Screening inpatients for abnormal thyroid function is not recommended unless thyroid disease is suspected since changes in thyroid hormones, binding proteins, and TSH concentrations occur in severe non-thyroidal illness (NTI).
1. To determine the indications for and interpretation of TFTs by junior medical staff
2. To estimate the cost burden on the health care system due to inappropriate requests to perform TFT’s in acute medical inpatients.
1- Reviewing patient database (CPF from 01st February 2012 to 30th March 2012) at Maroondah Hospital for TFTs ordered at admission and Indications for, interpretation of, and costs of TFTs in these patients.
2- A questionnaire regarding knowledge of interpretation of TFTs amongst the Junior Medical staff was administered and analysed
804 patients were admitted under the Medical unit at Maroondah Hospital between February 2012 and March 2012, a total of 208 patients (25.87%) had TFT’s performed. Out of which 123 (59%) patients were judged to have an acceptable indication for performing TFT’s. The most common indication was delirium, followed by tachycardia and exacerbation of congestive cardiac failure. 33 (16%) patients were found to have thyroid dysfunction and only 17 (8%) patients had a clinically significant thyroid disease. The most common thyroid disease was subclinical hypothyroidism (9/17 = 52.9%), followed by subclinical hyperthyroidism (6/17 = 35.29%).
Approximately 72% (36/50) junior doctors scored 50% or more in the questionnaire related to Thyroid and Non-Thyroid illness.
Thyroid function should not be done frequently in acute medical inpatients, unless there are clear indications.TSH should be the initial screening test as adding on fT4 or fT3 initially could lead to unnecessary expense for the health system.