title: Urgent Thyroid-Stimulating Hormone Testing in Emergency Medicine: A Useful Tool?
abstract: BACKGROUND
  Thyroid-stimulating hormone (TSH) has recently been introduced among the tests available to the Emergency Department (ED) of our hospital.
  
  
  OBJECTIVE
  To evaluate the prevalence of TSH-level-dependent thyroid dysfunction and to assess the usefulness of urgent TSH testing in a series of emergency patients.
  
  
  METHODS
  We planned a single-center observational cross-sectional clinical study. We divided patients in groups according to their thyroid status using defined TSH decision levels. Previously diagnosed history of thyroid dysfunction and newly diagnosed thyroid dysfunctions were differentiated. Further, we analyzed the subset of emergency patients affected by atrial fibrillation (AF) due to the role of hyperthyroidism in AF pathogenesis. For each TSH request, we made a retrospective chart review to assess the usefulness of the test based on clinical efficacy and management efficiency indicators.
  
  
  RESULTS
  The present study showed that, although the overall thyroid dysfunction rate was higher than in the general population, only a few newly diagnosed thyroid dysfunctions were found with limited clinical utility. We categorized urgent TSH requests as useful and not useful, by retrospective evaluation, and we identified and compared the main TSH testing clinical indications in the two groups.
  
  
  CONCLUSIONS
  We found a positive impact of urgent TSH determination in emergency decision-making. Nevertheless, a stronger clinical impact could be achieved by improving request appropriateness and by targeting TSH testing to some clinical indications identified by the study. The work was considered a quality-improvement project by the Hospital Committee for Quality Management.
authors.affiliation: Clinical Pathology Laboratory, Department of Laboratory Medicine, S. Antonio Hospital, Padova, Italy.
authors.forename: Alda
authors.initials: A
authors.lastname: Giacomini
authors.affiliation: Emergency Department, S. Antonio Hospital, Padova, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Chiesa
authors.affiliation: Clinical Pathology Laboratory, Department of Laboratory Medicine, S. Antonio Hospital, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carraro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000097:blood*; D013972:Thyrotropin / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D013972:Thyrotropin
keywords: TSH; emergency laboratory test; test appropriateness; test usefulness; thyrotropin