Low Yield of Thyroid-Function Tests in Adult Hospitalized Patients — A Retrospective Analysis
Open accessAbstract
BACKGROUND: In the US, serum thyroid-stimulating hormone (TSH) and thyroxine measurements are the fourth- and tenth-commonest laboratory tests ordered, respectively. Diagnosis of thyroid disorder requires clinical suspicion supported by laboratory values. However, in the setting of acute illness, both the clinical and laboratory pictures can be confounded. OBJECTIVE: To study clinical outcomes and derangement patterns of inpatient thyroid-function tests. DESIGN: This retrospective study was conducted at an academic center on admissions aged ≥18 years and TSH tests performed over a 1-year period. Admissions with active pregnancy and/or prior thyroid-related diagnosis were excluded. MAIN OUTCOMES: Clinical outcomes were divided based on new diagnosis of thyroid-related disorder, newly prescribed thyroxine replacement, or antithyroid drugs/ endocrinology referrals, or both. In order to analyze the derangement patterns of abnormal TSH, only the results of the first test ordered were considered (as some admissions had multiple TSH tests ordered). RESULTS: A total of 7,204 admissions aged ≥18 years had TSH tests done. Of these, 1,912 were excluded. Of the 5,292 admissions with no prior thyroid disorder or active pregnancy, 183 (3.46%) were assigned a new diagnosis of thyroid-related disorder, 54 (1.02%) received treatment/referral, and 46 (0.87%) received both a new diagnosis and treatment/referral. Based on the TSH results (reference range 0.42-4.0 mIU/L) of the 5,292 admissions, 4,312 (81.5%) and 980 (18.5%) admissions were flagged normal and abnormal, respectively. Of the 980 admissions with one or more abnormal TSH results, 21 (2.14%) had first ordered TSH <0.05 mIU/L, 855 (87.25%) admissions had first TSH result between 0.05-10 mIU/L, and lastly 104 (10.61%) were >10 mIU/L. CONCLUSION: There is low value in testing inpatients for thyroid disorders, and testing comes at significant expense to the health-care system.
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In the elderly, the upper bound of the TSH reference interval progressively increases with age.
“At the other age extreme, in the elderly, the upper bound of the TSH reference interval progressively increases with age and should be reflected in laboratory reports and taken into consideration for clinical interpretation of TSH test results.”
From Thyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status (2023) · cites this paper as [46]
The Methods use a single laboratory TSH reference range for adult admissions, and the Discussion proposes a wider range for hospitalized patients because illness can affect TSH results. Neither passage addresses whether the upper limit progressively increases with age in elderly people (searched: elderly upper limit, age-specific reference range). Page numbers were not available in our copy. (LLM, conf=0.74)
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References 22 · Cited by 6
- Authors
- Dogra, P., Paudel, R., Panthi, S., Cassity, E., & Tannock, L. R.
- Affiliations
- University of Kentucky (US)
- Baptist Memorial Hospital (US)
- University of Kentucky HealthCare (US)
- Corresponding author
- Dogra, Prerna
- Venue
- International Journal of General Medicine
- Publisher
- Informa UK Limited
- Published
- 2020-07
- Volume
- Volume 13
- Pages
- 343-349
- ISSN
- 1178-7074 (ISSN-L)
- PMC
- PMC7351628
- OpenAlex
- W3039010234
- Cited by
- 6
- References
- 22
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 2 · 2020: 1
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of General Medicine (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- thyroid-stimulating hormone, thyroid function tests, hospitalized adults, thyroid dysfunction, thyroxine, antithyroid drugs, thyroxine replacement, acute illness, health care costs
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