Vaidya Bijay, Ukoumunne Obioha C, Shuttleworth Joanna, Bromley Alan, Lewis Aled, Hyde Chris, Patterson Anthea, Fleming Simon, Tomlinson Julie
Department of Endocrinology, Royal Devon & Exeter Hospital, Exeter, UK.
Qual Prim Care. 2013;21(3):143-8.
The number of thyroid function tests (TFTs) performed in the UK and other countries has increased considerably in recent years. Inconsistent clinical practice associated with inappropriate requests for tests is thought to be an important cause for this increase.
To study the extent of variability in requests for TFTs from general practices.
We analysed routine data on all TFTs on patients aged 16 years and over carried out by two hospitals in south-west England (Royal Cornwall Hospital and Royal Devon & Exeter Hospital) during 2010 at the request of 107 general practices.
A total of 195 309 TFT requests were made for 148 412 patients (63% female). The total requests included 192 108 tests for thyroid-stimulating hormone (TSH), 43 069 for free thyroxine (FT4) and 1972 for free tri-iodothyronine (FT3). The number of TSH tests per 1000 list size varied widely across the practices, ranging from 84 to 482. Most of the variation was due to heterogeneity across practices and only 24% of this was accounted for by prevalence of hypothyroidism and socio-economic deprivation.
There is wide variation in TFT requests from general practice and scope to reduce both unnecessary TFTs and the variability in the clinical practice. Further studies are required to understand the causes for the variability in testing thyroid function.
近年来，英国及其他国家进行的甲状腺功能测试（TFT）数量大幅增加。与不适当的测试请求相关的不一致临床实践被认为是这一增长的重要原因。
研究全科医疗中甲状腺功能测试请求的变异程度。
我们分析了2010年期间，应107家全科医疗的请求，由英格兰西南部的两家医院（皇家康沃尔医院和皇家德文郡与埃克塞特医院）对16岁及以上患者进行的所有甲状腺功能测试的常规数据。
共对148412名患者（63%为女性）提出了195309项甲状腺功能测试请求。总请求包括192108项促甲状腺激素（TSH）测试、43069项游离甲状腺素（FT4）测试和1972项游离三碘甲状腺原氨酸（FT3）测试。每1000名登记人口的TSH测试数量在各医疗机构之间差异很大，范围从84到482。大部分变异是由于各医疗机构之间的异质性，其中只有24%可归因于甲状腺功能减退的患病率和社会经济剥夺情况。
全科医疗中甲状腺功能测试请求存在很大差异，有减少不必要的甲状腺功能测试和临床实践变异的空间。需要进一步研究以了解甲状腺功能测试变异的原因。
