Analytical Performance and Clinical Utility of Thyroid Function Tests

甲状腺功能测试的分析性能和临床实用性

• 批准号: 6431868
• 负责人: Gyorgy Csako
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6431868
• 关键词: clinical research; diagnosis design /evaluation; diagnostic tests; goiter; hormone regulation /control mechanism; hormone therapy; human subject; hypothyroidism; meta analysis; remission /regression; thyroid function; thyrotropin; thyroxine; thyroxine analog

In a multi-institute collaborative study, we assessed the potential clinical utility of thyroid hormone suppression therapy on benign multinodular thyroid disease. The study was performed using our previously developed method of quantitative research synthesis. This approach involved systematic review of the literature for relevant clinical studies and expert opinions, meta-analysis of selected interventional studies, surveys of NIH endocrinology practitioners for therapeutic decisions in hypothetic patients with benign multinodular thyroid disease, practice validation in NIH patients treated with levothyroxine suppression for benign multinodular thyroid disease, and application of Hill?s criteria to assess causality between thyroid suppression therapy and regression of benign nodules. Similar to our earlier observation for the effect of thyroid suppression therapy on benign solitary thyroid nodules, we found that a subset of patients with benign multinodular thyroid disease responded to this medical therapy with clinically significant reduction in nodule size. Consequently, an initial trial of this therapy is warranted in patients with benign multinodular thyroid disease in the absence of contraindication(s) to levothyroxine administration. In another study, we evaluated a case in which increased doses of levothyroxine replacement therapy were required to achieve euthyroid status in a patient with nephrotic syndrome. The clinical picture thus mimicked an "inappropriate" thyroid-stimulating hormone (TSH) secretion syndrome.We analyzed the effect of various blood collection tubes on the measurements of free thyroxine (FT4), free iodothyronine (FT3), and TSH (thyroid-stimulating hormone or thyrotropin) with different nonisotopic methods. We observed clinically significant effects only with one type of collection tube on some assays. Nevertheless, the findings indicate that routine evaluation of these tubes is warranted before their use for thyroid function testing.

在一项多机构合作研究中，我们评估了甲状腺激素抑制疗法对良性多结节性甲状腺疾病的潜在临床效用。该研究是使用我们之前开发的定量研究综合方法进行的。该方法包括对相关临床研究和专家意见的文献进行系统回顾、对选定的介入研究进行荟萃分析、对 NIH 内分泌学从业者进行调查，以制定假设的良性多结节性甲状腺疾病患者的治疗决策、对接受左旋甲状腺素抑制治疗良性多结节性甲状腺疾病的 NIH 患者进行实践验证，以及应用 Hill 标准来评估因果关系 甲状腺抑制治疗和良性结节消退之间的关系。与我们早期对甲状腺抑制治疗对良性孤立性甲状腺结节效果的观察类似，我们发现良性多结节性甲状腺疾病患者的一部分对这种药物治疗有反应，结节大小在临床上显着减小。因此，在没有左旋甲状腺素给药禁忌症的良性多结节性甲状腺疾病患者中，有必要对该疗法进行初步试验。在另一项研究中，我们评估了肾病综合征患者需要增加左旋甲状腺素替代治疗剂量才能达到甲状腺功能正常状态的病例。因此，临床表现类似于“不适当的”促甲状腺激素（TSH）分泌综合征。我们分析了不同采血管对采用不同非同位素方法测量游离甲状腺素（FT4）、游离碘甲状腺原氨酸（FT3）和TSH（促甲状腺激素或促甲状腺素）的影响。我们在某些检测中仅使用一种类型的收集管观察到临床显着效果。然而，研究结果表明，在将这些管用于甲状腺功能测试之前，有必要对这些管进行常规评估。