[Initial tests for examining patients with thyroid disorders].

Abstract

To determine what and how many test items are necessary for the initial tests of examining patients with thyroid disorders, a questionnaire was sent to the council members of the Japan Thyroid Association. The thyroid disorders were divided into 4 categories; hyperthyroidism, hypothyroidism, diffuse goiter and nodular goiter. The questionnaire was constructed to ask for; 1) items routinely ordered at the initial examination, 2) items at least necessary among them, 3) the 5 most important items in the order, and 4) selection of only 2 items at most. Finally 112 answers were collected and analyzed. When only 2 items were allowed, they selected TSH and fT4 commonly among hyperthyroidism, hypothyroidism and diffuse goiter, indicating 2 items to be insufficient for differentiation of disorders. While in the case of nodular goiter, ultrasonogram and fine aspiration needle biopsy were selected. The number of routinely ordered items were from 6.62 +/- 2.00 (s.d.) (hypothyroidism) to 8.06 +/- 2.48 (nodular goiter), but much fewer items were chosen to be necessary at least. In hyperthyroidism 4.56 +/- 1.92 items were required, in hypothyroidism 4.39 +/- 1.92, in diffuse goiter 4.93 +/- 1.75, and in nodular goiter 5.15 +/- 2.13, respectively. Most of the function-related items, ultrasonogram and autoantibodies were selected commonly, while TBII and uptake in hyperthyroidism, FNA, Tg and scintigram in nodular goiter were considered to be of specific needs. In summary, 5 or 6 items necessary on the initial tests of examining patients with 4 individual thyroid disorders were proposed.