Performance And Utility Of Thyroid Function Tests

甲状腺疾病代表最常见的内分泌异常，据估计，在美国每年约有2000万张左甲状腺素处方被分配给约1.8%的人口。因此，最佳使用有效的实验室检查评估甲状腺状态是重要的医学和经济。在一项多机构合作研究中，我们评估了甲状腺功能检测用于监测的性能以及甲状腺激素治疗抑制乳头状和/或滤泡性甲状腺癌的潜在临床效用。本研究采用定量研究综合法对甲状腺激素抑制治疗良性孤立性结节的疗效进行评价。该方法包括对相关临床研究和专家意见的文献进行系统综述，对选定的干预性研究进行荟萃分析，对NIH内分泌学从业人员进行调查，以确定乳头状和/或滤泡性甲状腺癌假设患者的治疗决策，对接受左旋甲状腺素抑制治疗的NIH乳头状和/或滤泡性甲状腺癌患者进行实践验证，以及应用Hill标准评估甲状腺抑制治疗与控制乳头状和/或滤泡状甲状腺癌之间的因果关系。在一个病例研究中，我们调查了实验室检查的效用，以揭示临床上重要的药物相互作用。这种药物相互作用的发生是由于在慢性胃肠道疾病的情况下同时摄入左甲状腺素和高剂量碳酸钙。尽管不同的病因，这种情况下，最初的介绍是类似于我们以前描述的情况下，需要增加剂量的左旋甲状腺素替代治疗，以达到甲状腺功能正常状态的肾病综合征患者。

Thyroid diseases represent the most common endocrine abnormalities and it has been estimated that about 20 million levothyroxine prescriptions are dispensed to about 1.8% of the population in the United States annually. Optimal use of valid laboratory tests for the assessment of thyroid status is thus important both medically and economically. In a multi-institute collaborative study, we assessed the performance of thyroid function tests for monitoring and the potential clinical utility of thyroid hormone therapy for suppressing papillary and/or follicular thyroid cancer. The study was carried out by our previously developed method of quantitative research sysnthesis for assessing the efficacy of thyroid hormone suppression therapy on benign solitary thyroid nodules. This approach involves systematic review of the literature for relevant clinical studies and expert opinions, meta-analysis of selected interventional studies, survey of NIH endocrinology practitioners for therapeutic decisions in hypothetical patients with papillary and/or follicular thyroid cancer, practice validation in NIH patients treated with levothyroxine suppression for papillary and/or follicular thyroid cancer, and application of Hill's criteria to asssess causality between thyroid suppression therapy and control of papillary and/or follicular thyroid cancer. In a case study, we investigated the utility of laboratory tests for revealing a clinically important drug-interaction. This drug-interaction occurred due to concomitant ingestion of levothyroxine with high doses of calcium carbonate in the presence of chronic gastrointestinal disorders. Despite different etiologies, initial presentation of this case was similar to our previously described case in which increased doses of levothyroxine replacement therapy were required to achieve euthyroid status in a patient with nephrotic syndrome.