I have followed the recent discussion on urgent thyroid function tests with
some interest. However I am still a little confused as to whether there is
any need for the measurement of thyroid function tests in the acute
situation.
Recently looking through my Oxford book of acute medicine at the endocrine
emergency sections, it states in the thyroid storm section that total t4 and
tsh measurements may be available urgently from some laboratories. This is
the first investigation listed and to me implies that the measurement of
TFTs is the most important test. Is this so ? Looking at the treatment
guidelines etc there is no mention of treatment based on these results and
the severity of the condition is scored without reference to the TFTs. So
why bother with the urgent measurement ?
In the myxodema coma situation, no mention is made of the measurement of
TFTs presumably therefore there is no indication whatsoever for the
measurement of TFTs in this situation. Plus many people can tolerate small
doses of T3 for example, if replacement is considered.
The final case I have often come across and in my limited experience is the
most common cause of a request for urgent TFTs is to see if someone has
taken a dose of thyroxine (usually a child). Are urgent TFTs indicated in
these cases ? If not why not ?
I would appreciated any comments anyone may have in this area
Craig Webster
Senior Clinical Biochemist
Broomfield Hospital, Chelmsford, Essex, UK
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|