Jarløv A E, Nygaard B, Hegedüs L, Hartling S G, Hansen J M
Department of Internal Medicine and Endocrinology F and Ultrasound, Herlev Hospital, Denmark.
Thyroid. 1998 May;8(5):393-8. doi: 10.1089/thy.1998.8.393.
Three endocrinologists assessed thyroid function (hypothyroid, possibly hypothyroid, euthyroid, possibly hyperthyroid, or hyperthyroid), thyroid size (small, medium, or large), thyroid type (diffuse, nodular, or solitary nodule), and diagnosis and treatment options in 55 patients (47 women and 8 men) with a median age of 43 years (range 19 to 74) suspected of thyroid disease. The observers were presented stepwise for the (1) patient, clinical examination, and patient history; (2) blood tests; (3) 99mTc-pertechnetate scintigraphy; and (4) ultrasonography. The reproducibility was assessed by means of the K coefficient. Compared with evaluation of the patient alone, agreement on thyroid dysfunction was almost perfect when the results of the blood tests were known. The K values for pairs of observers rose significantly from 0.55 to 0.65 to 0.88 to 0.93. All three observers altered their opinion as to thyroid dysfunction in one third of the patients when the blood tests were known. Compared with evaluation of the patient alone, agreement on the morphology of the thyroid gland did not improve significantly in spite of access to thyroid scintigraphy; with the addition of thyroid ultrasound, agreement improved significantly for some pairs of observers. The three observers agreed on the rough estimate of thyroid size in only 36% of the patients. When all information was available, the three observers agreed on diagnosis and treatment category in 60% of the patients. Doctors should bear in mind the considerable observer variation when they evaluate patients with suspected thyroid disease.
三位内分泌专家对55例疑似甲状腺疾病的患者（47名女性和8名男性）进行了甲状腺功能（甲状腺功能减退、可能甲状腺功能减退、甲状腺功能正常、可能甲状腺功能亢进或甲状腺功能亢进）、甲状腺大小（小、中或大）、甲状腺类型（弥漫性、结节性或孤立性结节）以及诊断和治疗方案的评估，这些患者的中位年龄为43岁（范围19至74岁）。观察人员按以下步骤依次查看：（1）患者、临床检查和患者病史；（2）血液检查；（3）99m锝高锝酸盐闪烁扫描；以及（4）超声检查。通过K系数评估再现性。与仅对患者进行评估相比，当知晓血液检查结果时，对甲状腺功能障碍的一致性几乎达到完美。观察者对之间的K值从0.55显著上升至0.65，再到0.88，最后到0.93。当知晓血液检查结果时，所有三位观察者在三分之一患者的甲状腺功能障碍问题上改变了看法。与仅对患者进行评估相比，尽管有甲状腺闪烁扫描检查，对甲状腺形态的一致性并未显著改善；在增加甲状腺超声检查后，部分观察者对之间的一致性显著提高。三位观察者仅在36%的患者中对甲状腺大小的粗略估计达成一致。当所有信息都可用时，三位观察者在60%的患者中对诊断和治疗类别达成一致。医生在评估疑似甲状腺疾病的患者时应牢记存在相当大的观察者差异。
