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Optimization of the thyroid panel for diagnostic purposes: Thyrotropin cut-off values for the reflex addition of free thyroxine
- Source :
- Clinica Chimica Acta. 505:125-129
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Background-aim Measurement of serum thyrotropin is currently the recommended test for the screening of thyroid dysfunction, while serum free thyroxine is kept as a reflex test. In our laboratory, the strategy followed in adult individuals from Primary Care includes a ‘safety margin’ for requests with a thyrotropin ≤1.0 or ≥4.0 mIU/L (normal: 0.35–4.95 mIU/L). Our aim was to optimize the thyrotropin cut-off values for the addition of free thyroxine and, based on these cut-offs, to retrospectively analyze avoidable free thyroxine measurements and possible adverse clinical consequences. Methods Retrospective observational study performed in a tertiary care hospital between 2013 and 2018. We considered all laboratory requests for screening of thyroid dysfunction (TD) in adult patients from Primary Care. Requests from patients with a previous diagnosis of thyroid disease or pregnant women were excluded. Different receiver operating characteristic (ROC) curves were performed and the obtained thyrotropin cut-off values were compared. Economic savings were assessed considering the current cost of free thyroxin assays in our laboratory. Results From a total of 554,529 TD protocols included, 119,504 requests had free thyroxine added. From the ROC curve that enables ≥95% of abnormal free thyroxine results to be detected, the thyrotropin values obtained were ≥4.58 mIU/L and ≤0.94 mIU/L. These thyrotropin cut-off values would lead to a saving of 22.7% of annual free thyroxine measurements without adverse clinical consequences. Discussion Setting optimized thyrotropin cutoffs for reflex testing of free thyroxine would reduce the need for this test. Clinical laboratories need to offer not only true results, but also become the cornerstone in the optimization of resources.
- Subjects :
- Adult
Male
0301 basic medicine
endocrine system
Pediatrics
medicine.medical_specialty
endocrine system diseases
Clinical Biochemistry
Thyrotropin
Thyroid Function Tests
Biochemistry
03 medical and health sciences
0302 clinical medicine
Free thyroxin
Reference Values
medicine
Humans
Aged
Retrospective Studies
Hematologic Tests
Primary Health Care
Receiver operating characteristic
business.industry
Thyroid disease
Biochemistry (medical)
Reproducibility of Results
Retrospective cohort study
General Medicine
Free thyroxine
Middle Aged
medicine.disease
Thyroid Diseases
Thyroxine
Treatment Outcome
030104 developmental biology
ROC Curve
030220 oncology & carcinogenesis
Thyroid panel
Reflex
Female
Cut-off
business
Algorithms
hormones, hormone substitutes, and hormone antagonists
Subjects
Details
- ISSN :
- 00098981
- Volume :
- 505
- Database :
- OpenAIRE
- Journal :
- Clinica Chimica Acta
- Accession number :
- edsair.doi.dedup.....885c05867ea13ec80f703db8c0a2c800