ArticlePloS one2018
Initial evaluation of thyroid dysfunction - Are simultaneous TSH and fT4 tests necessary?
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Subclinical thyroid dysfunction and incident diabetes: a systematic review and an individual participant data analysis of prospective cohort studies.European journal of endocrinology · 2022Pooled it
- Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis.Thyroid : official journal of the American Thyroid Association · 2020Pooled it
- An individual participant data analysis of prospective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms.Scientific reports · 2020Pooled it
- Thyroid hormones and energy metabolism in amyotrophic lateral sclerosis.Brain communications · 2026Article
- Diagnosis and Characterization of Thyroid Dysfunction in Patients Evaluated in Primary Care in a Rural Zone of Honduras.Journal of community hospital internal medicine perspectives · 2026Article
- Evaluation of Thyroid Hormone Status: Are Simultaneous TSH and FT4 Tests Necessary? Analysis of Thyroid Function Test Results Taken From the Greater Manchester Care Record 2010-2023.Clinical endocrinology · 2025Article
- Differential Impact of Metabolic Factors and Comorbidities on Peripheral Neuropathy.Journal of the peripheral nervous system : JPNS · 2025Article
- Uncovering the Efficacy and Mechanism of Zhenwu Decoction for Hypothyroidism Based on Non-Targeted Metabolomics.Drug design, development and therapy · 2025Article
- Quantitative Diagnosis Progress of Ultrasound Imaging Technology in Thyroid Diffuse Diseases.Diagnostics (Basel, Switzerland) · 2023Review
- Characteristics of Obese Patients with Acute Hypercapnia Respiratory Failure Admitted in the Department of Pneumology: An Observational Study of a North African Population.Sleep disorders · 2022Article
- Redefinition of Successful Treatment of Patients With Hypothyroidism. Is TSH the Best Biomarker of Euthyroidism?Frontiers in endocrinology · 2022Review
- Scintigraphy has the potential to replace thyroid stimulating hormone and ultrasonography in hyperthyroidism diagnosis.Saudi journal of biological sciences · 2020Article
- Subclinical thyroid dysfunction, bone mineral density, and osteoporosis in a middle-aged Korean population.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020Article
- Article
- Pesticides With Potential Thyroid Hormone-Disrupting Effects: A Review of Recent Data.Frontiers in endocrinology · 2019Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveGuidelines for thyroid function evaluation recommend testing TSH first, then assessing fT4 only if TSH is out of the reference range (two-step), but many clinicians initially request both TSH and fT4 (one-step). Given limitations of previous studies, we aimed to compare the two-step with the one-step approach in an unselected community-dwelling study population, and develop a prediction score based on clinical parameters that could identify at-risk patients for thyroid dysfunction.
designCross-sectional analysis of the population-based Busselton Health Study.
methodsWe compared the two-step with the one-step approach, focusing on cases that would be missed by the two-step approach, i.e. those with normal TSH, but out-of-range fT4. We used likelihood ratio tests to identify demographic and clinical parameters associated with thyroid dysfunction and developed a clinical prediction score by using a beta-coefficient based scoring method.
resultsFollowing the two-step approach, 93.0% of all 4471 participants had normal TSH and would not need further testing. The two-step approach would have missed 3.8% of all participants (169 of 4471) with a normal TSH, but a fT4 outside the reference range. In 85% (144 of 169) of these cases, fT4 fell within 2 pmol/l of fT4 reference range limits, consistent with healthy outliers. The clinical prediction score that performed best excluded only 22.5% of participants from TSH testing.
conclusionThe two-step approach may avoid measuring fT4 in as many as 93% of individuals with a very small risk of missing thyroid dysfunction. Our findings do not support the simultaneous initial measurement of both TSH and fT4.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.