Urgent Thyroid-Stimulating Hormone Testing in Emergency Medicine: A Useful Tool?

BACKGROUND: Thyroid-stimulating hormone (TSH) has recently been introduced among the tests available to the Emergency Department (ED) of our hospital. OBJECTIVE: To evaluate the prevalence of TSH-level-dependent thyroid dysfunction and to assess the usefulness of urgent TSH testing in a series of emergency patients. METHODS: We planned a single-center observational cross-sectional clinical study. We divided patients in groups according to their thyroid status using defined TSH decision levels. Previously diagnosed history of thyroid dysfunction and newly diagnosed thyroid dysfunctions were differentiated. Further, we analyzed the subset of emergency patients affected by atrial fibrillation (AF) due to the role of hyperthyroidism in AF pathogenesis. For each TSH request, we made a retrospective chart review to assess the usefulness of the test based on clinical efficacy and management efficiency indicators. RESULTS: The present study showed that, although the overall thyroid dysfunction rate was higher than in the general population, only a few newly diagnosed thyroid dysfunctions were found with limited clinical utility. We categorized urgent TSH requests as useful and not useful, by retrospective evaluation, and we identified and compared the main TSH testing clinical indications in the two groups. CONCLUSION: We found a positive impact of urgent TSH determination in emergency decision-making. Nevertheless, a stronger clinical impact could be achieved by improving request appropriateness and by targeting TSH testing to some clinical indications identified by the study. The work was considered a quality-improvement project by the Hospital Committee for Quality Management.

[Thrombophilia risk factors evaluation in a group of Italian patients with deep venous thrombosis]. / Valutazione del rischio trombofilico in una coorte di pazienti con trombosi venosa profonda.

UNLABELLED: Venous thrombosis usually results from coexistence of multiple genetic and acquired risk factors with a trigger condition. In this study the authors report their experience in a cohort of Italian patients with previous venous thrombosis. MATERIAL AND METHODS: We considered 292 consecutive patients. Each patient was studied by using a panel of functional and genetic tests to detect some of the most relevant thrombophilia risk factors. RESULTS: The single most frequent thrombophilia risk factor was activated C protein resistance due to FV Leiden. Tests for anti phospholipids auto antibodies showed reactivity in 62 subjects. CONCLUSION: The great majority (80%) of patients showed almost one thrombophilia risk factor. Presence of multiple risk factors was demonstrated in 128 (44%) patients.