Performance And Utility Of Thyroid Function Tests

甲状腺疾病是最常见的内分泌异常，据估计，在美国，每年约有2000万左甲状腺素处方分发给1.8%的人口。因此，最佳地利用有效的实验室检查来评估甲状腺状况在医学上和经济上都是重要的。在一项多机构合作研究中，我们评估了监测甲状腺功能测试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应用。本研究采用我们先前开发的定量研究综合方法来评估甲状腺激素抑制治疗良性孤立性甲状腺结节的疗效。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，以确定假设的乳头状和/或滤泡性甲状腺癌患者的治疗决策，对NIH接受左旋甲状腺素抑制治疗乳头状和/或滤泡性甲状腺癌的患者进行实践验证，应用希尔标准评估甲状腺抑制治疗与控制乳头状和/或滤泡性甲状腺癌之间的因果关系。在一个案例研究中，我们调查了实验室测试对揭示临床重要药物相互作用的效用。这种药物相互作用是由于慢性胃肠疾病患者同时服用左甲状腺素和高剂量碳酸钙所致。尽管病因不同，但该病例的初始表现与我们先前描述的病例相似，即肾病综合征患者需要增加左甲状腺素替代治疗剂量以达到甲状腺功能正常状态。

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.