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065 - TSH Reflex: the problems

Autor(s): E. Toffalori, S. Demattè, P. Caciagli

Issue: RIMeL - IJLaM, Vol. 5, N. 3-S1, 2009 (MAF Servizi srl ed.)

Page(s): 65-70

Summary
The point of view of the Endocrinologist and the point of view of the Laboratory The utilization of TSH Reflex (TSHR) for increasing appropriateness of thyroid diagnostics is an issue which requires facing strictly scientific aspects as well as management and administration challenges. In 2005, the Department of Laboratory Medicine of the Province of Trento established an interdisciplinary working group on this issue. Its aim has been to develop a shared improvement programme as well as to implement the TSHR in all laboratories. We encountered several problems both before and after the start up phase. The starting point has been the analysis of existing guidelines which led to the identification of the three main clinical situations of the thyroid pathology, the evaluation of the most critical aspects as well as the most useful tests for the different clinical conditions; the definition of the algorithm for the TSHR with the related mode for the request, execution and medical report. Also, the mode of communication and diffusion have has been established, the indicators of improvements have been defined and the controls have been planned. After having been available and utilised in the whole Province for two years, the algorithm is considered by the endocrinologist useful and effective in the assessment of the thyroid function in asymptomatic subjects, in the goitre, in suspected hypo and hyperthyroidism, but inappropriate in several other clinical situations conditions. The real difficulty for the doctor is to know the precise indications of tests which are different for any single patient and in each phase of the thyroid illness. Critical aspects faced by the laboratory in the realization of TSHR have been: the automatic implementation of the cascade of algorithm only upon request of the doctor; the management of the ticket as well as the diffusion of the information to GPs. After two years, the collected departmental results revealed a wide utilization in the whole Province, a general increasing in the appropriate use of the thyroid tests with a lower success for the oupatients.
Key-words: guidelines, thyroid function tests, algorithmic approach.

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