title: High incidence of occult thyroid disease among general medical ward patients.
abstract: The objective of this study was to prospectively determine the efficacy of the results of routine testing of thyroid functions in patients admitted to a general medical ward. Blood for thyroid function tests was drawn on admission as part of the laboratory screening panel from 270 consecutive patients. Fifty-one were excluded due to recognition of thyroid-related problems by the clinical staff. 138 patients (63%) had normal free thyroxin (FT4) levels, one patient had hyperthyroidism, 15 patients (6.8%) had laboratory primary hypothyroidism and 65 patients (29.6%) had equivocal results (FT4 < 0.9 ng/dL and TSH < 5.0 mmu/L). In eight out of 31 patients in the latter group, the thyroid releasing hormone (TRH) test revealed primary or secondary hypothyroidism. A total of 55 patients (25.1%) expired within one year. The mortality rate was significantly higher among the low FT4 patients (p < 0.01), and was independent of age and sex. We conclude that inclusion of FT4 in a laboratory screening panel will reveal a large patient population with abnormal results. However, establishing the diagnosis requires additional tests. Therefore, screening for occult hypothyroidism among a select population, not the acutely sick, populations may be more efficient.
authors.affiliation: Department of Internal Medicine D, Beilinson Medical Center, Petah Tiqva, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Arber
authors.forename: J M
authors.initials: JM
authors.lastname: Schapiro
authors.forename: M
authors.initials: M
authors.lastname: Lapidot
authors.forename: L
authors.initials: L
authors.lastname: Benosh
authors.forename: E
authors.initials: E
authors.lastname: Lubin
authors.forename: J
authors.initials: J
authors.lastname: Pinkhas
authors.forename: Y
authors.initials: Y
authors.lastname: Sidi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D013959:Thyroid Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013960:Thyroid Function Tests / Q000706:statistics & numerical data*; D013972:Thyrotropin / Q000097:blood; D013973:Thyrotropin-Releasing Hormone / Q000097:blood; D013974:Thyroxine / Q000097:blood
chemical_list: D013973:Thyrotropin-Releasing Hormone; D013972:Thyrotropin; D013974:Thyroxine