Endocrine Abstracts

Isolated change in serum TSH concentration occurs in 15% of hospitalised patients in response to non-thyroidal illness or various drugs, which interfere with thyroidal synthesis and secretion, thyroid hormone metabolism and absorption. Significant change in concentration of either suppressed (<0.1 mU/l) or elevated (>10 mU/l) TSH level is seen in 1–2% of them but only less than half have underlying thyroid disorder.

UK Guideline for use of TFT (July 2006) recommends ‘routine testing of thyroid function in patient admitted to hospital is not warranted unless specific condition exist’.

The aim of our audit was to look into the sample size, indication for request, proportion of abnormal results (which were clinically significant) and the outcome of the TFTs done in patients on the first day of admission to the Medical Assessment Unit in a DGH between Jan and March 2007.

Total number of samples received were 1952 of which 427 (21.8%) requests were received for thyroid functions

• From the 427 requests 50 were randomly selected and analysed

• Two-thirds were females and majority were over 50

• Five patients had clinically non-significant abnormality in TFT (normalised on further follow-up)

• Only 5 of them had significantly abnormal TFT

• Out of these, 3 patients were already known to have thyroid disease

• One patient with hyponatraemia and atrial fibrillation was found to have hyperthyroidism

• One patient with trigeminal neuralgia was incidentally found to be grossly hypothyroid

• The case finding in our group of patients was about 2%

We conclude that it is justifiable to screen (at risk population) for thyroid diseases as they are common and present with non-specific symptoms. The importance of alteration in thyroid functions in acute illness lies in their potential to cause diagnostic confusion.