Fragu P, Alperovitch A, Gardet P, Charbord P, Parmentier C, Tubiana M
Nouv Presse Med. 1979 Nov 19;8(45):3723-7.
A study carried out on 808 patients examined because hyperthyroidism was suspected has shown that the most discriminating thyroid test is the free thyroxin index (FT4) in the plasma. For about 70% of the patients the comparison between the clinical diagnosis made by a clinician at his first interview and the results of FT4, leads one to an accurate assessment of the thyroid function. For the remaining 30% of the patients the assay of triiodothyronin (T3) in the plasma is the best laboratory test; it enables a diagnosis in 20% of those patients. It is therefore only in about 10% of the patients that more sophisticated laboratory tests would be necessary, such as TRH stimulation test and a technetium uptake whenever a scintigraphy is performed. Scintigraphy with technetium is only required to look for a possible toxic adenoma. In summary such a decision tree makes it possible to reduce considerably the cost of the diagnosis.
一项针对808名因疑似甲状腺功能亢进而接受检查的患者进行的研究表明，最具鉴别力的甲状腺检查是血浆中的游离甲状腺素指数（FT4）。对于约70%的患者，临床医生在首次问诊时做出的临床诊断与FT4结果之间的比较，能使人们准确评估甲状腺功能。对于其余30%的患者，血浆中三碘甲状腺原氨酸（T3）的检测是最佳实验室检查；它能在其中20%的患者中做出诊断。因此，仅约10%的患者需要更复杂的实验室检查，如TRH刺激试验以及进行闪烁扫描时的锝摄取检查。仅在寻找可能的毒性腺瘤时才需要进行锝闪烁扫描。总之，这样的决策树可以大幅降低诊断成本。
