Are we using Thyroid Function Tests Appropriately?

Abstract

Thyroid function tests are very important for the diagnosis and monitoring of patients with thyroid dysfunction. The guidelines recommend serum thyroid stimulating hormone (TSH) as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism. The aim of this study was to analyze the ordering pattern for thyroid function tests by physicians and the analysis of results based on the clinical history. The mean age of the patients was 32.5 ± 6.5 years. Majority of samples (87.7% of total) were received from the departments of Medicine and Gynae. Thyroid profiles (47.5%) were ordered more frequently as compared to TSH only (46%). There was no significant difference in the percentage of normal reports for both types of tests. 77.8% of TFT and 76.6% of TSH samples had results within the reference range. The percentage of abnormal results was 13.7% in the patients who were screened for thyroid disorders. There is a need to redefine the case definition for thyroid dysfunction and order the appropriate test in a rational and cost effective manner.

Estimation of thyroid profile in patients with diabetes mellitus in New Civil Hospital, Surat

“…Patients with thyroid disorders had higher levels of TSH compared to those without thyroid disorders whereas there was no much difference in T4 and T3 levels. Findings in our study are similar to that of Pashupathi et al and Shalinigupta et al 19,34 The guidelines of American Thyroid Association and American Association of Clinical Endocrinology recommends serum TSH measurement as single most relevant test to diagnose all forms of hypo and hyperthyroidism. 35 In our study, we have found that 80% of the patients of thyroid dysfunction had diabetes for more than 10 years, 57% patients of thyroid dysfunction had duration of diabetes between 6 and 10 years and 6% had thyroid dysfunction having duration of diabetes <5 years.…”

A Study of Prevalence of Hypothyroidism in Diabetic Patients

“…Findings in our study are similar to that of Pasupathi et al (2008) 16 and Shalini Gupta et al (2011). 17 In our study, increased duration of diabetes had significant relation to hypothyroidism in this study (p= 0.0037). These observations are similar to study by R. Anil Kumar et al (2013), 18 the reported study in which they had subclinical hypothyroidism and overt hypothyroidism appear to be significantly associated with duration of diabetes, 11.48 ± 7.96 years and 8.76 ± 7.23 years respectively vs. 7.91 ± 7.07 years in euthyroid diabetes patients (p= 0.019).…”

Use of Electronic Clinical Decision Support and Hard Stops to Decrease Unnecessary Thyroid Function Testing

“…TFTs are ordered more often than just a TSH level alone,5 even though the TSH level is substantial enough on admission to determine if future studies should be pursued 6. The clinical symptoms of thyroid dysfunction are very sensitive yet less specific, and thus, a majority of symptomatic patients will have normal TFTs 7…”