Sensitivity, Specificity, and Cost-effectiveness of the Sensitive Thyrotropin Assay in the Diagnosis of Thyroid Disease in Ambulatory Patients

Santos, Edith T. de los

doi:10.1001/archinte.1989.00390030032006

Cited by 66 publications

(19 citation statements)

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“…7 about 90%, results that are not substantially different from those obtained with more sophisticated and expensive thyroid tests. 6 However, a number of non thyroidal illnesses and drugs may drastically alter the total T 4 concentration. Euthyroid hyperthyroxinemia is a collective term applied to nonthyroidal illnesses that elevate T 4 levels while the status of the patient's thyroid metabolism remains normal.…”

Section: Measurements Of Thyroid Hormone Bindingmentioning

confidence: 99%

“…Low serum T 3 levels occur in 70% of hospitalized patients and 26% of chronically ill patients; in contrast, only 8% ofT 4 , 4% ofiT 4 1, and 3% to 6% of sensitive-TSH (s-TSH) determinations are lowered by non thyroidal illness. 6 The fall in serum T 3 levels seen with nonthyroidal illness is due to decreased peripheral conversion ofT 4 by 5' -deiodination. 5 · 9 · 10 These changes may represent an attempt to maintain homeostasis by energy conservation through hormone inactivation.…”

Section: Thyroid Function Testsmentioning

confidence: 99%

“…Selection of a test should take into account both its diagnostic accuracy relative to the thyroid disease being considered and also its cost -effectiveness. 6 Using this approach, guidelines for obtaining thyroid function tests can be established.…”

Section: Clinical Application Of Testsmentioning

confidence: 99%

“…However, the cost of the s-TSH test is currently about twice that ofthe FT 4 1. 6 Therefore, an FT 4 I is the first test we use if thyrotoxicosis is suspected.…”

Section: Diagnosis Of Tiiyrotoxicq-mentioning

confidence: 99%

“…However, this is not a cost -effective approach. The current cost of an s-TSH test is about $40, which is almost twice the cost of an FT 4 1 6. Thus, for a patient suspected of having thyrotoxicosis, we recommend that an FT J be ordered first.…”

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confidence: 99%

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Thyroid function tests

El²

1989

Postgraduate Medicine

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Section: Measurements Of Thyroid Hormone Bindingmentioning

confidence: 99%

Section: Thyroid Function Testsmentioning

confidence: 99%

Section: Clinical Application Of Testsmentioning

confidence: 99%

“…However, the cost of the s-TSH test is currently about twice that ofthe FT 4 1. 6 Therefore, an FT 4 I is the first test we use if thyrotoxicosis is suspected.…”

Section: Diagnosis Of Tiiyrotoxicq-mentioning

confidence: 99%

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Thyroid function tests

El²

1989

Postgraduate Medicine

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Alternative Sequences of Thyrotropin and Free Thyroxine Assays for Routine Thyroid Function Testing

Nordyke¹,

Reppun²,

Madanay³

et al. 1998

Arch Intern Med

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Starting with the TSH test and reflexing to the FT4 test provides a better first-line all-purpose sequence than the reverse. In managed care settings, the slightly higher direct cost of this approach is offset by greater clinical effectiveness. In fee-for-service settings, cost differences can be nearly eliminated by equalizing TSH and FT4 charges to reflect current direct-cost realities. Obtaining both tests together overcomes the disadvantages of each at a slightly higher direct cost.

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Hyperthyroidism

Lee,

Pearce

2023

JAMA

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ImportanceOvert hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality.ObservationsThe most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.Conclusions and RelevanceHyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.

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Sensitivity, Specificity, and Cost-effectiveness of the Sensitive Thyrotropin Assay in the Diagnosis of Thyroid Disease in Ambulatory Patients

Cited by 66 publications

References 1 publication

Thyroid function tests

Thyroid function tests

Alternative Sequences of Thyrotropin and Free Thyroxine Assays for Routine Thyroid Function Testing

Hyperthyroidism

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