Submitted by: sdemir   Date: 2014-11-25 14:03
LABORATORY TESTS OF THYROID FUNCTION: PITFALLS IN INTERPRETATION
Carolyn Fedler

CME July 2006 Vol.24 No.7 Tam metin için tıklayınız

Clinicians rely on the laboratory for quality testing in order to make decisions concerning diagnoses and cost-effective management of thyroid disorders. Because of the diverse clinical presentations of thyroid dysfunction (the majority of thyroid disease symptoms are often subtle and nonspecific in presentation), initial requests for assessing thyroid function are often made.
When the clinical suspicion is strong (e.g. in a patient who exhibits overt symptoms and signs of hyperthyroidism), thyroid function tests are helpful in confirming the diagnosis.
However, situations may occur where clinicians receive ‘abnormal’ test results that appear to be discordant with the clinical findings, and which also occur in the absence of a clearly definable thyroid disease. Such test results may be misinterpreted, the unfortunate outcome being that inappropriate management may be instituted.
Thus, while clinicians may be alert to the possibility of thyroid dysfunction, they may not be familiar with the interpretation of laboratory tests, or with the various factors that can compromise the laboratory tests. Good communication between the requesting clinician and the laboratory is therefore essential for correct interpretation.
Much of the difficulty in diagnosing thyroid dysfunction arises from a lack of awareness regarding the complexities in the biology of thyroid physiology and pathophysiology, limitations of the test methods in terms of diagnostic accuracy, and misunderstanding the meaning of thyroid function results in the clinical context.
This article aims to address these issues by discussing the variables (pre-analytical and analytical – see Table I) that affect the interpretation of test results, in the hope that clinicians will have a better understanding of how to interpret discrepant test results in the clinical context.

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