An audit of thyroid function testing in acutely ill patients at a South African academic hospital

Background. Non-thyroidal illness syndrome (NTIS) can be defined as the presence of abnormal thyroid function in the absence of primary thyroid dysfunction and is associated with acute illness. Thyroid function testing is generally not advised in the critically ill patient. Thyroidstimulating hormon...

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Bibliographic Details
Published in:The Southern African journal of critical care 2020-07, Vol.36 (1), p.46-50
Main Authors: Kruger, E.C., Coetzee, A., Conradie, M., Hoffmann, M.
Format: Article
Language:English
Subjects:
Audit
Cost-saving
Emergency medicine
Health screening
Medical tests
Non-thyroidal illness syndrome
Thyroid diseases
Thyroid function tests
Thyroid gland
Thyroid-stimulating hormone
Thyrotropin
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Summary:Background. Non-thyroidal illness syndrome (NTIS) can be defined as the presence of abnormal thyroid function in the absence of primary thyroid dysfunction and is associated with acute illness. Thyroid function testing is generally not advised in the critically ill patient. Thyroidstimulating hormone (TSH) measurement is the preferred screening test for thyroid disease, but results may be misleading and variable in the setting of critical illness.Objective. To describe the pattern of requests for TSH testing in patients admitted to the emergency department and intensive care units at Tygerberg Hospital, Cape Town, South Africa.Methods. A retrospective, descriptive (observational) study was conducted over a 6-month period to determine the number of requests for TSH testing received for patients admitted to the emergency department and intensive care units.Results. A total of 1 139 requests for TSH testing were received from the emergency department and intensive care units, of which 166 were excluded. Of the 973 requests evaluated, 14% yielded abnormal results. The majority (79.4%) of the abnormal TSH results were most likely attributed to NTIS. Follow-up TSH results after 6 - 8 weeks were available in only 18% of cases with abnormal TSH levels at initial presentation.Conclusion. We found that TSH testing was often requested in critically ill patients, but that most results were either normal or indicative of NTIS. Follow-up testing of abnormal TSH results was rarely performed. We recommend continued education of junior clinicians regarding thyroid function testing in critically ill patients.
ISSN:1562-8264
2078-676X
DOI:10.7196/SAJCC.2020.v36i1.406