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CLIA-Waived Test for Hypothyroidism
| Article Date: 5/31/2007 |
Screen for Hypothyroidism with TSH
ÓA TSH test alone is sufficient to rule out thyroid dysfunction in outpatients.Ó
Hypothyroidism is the most common disease of the thyroid. Testing for elevated TSH is the first step taken when the patientÕs symptoms spell SLUGGISH.* A TSH test alone can open the door to the direction of treatment.
Dr. Anthony Viera was a resident at the family practice clinic at the Naval Hospital in Jacksonville, FL in the mid nineties when he gathered the records of nearly 3000 patients over a two year period to come to this conclusion. He won an award from the American Academy of Family Medicine for his work.
TSH was rarely ordered alone in Jacksonville. It was routinely paired with T4.
T4 was never ordered alone. Bauer and Brown had just published a study that concluded that if TSH was normal, the likelihood of a normal T4 result is extremely high. 1.
Dr. Viera took the challenge with these results:
Low TSH Normal TSH High TSH
Low T4 0 2 112
Normal T4 19 1187 28
High T4 41 3 0
Viera was not looking for a specific thyroid disease when he did the study. However, TSH elevates before T4 decreases indicating the possibility of hypothyroidism. In a routine outpatient population, if the TSH is normal, the likelihood of an abnormal T4 is less than 1%. He also showed that there could be significant cost savings if T4 tests are only performed when the TSH results are abnormal. He projected that the hospital in Jacksonville could save upwards of $300,000 over 10 years.
ÒIn all medicine, clinical judgment still dictates in those rare instances when testing both TSH and T4 or T4 alone is appropriateÓ, Dr. Viera concluded, Òespecially when pituitary or hypothalamic disease is suspected or known.Ó Three years after the study was completed, the American Thyroid Foundation published its guideline recommending screening adults with thyroid dysfunction with TSH only.
Sleepiness, Fatigue
Loss of memory, Trouble Concentrating
Unusually dry skin
Goitre
Gradual Personality Change, Depression
Increase in Weight
Sensitivity to Cold
Hair Loss
Bauer DC, Brown AN. Sensitive thyrotropin and free thyroxine testing in outpatients: Area both necessary? Arch Intern Med 1966; 156:2333-7.
For further information, see ÒThyroid Function Testing in Outpatients: Are Both Sensitive Thyrotropin (sTSH) and Free Thyroxine (FT4) Necessary?Ó Anthony J. Viera, MD (Fam Med 2003:35(6); 408-10). Or contact www.thyrochek.com for a copy.
ÓA TSH test alone is sufficient to rule out thyroid dysfunction in outpatients.Ó
Hypothyroidism is the most common disease of the thyroid. Testing for elevated TSH is the first step taken when the patientÕs symptoms spell SLUGGISH.* A TSH test alone can open the door to the direction of treatment.
Dr. Anthony Viera was a resident at the family practice clinic at the Naval Hospital in Jacksonville, FL in the mid nineties when he gathered the records of nearly 3000 patients over a two year period to come to this conclusion. He won an award from the American Academy of Family Medicine for his work.
TSH was rarely ordered alone in Jacksonville. It was routinely paired with T4.
T4 was never ordered alone. Bauer and Brown had just published a study that concluded that if TSH was normal, the likelihood of a normal T4 result is extremely high. 1.
Dr. Viera took the challenge with these results:
Low TSH Normal TSH High TSH
Low T4 0 2 112
Normal T4 19 1187 28
High T4 41 3 0
Viera was not looking for a specific thyroid disease when he did the study. However, TSH elevates before T4 decreases indicating the possibility of hypothyroidism. In a routine outpatient population, if the TSH is normal, the likelihood of an abnormal T4 is less than 1%. He also showed that there could be significant cost savings if T4 tests are only performed when the TSH results are abnormal. He projected that the hospital in Jacksonville could save upwards of $300,000 over 10 years.
ÒIn all medicine, clinical judgment still dictates in those rare instances when testing both TSH and T4 or T4 alone is appropriateÓ, Dr. Viera concluded, Òespecially when pituitary or hypothalamic disease is suspected or known.Ó Three years after the study was completed, the American Thyroid Foundation published its guideline recommending screening adults with thyroid dysfunction with TSH only.
Sleepiness, Fatigue
Loss of memory, Trouble Concentrating
Unusually dry skin
Goitre
Gradual Personality Change, Depression
Increase in Weight
Sensitivity to Cold
Hair Loss
Bauer DC, Brown AN. Sensitive thyrotropin and free thyroxine testing in outpatients: Area both necessary? Arch Intern Med 1966; 156:2333-7.
For further information, see ÒThyroid Function Testing in Outpatients: Are Both Sensitive Thyrotropin (sTSH) and Free Thyroxine (FT4) Necessary?Ó Anthony J. Viera, MD (Fam Med 2003:35(6); 408-10). Or contact www.thyrochek.com for a copy.