But frequently the request says "On T4" ...
Michael
----Original Message----
From: [log in to unmask]>
Date: 11/02/2018 13:50
To: <[log in to unmask]>
Subj: Re: front line TSH for primary care
Hi I would like to bring this to your attention
The British Thyroid Association recommends the measurement of both TSH and fT4 (ie the parallel test) on the basis that the laboratories do
not necessarily know the reasons why a test has been requested and there is a risk of missing pituitary failure
regards
Danielle
Dr Danielle B. Freedman MB BS, FRCPath,EuSpLM
Director
Pathology
Luton and Dunstable University Hospital NHS FT
Luton, LU4 0DZ
+441582 497212
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Bradbury Wayne (RNL) North Cumbria
University Hospitals
Sent: 09 February 2018 16:57
To: [log in to unmask]
Subject: Re: front line TSH for primary care
This is covered in the latest Keele Benchmarking report:
“4.4 Free T4 Testing Rate
The use of Free T4 testing is also one which is of general interest at the moment, specifically around whether it should be used as a
frontline test or only added with an abnormal TSH result.
The following table shows the variation in the way Free T4 testing is carried out, by expressing the number of Free T4 tests against the
number of TSH tests performed in-house.”
It shows 25 out of 78 labs do FT4 and TSH on every thyroid function request.
Regards,
Wayne.
Mr WH Bradbury BSc MSc FRCPath
Consultant Biochemist / Head of Blood Sciences,
North Cumbria University Hospitals NHS Trust,
Cumberland Infirmary,
CARLISLE, CA2 7HY.
Tel: 01228 814521 Fax: 01228 814831
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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Steven John Mccann
Sent: 09 February 2018 16:35
To: [log in to unmask]
Subject: Re: front line TSH for primary care
Thanks Jonathan.
I am sure things have changed since these surveys as labs are always looking for cost savings. We do offer TSH only if a patient is on T4
Rx (which is probably about 5% of all our Thyroid requests). I was just wondering if there was more recent bench marking data or some sort
of Atlas of Variation which would indicate what lab variation there is. I thought GP electronic reporting data went through a single
processing system…surely that could be used to determine what proportion of GP thyroid requests had TSH or TSH+FT4?
Interestingly in from Bart in Leiden: Using TSH only….
This is embedded in national Dutch guidelines for primary care.
Best regards,
Bart
B.E.P.B. Ballieux PhD, Laboratory Specialist Clinical Biochemistry and Endocrinology
Department KCL, E2-P. Leiden University Medical Centre, P.O.box 9600, 2300RC Leiden
Tel: +3171-5262165/62278 Fax: +3171-5266753 email: [log in to unmask]<mailto:[log in to unmask]>
P Please consider the environment before printing this e-mail
Steven
From: Jonathan Kay [mailto:[log in to unmask]]
Sent: 09 February 2018 16:21
To: Steven John Mccann
Cc: Jonathan Kay; [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: front line TSH for primary care
IIRC Julian Barth and others surveyed this twice, but that’s now going back a few years.
There’s also some discussion in the archives of the prevalence of hypopituitarism. (And I remain totally unconvinced by that argument.)
I’d be very interested in what impact the move to computerised requesting has had on this.
Jonathan
On 9 Feb 2018, at 15:49, Steven John Mccann <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Does anyone have an idea what proportion of UK labs (or other for that matter) are using just TSH as their front line test?
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