Identification and Management of Thyroid Dysfunction Using At-Home Sample Collection and Telehealth Services: Retrospective Analysis of Real-World Data

Abstract

Background Programs aimed at modernizing thyroid care by pairing at-home sample collection methods with telehealth options may serve an important and emerging role in thyroid care. Objective The primary objective of this analysis was to evaluate telehealth use, demographics, and clinical characteristics of a cohort of consumer-initiated at-home laboratory thyroid test users who were also offered the option of follow-up telehealth consultations. Methods This was a retrospective analysis of real-world data from a deidentified consumer database of home-collected, mail-in thyroid tests used from March to May 2021 (N=8152). The mean age was 38.6 (range 18-85) years, and 86.6% (n=7061) of individuals identified as female. Results In total, 7% (n=587) of test takers fell into a thyroid dysfunction category (overt hypothyroidism: n=75, 0.9%; subclinical hypothyroidism: n=236, 2.9%; overt hyperthyroidism: n=5, 0.1%; and subclinical hyperthyroidism: n=271, 3.3%). Overall, 12% (n=984) of the overall sample opted into a telehealth consultation, with 91.8% (n=903) receiving a nontreatment telehealth consultation and 8.2% (n=81) receiving a treatment telemedicine consultation. Furthermore, 16% (n=96) of individuals with overt or subclinical thyroid dysfunction engaged in telehealth consultations. The majority of treatment consultations (59.3%, n=48) were conducted with people reporting a history of thyroid issues, with 55.6% (n=45) of people indicating wanting to discuss their current thyroid medication and 48% (n=39) receiving a prescription medication. Conclusions The combination of at-home sample collection and telehealth is an innovative model for screening thyroid disorders, monitoring thyroid function, and increasing access to care, which can be implemented at a large scale and across a wide range of age groups.

Diagnostic criteria and scoring systems for thyroid storm: An evaluation of their utility – comparative review

“…The challenge arises when scoring systems designed for a younger demographic encounter elderly patients who deviate from the expected clinical profile. [18] Laboratory variability, influenced by variations in reference ranges, casts a shadow over the diagnostic process. Inconsistent results in interpreting thyroid function tests, a cornerstone of scoring systems, may emerge due to these variations.…”

“…The challenge arises when scoring systems designed for a younger demographic encounter elderly patients who deviate from the expected clinical profile. [ 18 ]…”

“…Controversies and debates within the medical community surround the utility of diagnostic criteria and scoring systems for thyroid storm, touching upon several critical points of contention. [ 17 , 18 ] Sensitivity versus specificity is an ongoing debate, with arguments about the potential trade-off. Some contend that stricter criteria with higher specificity might miss milder cases, while more sensitive criteria could lead to overdiagnosis and unnecessary treatment.…”

“…[ 5 ] Point-of-care testing devices for thyroid hormones and relevant biomarkers are developing, offering rapid diagnostic capabilities in emergency settings where timely intervention is paramount. [ 18 ] Patient monitoring apps and wearable devices enable remote tracking of vital signs and symptoms. These technologies can potentially monitor individuals at risk for thyroid storm, facilitating early intervention.…”

Determination of Capillary Blood TSH and Free Thyroxine Levels Using Digital Immunoassay

“…Additionally, the few POC quantitative assay kits for TSH, T4, and T3 are not yet commercially available in most countries. A recent study that analyzed thyroid hormone data obtained from a commercially available testing kit using capillary blood collected by the finger prick method revealed the prevalence of potential thyroid dysfunction among the general population [ 19 ]. However, the study did not evaluate the accuracy of the test results.…”