PMID- 36008599
OWN - NLM
STAT- MEDLINE
DCOM- 20221115
LR  - 20221206
IS  - 1970-9366 (Electronic)
IS  - 1828-0447 (Linking)
VI  - 17
IP  - 8
DP  - 2022 Nov
TI  - Impact of thyroid function screening in a large cohort of patients admitted to an 
      emergency department.
PG  - 2379-2389
LID - 10.1007/s11739-022-03071-0 [doi]
AB  - BACKGROUND: Thyroid dysfunctions are highly prevalent and can worsen underlying 
      cardiopathies, but despite that the routine screening of thyroid function in the 
      Emergency Department (ED) setting is not generally recommended. OBJECTIVE: To 
      understand if staff training and implementation of rapid TSH screening (rTSH) 
      could improve the management of patients arrived in the ED. Specifically, we 
      aimed at evaluating the prevalence of undiagnosed thyroid diseases among ED 
      patients; the effects of educational meetings in the clinical decision-making 
      process; the usefulness of rTSH, in terms of variation of either the clinical 
      work out or the existing treatment. DESIGN: Retrospective case-control study of 
      9227 patients managed in the ED of an academic institution. rTSH was routinely 
      available for all patients, who were divided into rTSH-YES and rTSH-NO groups. 
      RESULTS: We included 4243 and 4984  patients in the rTSH-YES and rTSH-NO group, 
      respectively. Trained personnel uncovered a high prevalence of undiagnosed 
      thyroid dysfunction (7%). The diagnosis in the ED of heart failure, history of 
      thyroid diseases, contrast media/amiodarone administration and female gender were 
      independently associated with an increased likelihood to have thyroid 
      dysfunction. The rTSH improved the clinical outcome by (a) appropriate treatment 
      of an underlying clinical condition causing ED entrance, (b) appropriate 
      prophylaxis in patients requiring contrast media, (c) uncovering incorrect 
      treatments, with 60% of patients on levothyroxine requiring a dose reduction. 
      CONCLUSIONS: The rTSH in the ED revealed a high prevalence of untreated thyroid 
      disorders with a major impact on following interventions. The training of a 
      multidisciplinary team is crucial in driving the correct decision-making process.
CI  - (c) 2022. The Author(s), under exclusive licence to Societa Italiana di Medicina 
      Interna (SIMI).
FAU - Campi, Irene
AU  - Campi I
AUID- ORCID: 0000-0002-0340-9923
AD  - Department of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a 
      Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, San Luca Hospital, 
      Piazzale Brescia 20, 20149, Milan, Italy. i.campi@auxologico.it.
FAU - Perego, Giovanni Battista
AU  - Perego GB
AUID- ORCID: 0000-0001-8735-7851
AD  - Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto 
      Auxologico Italiano, San Luca Hospital, Milan, Italy.
FAU - Ravogli, Antonella
AU  - Ravogli A
AD  - Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto 
      Auxologico Italiano, San Luca Hospital, Milan, Italy.
FAU - Santafede, Francesca
AU  - Santafede F
AD  - IT Service Management, IRCCS Istituto Auxologico Italiano, Milan, Italy.
FAU - Sileo, Federica
AU  - Sileo F
AUID- ORCID: 0000-0001-5732-2228
AD  - Department of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a 
      Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, San Luca Hospital, 
      Piazzale Brescia 20, 20149, Milan, Italy.
FAU - Dubini, Antonella
AU  - Dubini A
AUID- ORCID: 0000-0003-1563-9280
AD  - Department of Laboratory Medicine, IRCCS Istituto Auxologico Italiano, Milan, 
      Italy.
FAU - Parati, Gianfranco
AU  - Parati G
AUID- ORCID: 0000-0001-9402-7439
AD  - Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto 
      Auxologico Italiano, San Luca Hospital, Milan, Italy.
AD  - Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
FAU - Persani, Luca
AU  - Persani L
AUID- ORCID: 0000-0003-2068-9581
AD  - Department of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a 
      Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, San Luca Hospital, 
      Piazzale Brescia 20, 20149, Milan, Italy.
AD  - Department of Medical Biotechnology and Translational Medicine, University of 
      Milan, Milan, Italy.
FAU - Fugazzola, Laura
AU  - Fugazzola L
AUID- ORCID: 0000-0001-5372-0982
AD  - Department of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a 
      Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, San Luca Hospital, 
      Piazzale Brescia 20, 20149, Milan, Italy.
AD  - Department of Pathophysiology and Transplantation, University of Milan, Milan, 
      Italy.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220825
PL  - Italy
TA  - Intern Emerg Med
JT  - Internal and emergency medicine
JID - 101263418
RN  - 0 (Contrast Media)
RN  - 9002-71-5 (Thyrotropin)
SB  - IM
MH  - Humans
MH  - Female
MH  - Retrospective Studies
MH  - Case-Control Studies
MH  - *Contrast Media
MH  - Thyrotropin
MH  - *Thyroid Diseases/complications/diagnosis/epidemiology
MH  - Emergency Service, Hospital
OTO - NOTNLM
OT  - Iodine load
OT  - Levothyroxine overtreatment
OT  - Rehabilitation
OT  - TSH
OT  - Thyrotoxicosis
EDAT- 2022/08/26 06:00
MHDA- 2022/11/16 06:00
CRDT- 2022/08/25 23:33
PHST- 2022/03/28 00:00 [received]
PHST- 2022/07/28 00:00 [accepted]
PHST- 2022/08/26 06:00 [pubmed]
PHST- 2022/11/16 06:00 [medline]
PHST- 2022/08/25 23:33 [entrez]
AID - 10.1007/s11739-022-03071-0 [pii]
AID - 10.1007/s11739-022-03071-0 [doi]
PST - ppublish
SO  - Intern Emerg Med. 2022 Nov;17(8):2379-2389. doi: 10.1007/s11739-022-03071-0. Epub 
      2022 Aug 25.