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Effective usage of in vitro tests mandates as a prerequisite to have some
clinical information on the patient and to consider the diagnostic setting.
At least three clinical situations may be discerned.
First, the patient who on clinical grounds is highly likely to have thyroid disease, second, the entirely asymptomatic patient with a low a priori probability of thyroid disease and third, the patient in whom thyroid testing is severely hampered by interfering factors, such as intake of various drugs, and/or the presence of nonthyroidal illness (NTI). With a thyroid disease being clinically unlikely, screening of serum basal thyrotropin (TSH) levels may be the single most effective means of excluding thyroid dysfunction. Indeed, this is the approach we favor. In case of substantial clinical suspicion use of a combination of thyroid in vitro parameters seems to be more appropriate, i.e.
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