Mori T, Sugawa H, Akamizu T, Kosugi S, Okuda J
Department of Laboratory Medicine, Kyoto University School of Medicine, Japan.
Endocr J. 1996 Apr;43(2):197-204. doi: 10.1507/endocrj.43.197.
In order to determine what and how many test items are necessary for the initial tests when examining patients with thyroid disorders, a questionnaire was sent to the council members of the Japan Thyroid Association. Thyroid disorders were divided into 4 categories; hyperthyroidism, hypothyroidism, diffuse goiter, and nodular goiter. The questionnaire was designed to assess: 1) tests routinely ordered at the initial examination; 2) minimum test battery necessary; 3) the 5 most important tests in order; and 4) selection of only 2 tests at most. The data on 112 completed questionnaires were collected and analyzed. When the choice was limited to only 2 tests, TSH and fT4 were commonly selected for hyperthyroidism hypothyroidism and diffuse goiter, but these 2 tests would be insufficient for the differentiation of disorders. In the case of nodular goiter, ultrasonogram and fine needle aspiration biopsy (FNA) were selected. The mean number of routinely ordered tests was 6.62 +/- 2.00 (S.D.) for hypothyroidism and 8.06 +/- 2.48 for nodular goiter, but many fewer tests were cited as absolutely necessary. In hyperthyroidism, 4.56 +/- 1.92 tests were required, in hypothyroidism 4.39 +/- 1.92, in diffuse goiter 4.93 +/- 1.75, and in nodular goiter 5.15 +/- 2.13. Most of the function-related tests, ultrasonogram and autoantibodies were commonly selected, while TBII and thyroid 123I or 99mTcO4 uptake in hyperthyroidism, and FNA, Tg and scintigram in nodular goiter were considered to be for specific purposes. Summarizing all these, the authors propose 5 or 6 tests to be necessary as the initial tests when examining patients with 4 individual thyroid disorders.
为了确定在检查甲状腺疾病患者时，初次检查需要哪些以及多少项检测项目，向日本甲状腺协会的理事会成员发放了一份调查问卷。甲状腺疾病分为4类：甲状腺功能亢进症、甲状腺功能减退症、弥漫性甲状腺肿和结节性甲状腺肿。该调查问卷旨在评估：1）初次检查时常规开具的检测项目；2）所需的最少检测组合；3）按重要性排序的5项最重要检测项目；4）最多仅选择2项检测项目。收集并分析了112份完整问卷的数据。当选择仅限于2项检测项目时，促甲状腺激素（TSH）和游离甲状腺素（fT4）通常被选用于甲状腺功能亢进症、甲状腺功能减退症和弥漫性甲状腺肿，但这2项检测不足以区分疾病。对于结节性甲状腺肿，选择了超声检查和细针穿刺活检（FNA）。甲状腺功能减退症患者常规开具的检测项目平均数量为6.62±2.00（标准差），结节性甲状腺肿患者为8.06±2.48，但被认为绝对必要的检测项目要少得多。甲状腺功能亢进症需要4.56±1.92项检测，甲状腺功能减退症需要4.39±1.92项，弥漫性甲状腺肿需要4.93±1.75项，结节性甲状腺肿需要5.15±2.13项。大多数与功能相关的检测、超声检查和自身抗体通常被选中，而甲状腺刺激性抗体（TBII）以及甲状腺疾病中甲状腺123I或99m锝高锝酸盐摄取用于甲状腺功能亢进症，结节性甲状腺肿中的FNA、甲状腺球蛋白（Tg）和闪烁扫描则被认为用于特定目的。总结所有这些情况，作者提议在检查患有4种不同甲状腺疾病的患者时，初次检查需要5或6项检测项目。
