Observer Variation in the Clinical and Laboratory Evaluation of Patients with Thyroid Dysfunction and Goiter
Abstract
Three endocrinologists assessed thyroid function (hypothyroid, possibly hypothyroid, euthyroid, possibly hyperthyroid, or hyperthyroid), thyroid size (small, medium, or large), thyroid type (diffuse, nodular, or solitary nodule), and diagnosis and treatment options in 55 patients (47 women and 8 men) with a median age of 43 years (range 19 to 74) suspected of thyroid disease. The observers were presented stepwise for the (1) patient, clinical examination, and patient history; (2) blood tests; (3) 99mTc-pertechnetate scintigraphy; and (4) ultrasonography. The reproducibility was assessed by means of the K coefficient. Compared with evaluation of the patient alone, agreement on thyroid dysfunction was almost perfect when the results of the blood tests were known. The K values for pairs of observers rose significantly from 0.55 to 0.65 to 0.88 to 0.93. All three observers altered their opinion as to thyroid dysfunction in one third of the patients when the blood tests were known. Compared with evaluation of the patient alone, agreement on the morphology of the thyroid gland did not improve significantly in spite of access to thyroid scintigraphy; with the addition of thyroid ultrasound, agreement improved significantly for some pairs of observers. The three observers agreed on the rough estimate of thyroid size in only 36% of the patients. When all information was available, the three observers agreed on diagnosis and treatment category in 60% of the patients. Doctors should bear in mind the considerable observer variation when they evaluate patients with suspected thyroid disease.
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One study found that experienced physicians' estimate of thyroid size is accurate compared with anatomic imaging, but other investigators have not confirmed this observation.
“One study found that this estimate by experienced physicians is accurate compared with anatomic imaging (86); however, other investigators have not confirmed this observation (87).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [87]
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- Authors
- JARLØV, A. E., NYGAARD, B., HEGEDÜS, L., HARTLING, S. G., & HANSEN, J. M.
- Affiliations
- Herlev Hospital (DK)
- ORCID
- NYGAARD, BIRTE
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 1998-05
- Volume
- 8
- Issue
- 5
- Pages
- 393-398
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W1986813772
- Cited by
- 86
- References
- 10
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 5 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 1 · 2013: 3 · 2012: 2
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- observer variability, interobserver agreement, thyroid dysfunction, goiter, hypothyroidism, hyperthyroidism, thyroid morphology, thyroid scintigraphy, thyroid ultrasound, thyroid function tests
- MeSH terms
- Adult, Aged, Female, Goiter, Hematologic Tests, Humans, Male, Middle Aged, Thyroid Diseases, Thyroid Function Tests, Thyroid Gland, Reproducibility of Results, Observer Variation, Clinical Laboratory Techniques
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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