Document Detail

Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients.
MedLine Citation:
PMID:  3301067     Owner:  NLM     Status:  MEDLINE    
Thyrotropin (TSH) concentrations were measured in 1580 hospitalized patients and 109 normal persons. Using the mean +/- 3 SD limits of the log values for the controls (0.35-6.7 milli-int. units/L), the proportion of abnormal TSH results in the hospitalized patients was 17.2%. TSH was undetectable (less than 0.1 milli-int. unit/L) in 3.1% of patients, suggesting hyperthyroidism, and high (greater than 20 milli-int. units/L) in 1.6%, suggesting hypothyroidism. On follow-up of 329 patients, 62% with abnormal TSH (less than 0.35 or greater than 6.7 milli-int. units/L) and 38% with normal TSH concentrations, only 24% of those with undetectable TSH had thyroid disease: 36% of them were being treated with glucocorticoids and 40% had nonthyroidal illness (NTI). Although half the patients with TSH greater than 20 milli-int. units/L had thyroid disease, 45% of patients had high TSH values associated with NTI. TSH concentrations usually returned towards normal when patients' therapy with glucocorticoids was discontinued or they recovered from NTI. TSH test sensitivity appeared good when the mean +/- 3 SD limits of the reference population were used, i.e., no cases of hyper- or hypothyroidism, as identified by free thyroxin index (FT4I), were missed. However, TSH test specificity was inferior to that of the FT4I test (90.7% vs 92.3%), although specificity could be improved to 97.0% if the wider TSH reference limits of 0.1 to 20 milli-int. units/L were used--limits considered pathological if applied to outpatients. Evidently, different reference intervals for TSH are needed for hospitalized and nonhospitalized patients. We conclude that a "sensitive TSH assay" is not a cost-effective thyroid screening test for hospitalized patients as compared with the FT4I.
C Spencer; A Eigen; D Shen; M Duda; S Qualls; S Weiss; J Nicoloff
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Clinical chemistry     Volume:  33     ISSN:  0009-9147     ISO Abbreviation:  Clin. Chem.     Publication Date:  1987 Aug 
Date Detail:
Created Date:  1987-09-10     Completed Date:  1987-09-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9421549     Medline TA:  Clin Chem     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1391-6     Citation Subset:  IM    
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MeSH Terms
Ambulatory Care
Glucocorticoids / blood
Immunoenzyme Techniques
Reference Values
Thyroid Diseases / blood*
Thyrotropin / blood*
Thyroxine / blood
Grant Support
Reg. No./Substance:
0/Glucocorticoids; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin

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