKD patients (3,4).

关键词： Kidney thyroid hormones Thorium Kidney Diseases thyroid function test End Stage Kidney Disease kidney function thyroid Diseases

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Laboratory thyroid function testing: Do Abnormalities Always Mean Pathology?

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CLINICAL PEDIATRICS 2013年第4期52卷 287-296页

作者： Lahoti, Amit Frank, Graeme R. North Shore LIJ Hlth Syst Cohen Childrens Med Ctr New York New Hyde Pk NY USA

The article discusses abnormalities in thyroid function tests (TFTs) that help in diagnosis of primary thyroid disorders as well as secondary or central thyroid disorders. The review discusses hypothyroidism and states that on finding an 'abnormal' TFT, the physician recommends parents the referral to a pediatric endocrinologist. This review provides pediatricians with guidelines that will help them distinguish between variants of normal from true thyroid pathology.

关键词： Hypothyroidism Normal Range Thyrotropin Thyroxine thyroid function test thyroid Diseases subclinical hypothyroidism Prevalence Studies Goiter laboratory procedure thyroid function Laboratories pathology

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Interrelationships between bone morphometry, thyroid function tests and serum parathyroid hormone in hyperthyroidism

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Calcified Tissue Research 1976年第1 Supplement期22卷 229-235页

作者： Mosekilde, L. Melsen, F. Christensen, M.S. Medical Dept. III and University Institute of Pathology Aarhus Amtssygehus Aarhus Denmark Institute of Pharmacology University of Aarhus Aarhus Denmark

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