We recently had an elderly patient admitted to hospital in a moribund state. The patient was admitted to ITU and the SpR made a clinical diagnosis of Myxoedema Coma. The patient was on Carbimazole for 'thyrotoxicosis'. I was asked for urgent TFTs. As a provisional clinical diagnosis has already been made and treament initiated, I could not see the merit of urgent TFT. They were done the day after and confirmed hypothyroidism. Sometimes it is difficult to know the right approach to these situations. Such requests are likely to be infrequent and if, in my own view, a valid result could be provided with no major extra effort then they should be done. After all it is usually possible to accomodate such request if this was 'during normal working hours' without too much trouble. The important thing is, of course, that treatment should not be withheld pending the laborataory results being available. After all TFTs where not as easily available in the days when Richard Asher described the condition.
Ahmed Waise FRCP FRCPath
Cosultant Chemcial Pathologist
Northallerton, North Yorks
Tel 01609 763030
Fax 01609 764632
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Sent: 21 June 1999 11:01
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Subject: Hypothermia, are TFT's urgent?
An unconscious hypothermic (core temp 31'C) 28y old women was recently
admitted through casualty at 6.0 PM on a Saturday evening.
Urgent investigations were requested (U&E, Glucose, Amylase, CK, LFT
Salicylate & paracetamol & thyroid function tests).
The casualty consultant insisted that the TFT's were done urgently
that evening, as myxoedema could not be excluded as a contributing
cause to her hypothermia. Was the urgency of this request reasonable,
or could the TFT's have been left until Sunday morning or even Monday?
I would be interested to know how other laboratories would approach
this scenario. We did the TFT's that evening.
Nevill Hall Hospital
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