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Optimal Use of Blood Tests for Assessment of Thyroid Function FREE

David V. Becker, MD; S. Thomas Bigos, MD; Eduardo Gaitan, MD; John C. Morris, III, MD; Marvin L. Rallison, MD; Carol Ann Spencer, PhD, MT; Masahiro Sugawara, MD; Lester Van Middlesworth, PhD, MD; Leonard Wartofsky, MD
JAMA. 1993;269(21):2736-2737. doi:10.1001/jama.1993.03500210036021
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To the Editor.  —The American Thyroid Association (ATA) in 1990 and 1991 issued guidelines for use of laboratory tests in thyroid disorders.1,2 These ATA position papers update previous recommendations because of the development and availability of improved thyrotropin (thyroid-stimulating hormone [TSH]) methods capable of clearly separating normal from subnormal serum TSH levels. The highly sensitive TSH assay constitutes a practical, useful, and significant laboratory advance in clinical thyroidology. There is agreement among thyroid specialists that measurement of serum TSH level, complemented by an appropriate free thyroxine (FT4) estimate, represents the best and most efficient combination of blood tests for diagnosis and follow-up of most patients with thyroid disorders.Currently in the investigation of thyroid disease there is a trend to replace a combination of tests (eg, total T4 + triiodothyronine resin uptake + FT4 + total T3 + TSH) by a discriminating single thyroid function test. This trend reflects

REFERENCES

Surks I, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH.  American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. JAMA . 1990;; 263:1529-1532.
Hay ID, Bayer MF, Kaplan MM, Klee GG, Larsen PR, Spencer CA.  American Thyroid Association assessment of current free thyroid hormone and thyrotropin measurements and guidelines for future clinical assays. Clin Chem . 1991;;37:2002-2008.
Spencer CA, LoPresti JS, Patel A, et al.  Applications of a new chemiluminometric thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab . 1990;;70:453-460.
Davies PH, Franklyn JA, Daykin J, Sheppard MC.  The significance of TSH values measured in a sensitive assay in the follow-up of hyperthyroid patients treated with radioiodine. J Clin Endocrinol Metab . 1992;;74:1189-1194.
Gaitan E, Cooper DS.  Primary hypothyroidism.  In: Bardin CW, ed. Current Therapy in Endocrinology and Metabolism . St Louis, Mo: BC Decker Inc; 1991;:7578.
Burmeister LA, Goumaz MO, Mariash CN, Oppenheimer JH.  Levothyroxine dose requirements for thyrotropin suppression in the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab . 1992;;75:344-350.

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Surks I, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH.  American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. JAMA . 1990;; 263:1529-1532.
Hay ID, Bayer MF, Kaplan MM, Klee GG, Larsen PR, Spencer CA.  American Thyroid Association assessment of current free thyroid hormone and thyrotropin measurements and guidelines for future clinical assays. Clin Chem . 1991;;37:2002-2008.
Spencer CA, LoPresti JS, Patel A, et al.  Applications of a new chemiluminometric thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab . 1990;;70:453-460.
Davies PH, Franklyn JA, Daykin J, Sheppard MC.  The significance of TSH values measured in a sensitive assay in the follow-up of hyperthyroid patients treated with radioiodine. J Clin Endocrinol Metab . 1992;;74:1189-1194.
Gaitan E, Cooper DS.  Primary hypothyroidism.  In: Bardin CW, ed. Current Therapy in Endocrinology and Metabolism . St Louis, Mo: BC Decker Inc; 1991;:7578.
Burmeister LA, Goumaz MO, Mariash CN, Oppenheimer JH.  Levothyroxine dose requirements for thyrotropin suppression in the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab . 1992;;75:344-350.
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