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CitationLæknablaðið 1994, 80(5):169-75
AbstractThe relatively high prevalence of thyroid disorders with their protean symptoms has put thyroid tests in high demand. Due to ever improving thyroid tests, doctors must continually reassess their use of them in diagnosis and treatment. In the present paper we have studied the use of serum thyroid tests among Icelandic doctors and compared it to that of their colleagues in other countries. We studied 7674 thyroid tests performed in a general laboratory during 1987-1990. Referrals came from 31 general practitioners, 4 endocrinologists, 20 internists and 22 other doctors of different specialities. Endocrinologists requested thyroid tests in about 75% of their referrals, general practitioners in about 9% and others in 10-17% of referrals. There was a considerable variation between individual doctors. About 40% of tests from endocrinologists were outside the reference range while 20% of the tests from other doctors were outside that range. Less than 15% of the patients were referred more than once by doctors other than the endocrinologists who referred 26% of the patients more than once. The most common combination of tests was TSH+T4+T3, especially among the general practitioners where it occurred in 56% of requests, but there was a considerable individual variation. The inverse relationship between serum values of T4 and TSH was found to be much stronger than that of T3 and TSH indicating less negative feedback connection between T3 and the pituitary and therefore perhaps less weight as diagnostic test. Results seem to indicate that thyroid tests are used in a similar fashion by Icelandic doctors as by their colleagues in the Scandinavian countries. The search for thyroid diseases seems to be actively conducted by the general practitioners and various physicians who could perhaps use thyroid tests more efficiently if they had the latest information on them more readily available.
Tiltölulega há tíðni skjaldkirtilssjúkdóma og margslungin einkenni þeirra skapa þörf fyrir markvísar og áreiðanlegar mælingar á starfsemi kirtilsins. Nýjar og betri mælingaraðferðir síðustu árin hafa smám saman verið að breyta vali lækna á skjaldkirtilsprófum. Til að fá hugmynd um hvernig íslenskir læknar nota hormónamælingar TSH, T4, FT4, T3 í sermi við rannsókn á skjaldkirtli, höfum við kannað 7674 beiðnir um skjaldkirtilspróf og niðurstöður þeirra sem gerð voru á árunum 1987-1990 á almennri rannsóknarstofu fyrir læknisþjónustu utan sjúkrahúsanna. Algengasta samsetning prófa á beiðnum var TSH+T4+T3, sérstaklega frá heimilislæknum (56%), en breytileiki var mikill. Sérfræðingar í innkirtlafræðum báðu um skjaldkirtilspróf á yfir 70% beiðna, en heimilislæknar á tæpum 9% og aðrir á 10-20% beiðna. Innan við 15% sjúklinga var vísað aftur til skjaldkirtilsmælinga af læknum öðrum en innkirtlalæknum sem vísuðu 26% sjúklinga oftar en einu sinni til mælinga á tímabilinu. Mun nánara samband var á milli sermisstyrks T4 og TSH en T3 og TSH.
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