title: Subclinical hypothyroidism: a comparison of strategies to achieve adherence to treatment guidelines.
abstract: BACKGROUND
  Subclinical hypothyroidism is an entity based on the laboratory findings of a raised serum thyrotrophin (TSH) concentration and a normal free thyroxine (FT(4)) concentration. Patients with subclinical hypothyroidism who also have anti-thyroid peroxidase (TPO) antibodies have a higher conversion to overt hypothyroidism than those without, and treatment with thyroxine is recommended.
  
  
  METHODS
  We audited anti-TPO assay requests within two NHS Trust hospitals, against consensus standards, to ascertain whether a cascade approach to anti-TPO testing and direct advice leads to more appropriate prescribing of thyroxine in general practice.
  
  
  RESULTS
  Our data show that where anti-TPO status was automatically tested for and clear advice for treatment given, >85% of patients were treated according to the standard required by the consensus document, with >90% of those recommended to be commenced on thyroxine actually doing so. In contrast, where anti-TPO was not routinely assessed, treatment was started in 46% of patients, without clear evidence that this was appropriate.
  
  
  CONCLUSIONS
  In order to better advise clinicians and in accordance with the agreed protocol, laboratory-generated cascade testing for anti-TPO antibodies should be an integral part of the investigation of subclinical hypothyroidism, and reports should contain appropriate interpretation and advice.
authors.affiliation: Immunology and Immunogenetics, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lock
authors.forename: N A
authors.initials: NA
authors.lastname: Marden
authors.forename: H J
authors.initials: HJ
authors.lastname: Kemp
authors.forename: P H
authors.initials: PH
authors.lastname: Thomas
authors.forename: D J
authors.initials: DJ
authors.lastname: Goldie
authors.forename: M M
authors.initials: MM
authors.lastname: Gompels
mesh_terms: D000906:Antibodies / Q000032:analysis; D019983:Guideline Adherence; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000628:therapy*; D007453:Iodide Peroxidase / Q000276:immunology; D007755:Laboratories, Hospital / Q000592:standards; D017410:Practice Guidelines as Topic; D013960:Thyroid Function Tests / Q000592:standards; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use
chemical_list: D000906:Antibodies; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine