Linking medical needs and performance goals

clinical and laboratory perspectives on thyroid disease

Ian D Hay, George G. Klee

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Diagnosis and management of thyroid disease benefit substantially from close interactions between clinicians and laboratorians. Clinicians desire reliable tests for diagnosis and management of both hypothyroidism and thyrotoxicosis. Traditionally, multitiered testing has been used, beginning with an index of free thyroxine concentration, which, if abnormal, has been followed by basal thyrotropin (TSH) measurements (for hypothyroidism) or thyrotropin-releasing hormone-stimulated TSH measurements (for thyrotoxicosis). Improvements in analytical methods for TSH have made it practical to use basal TSH measurements in serum as the first-line test for thyroid disease. However, performance guidelines are needed, because not all TSH assays work well in this role. The performance guidelines developed by the American Thyroid Association are reviewed to illustrate how they help to assure consistent analytical testing. Further improvements in TSH assays (third- and fourth-generation assays), which support measurements down to 0.01 mlU/L and 0.001 mlU/L, may provide additional advantages for classifying thyrotoxic patients and monitoring thyroxine-suppressive therapy in patients with thyroid cancer. The potential advantages of these newer assays are illustrated with case examples. Additional analytical performance monitors are proposed to help ensure that these next-generation TSH assays meet the expanded clinical needs.

Original languageEnglish (US)
Pages (from-to)1519-1524
Number of pages6
JournalClinical Chemistry
Volume39
Issue number7
StatePublished - 1993

Fingerprint

Thyrotoxicosis
Thyroid Diseases
Hypothyroidism
Thyroxine
Assays
Guidelines
Thyrotropin-Releasing Hormone
Physiologic Monitoring
Thyrotropin
Thyroid Neoplasms
Serum
Testing
Therapeutics
Monitoring

Keywords

  • Immunometric assays
  • Thyroid status
  • Thyrotropin
  • Thyroxine

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

Linking medical needs and performance goals : clinical and laboratory perspectives on thyroid disease. / Hay, Ian D; Klee, George G.

In: Clinical Chemistry, Vol. 39, No. 7, 1993, p. 1519-1524.

Research output: Contribution to journalArticle

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