Sensitivity, Specificity, and Cost-effectiveness of the Sensitive Thyrotropin Assay in the Diagnosis of Thyroid Disease in Ambulatory Patients
Abstract
• The sensitivity and specificity of two sensitive thyrotropin assays were compared with those of other standard thyroid function tests in 544 ambulatory subjects who were clinically euthyroid, thyrotoxic, or hypothyroid. Both sensitive thyrotropin assays had the highest sensitivity and specificity (95%/89% and 92%/95%), followed by estimated free thyroxine (T4) level (82% and 94%), calculated free T4index (78% and 93%), and free triiodothyronine index (86% and 88%). Sensitivity of the two thyrotropin assay kits in the diagnosis of thyrotoxicosis was 86% and 95%, and that in the diagnosis of hypothyroidism was 92% and 94%. Other tests were nearly as sensitive in the diagnosis of thyrotoxicosis but not hypothyroidism. A cost analysis of a testing strategy that used either total T4, free T4index, or sensitive thyrotropin assay alone as the first-line thyroid test disclosed that to establish the patient's thyroid metabolic status would have cost $11 093, $14 536, and $24 902, respectively, using each test first. We suggest that, at current prices, routine use of the thyrotropin assay as a first-line test in ambulatory patients is not as cost-effective as the free T1index. (Arch Intern Med1989;149:526-532)
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Serum TSH measurement has the highest sensitivity and specificity of any single blood test used in the evaluation of suspected thyrotoxicosis.
“Serum TSH measurement has the highest sensitivity and specificity of any single blood test used in the evaluation of suspected thyrotoxicosis and should be used as an initial screening test (34).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [34]
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“Serum TSH measurement has the highest sensitivity and specificity of any single blood test used in the evaluation of suspected thyrotoxicosis and should be used as an initial screening test (34).”
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- Authors
- de los Santos, E. T.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1989-03-01
- Volume
- 149
- Issue
- 3
- Pages
- 526
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2133425641
- Cited by
- 92
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 8 · 2020: 7 · 2019: 3 · 2018: 4 · 2017: 3 · 2016: 4 · 2014: 1 · 2013: 5 · 2012: 4
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01-RR-00034)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid function tests, thyrotoxicosis, hypothyroidism, free thyroxine index, sensitivity and specificity, cost-effectiveness, outpatients
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Costs and Cost Analysis, Female, Humans, Male, Middle Aged, Outpatients, Radioimmunoassay, Reference Values, Thyroid Diseases, Thyroid Function Tests, Thyrotropin
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