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
Friarage hospital,
Northallerton, North Yorks

Tel 01609 763030
Fax 01609 764632
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