Routine thyroid screening in psychiatric inpatients

Abstract

Routine thyroid screening tests are frequently ordered in psychiatric hospitals but there is no substantial evidence to justify this practice. Furthermore, there is little evidence to substantiate the belief that thyroid disease is more commonly associated with mood disorders than other psychiatric disorders. The few reports available do not take age and sex into account. The authors attempted to clarify both of these issues. A retrospective review of 3,188 psychiatric inpatient charts was conducted to determine the usefulness of routine thyroid junction tests (TFTs). While 25% of this population exhibited some abnormality in TFTs, the majority were judged insignificant. There was a 2.5% prevalence of thyroid disease and a 0.5% incidence of newly diagnosed thyroid disease based solely on screening TFTs. There was a significant relationship between mood disorders and thyroid disease with age and sex held constant. The prevalence of thyroid disease in psychiatric patients is consistent with the general population. Since there was a significant relationship between mood disorders and thyroid disease, if screening TFTs are performed, they may be most appropriate in this group. Whether routine TFTs should or should not be done on all psychiatric inpatients is not answered with this study. Depression 1:143–148 (1993). © 1993 Wiley‐Liss, Inc.

Thyroid Evaluation of Hospitalized Psychiatric Patients: The Role of TSH Screening for Thyroid Dysfunction

“…Styra et al (19) found elevated TSH levels in 7 of 99 patients with major affective disorders, all of whom had normal T4 values. Elevated TSH concentrations were found in 234 patients (7.3%) in a very large retrospective study (8). In a small, prospective study of 84 patients using a sensitive TSH assay, 14 patients were found to have elevated values, despite normal or high T4 concentrations, while in one patient the TSH level was low (6).…”

“…Spratt et al (3) reported a 33% incidence of elevated T4 values in 645 patients admitted to a county facility and a 25% incidence was seen in a retrospective, county/state hospital based study of 3188 patients (8). Spratt et al (3) reported a 33% incidence of elevated T4 values in 645 patients admitted to a county facility and a 25% incidence was seen in a retrospective, county/state hospital based study of 3188 patients (8).…”

“…The respective intra-and interassay coefficients of variation for two levels of control and the analytical sensitivities were TSH, 5.3% at 0.3 /¿U/ml, 5.5% at 1.1 and 0.03 pU/mL; T4, 3.0% at 4.7 pg/dL, 7.9% at 3.8 and 1.5 pg/dL; free T4, 6.6% at 0.7 ng/dL, 10.3% at 0.5 and 0.4 ng/dL; T3, 8.0% at 64 ng/dL, 9.5% at 89 and 15 ng/dL. The respective intra-and interassay coefficients of variation for two levels of control and the analytical sensitivities were TSH, 5.3% at 0.3 /¿U/ml, 5.5% at 1.1 and 0.03 pU/mL; T4, 3.0% at 4.7 pg/dL, 7.9% at 3.8 and 1.5 pg/dL; free T4, 6.6% at 0.7 ng/dL, 10.3% at 0.5 and 0.4 ng/dL; T3, 8.0% at 64 ng/dL, 9.5% at 89 and 15 ng/dL.…”

“…Multiple studies have shown that patients admitted for acute psychiatric care, both in the United States (1)(2)(3)(4)(5)(6)(7)(8) and worldwide (9)(10)(11)(12)(13)(14), have a prevalence of bonafide thyroid dysfunction that is similar to the general population (1,(7)(8)(9)(11)(12)(13), although few have been large scale, prospective investigations (1,3,7,9,12). Multiple studies have shown that patients admitted for acute psychiatric care, both in the United States (1)(2)(3)(4)(5)(6)(7)(8) and worldwide (9)(10)(11)(12)(13)(14), have a prevalence of bonafide thyroid dysfunction that is similar to the general population (1,(7)(8)(9)(11)(12)(13), although few have been large scale...…”

“…High as well as low values have been observed across the full panoply of tests. Although there is growing interest in using sensitive TSH assays (lower limit of sensitivity below 0.1 p\J/mL) in screening for both hypothyroidism and hyperthyroidism in the general hospitalized population (16), there are only two reports using this methodology in psychiatric patients (6,8). Although there is growing interest in using sensitive TSH assays (lower limit of sensitivity below 0.1 p\J/mL) in screening for both hypothyroidism and hyperthyroidism in the general hospitalized population (16), there are only two reports using this methodology in psychiatric patients (6,8).…”