Thyroid disease: was rare in hospitalised patients.

Clinical bottom line (level 2a)

  1. Thyroid disease was very rare in hospital in-patients.
  2. A low TSH helped diagnose hyperthyroidism but was insufficient alone.
  3. A high TSH helped diagnose hypothyroidism but was insufficient alone.
Attia et al: Archives of Internal Medicine 1999; 159: 658-665
Expires November 2003

The study

Systematic review of all studies of
  • Patients: hospitalised with acute illness not related to thyroid disease
  • Intervention: TSH
  • Outcome: diagnosing thyroid disease


    • Articles found in English using MEDLINE, 1966 to 1996 (search terms: 'thyroid disease', 'prevalence' and one of 'hospitalized' or 'medical' or inpatient' or 'atrial fibrillation' or 'mental disorder' or 'dementia' or 'geriatrics' ) and bibliographic references of relevant and review articles

    Selection criteria: not detailed
    Appraisal criteria: detailed in text
    Articles excluded if:
    • postpartum
    • <50 patients


    110 articles were found.
    Results were pooled only if studies were not heterogeneous.

    The evidence


    diagnostic test LR
    (95% CI)    		 post-test probability
    target disorder- hyperthyroidism: TSH (mcIU/ml) <0.1 11 34 7.7
    (5.6 to 11)     		%
    0.1 to 0.6 0 124 0.0
    (0.0 to 1.6)     		%
    >0.6 to 6.7 0 103 0.0
    (0.0 to 1.9)     		%
    target disorder- hypothyroidism: TSH (mcIU/ml) >6.7 to 20 0 103 0.0
    (0.0 to 1.1)     		%
    >6.7 to 20 2 30 0.74
    (0.20 to 2.75)     		%
    >20 11 11 11
    (6.0 to 20)     		%
    total . .

    • acute medical ward:
      • prevalence of hyperthyroidism 0.55%
      • prevalence of hypothyroidism 1.0%
    • acute geriatric ward:
      • prevalence of hyperthyroidism 0.32%
      • prevalence of hypothyroidism 0.98%
    • psychogeriatric unit:
      • prevalence of hyperthyroidism 0.15%
      • prevalence of hypothyroidism 1.2%
    • admitted acute medical emergency and atrial fibrillation:
      • prevalence of hyperthyroidism 5.3%
    • atrial fibrillation:
      • prevalence of hyperthyroidism 0.96%
      • prevalence of hypothyroidism 1.5%

    Comments

    1. No studies of clinical features were blinded or prospective and used signs and symptoms assessed by a single clinician.

    Citation

    1. Attia J, Margetts P, Guyatt G: Diagnosis of thyroid disease in hospitalized patients: a systematic review. Archives of Internal Medicine 1999; 159: 658-665
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient hospitalised with acute illness
    Intervention or Exposure TSH
    Outcome diagnosis of thyroid disease