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Functional disorders of the thyroid are among the most common health disorders
with a prevalence of approximately 5% in a general population and an even
higher frequency of occurence in the elderly. During the past decade our
diagnostic approach has undergone a considerable change in that laboratory
tests have become increasingly important in diagnosing asymptomatic stages
of the disease rather than waiting for clinical symptoms to occur. From
a therapeutic point of view, interest has been shifted from treatment options
to preventive measures. Availability of genetic testing of medullary thyroid
carcinoma is an excellent example in this respect because it allows for
reliable diagnosis of the disease long before its clinical manifestation.
As a consequence, patients can be cured by preventive thyroidectomy even
before they have become ill.
The effectiveness of laboratory thyroid tests is of major relevance, as is their appropriate use in a given clinical situation. In the daily practice many generalists and various specialists depend on reliable diagnosis of a thyroid disorder or its definitive exclusion. Fortunately, thyroid tests have considerably improved making this option generally possible. Standards of laboratory practice have been set forward by the relevant societies including the American Thyroid Association, the European Thyroid Association, and also the German Endocrine Society and guidelines for thyroid testing have been issued in order to assure analytical and clinical performance goals for patients as well as to achieve a cost effective use of these techniques. Despite their undisputed usefulness such guidelines may hardly substitute for personal experience and expertise of the thyroid specialist which may dictate deviation from rules in certain situations. In the present report we will give an update on thyroid tests that reflects
the vast experience in dealing with thyroid problems at our university
hospital and provide critical comments on practical aspects of the usage
of various diagnostic tests.
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