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Review: sensitive thyrotropin testing in unselected inpatients has low diagnostic accuracy

Data sources
Studies were identified by searching Medline with the following 2 groups of terms: thyroid diseases, cohort studies, and signs or symptoms; and thyrotropin, hospitalised or medical or inpatient, and sensitivity or specificity. Bibliographies of relevant articles were scanned. Searches were done by 2 different researchers.

Study selection
English-language studies were selected if they enrolled >50 patients. Studies on signs or symptoms were included if they reported sufficient information to allow positive likelihood ratios (+LRs) to be calculated. Studies on sTSH assays were selected if they included patients who were acutely ill or hospitalised with an NTI and if they used second- or third-generation sTSH assays and follow-up after resolution of NTI as reference standards.

Data extraction
2 reviewers independently extracted data on patients, study type, diagnostic standard, follow-up, and number of signs and symptoms. +LRs were calculated. The quality of study methods was assessed by using 3 criteria: follow-up of patients with normal and . . . [Full text of this article]

Douglas C Bauer, MD

University of California at San Francisco San Francisco, California, USA