Over the past decade it has been generally accepted that the serum thyrotropin (TSH) represents the best biochemical marker of thyroid function when measured using an adequately sensitive assay. Considerable debate centers on the role of other thyroid function tests in supplementing TSH and on the recommendations as to which patients should be tested. In the current cost-conscious era, significant issues focus on cost-effectiveness and medical outcomes. Routine laboratory testing, which has been a mainstay of medicine in the United States for many years, is now being closely scrutinized by both health insurance companies and managed care organizations. Algorithms and guidelines for thyroid function testing have been published by Klee and Hay <sup>20 Klee G.G., Hay I.D. Assessment of sensitive thyrotropin assays for an expanded role in thyroid function testing: Proposed criteria for analytic performance and clinical utility J Clin Endocrinol Metab 1987 ;  64 : 461-471  [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 21 Klee G.G., Hay I.D. Biochemical thyroid function testing Mayo Clin Proc 1994 ;  69 : 469-470

Haga clic aquí para ir a la sección de Referencias</sup> and others, <sup>3 Brody M.B., Reichard R.A. Thyroid screening: How to interpret and apply the results Postgrad Med 1995 ;  98 : 54-56 61–66, 68.

Haga clic aquí para ir a la sección de Referencias, 5 Davey R.X., Clarke M.I., Webster A.R. Thyroid function testing based on assay of thyroid-stimulating hormone: Assessing an algorithm's reliability Med J Aust 1996 ;  164 : 329-332

Haga clic aquí para ir a la sección de Referencias, 8 Feldkamp C.S., Carey J.L. An algorithmic approach to thyroid function testing in a managed care setting Am J Clin Pathol 1996 ;  105 : 11-16

Haga clic aquí para ir a la sección de Referencias, 13 Hamburger J.I., Kaplan M.M. Diagnosis of thyroid dysfunction in ambulatory patients: Primacy of the supersensitive thyroid-stimulating hormone assay Compr Ther 1990 ;  16 : 3-7

Haga clic aquí para ir a la sección de Referencias, 23 Lazarus L. Thyroid function testing and clinical practice guidelines Med J Aust 1996 ;  164 : 324-325

Haga clic aquí para ir a la sección de Referencias</sup> including various medical societies. <sup>2 Becker D.V., Bigos S.T., Gaitan E. , y al. Optimal use of blood tests for assessment of thyroid function JAMA 1993 ;  269 : 2736-2737

Haga clic aquí para ir a la sección de Referencias, 10 Garcia M., Baskin H.J., Feld S. , y al. AACE clinical practice guidelines for the evaluation and treatment of hyperthyroidism and hypothyroidism Endocr Pract 1995 ;  1 : 56-62

Haga clic aquí para ir a la sección de Referencias, 19 Standards of Laboratory Practice: Laboratory Support for the Diagnosis & Monitoring of Thyroid Disease Washington, DC: National Academy of Clinical Biochemistry (1996). 

Haga clic aquí para ir a la sección de Referencias, 25 National Academy of Clinical Biochemistry (NACB) Standards of laboratory practice symposium on thyroid-function testing Clin Chem 1996 ;  42 : 119-192

Haga clic aquí para ir a la sección de Referencias, 28 Singer P.A., Cooper D.S., Levy E.G. , y al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism JAMA 1995 ;  273 : 808-812

Haga clic aquí para ir a la sección de Referencias, 30 Surks M.I., Chopra I.J., Mariash C.N. , y al. American Thyroid Association guidelines for use of laboratory tests in thyroid disorders JAMA 1990 ;  263 : 1529-1532

Haga clic aquí para ir a la sección de Referencias, 31 Vanderpump M.P., Ahlquist J.A. Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism BMJ 1996 ;  313 (7056) : 539-544

Haga clic aquí para ir a la sección de Referencias</sup> These guidelines generally are based on pathophysiologic principles and practice consensus; few have been derived from actual practice outcomes data. Recently, some outcomes studies have been conducted, the results of which support some parts of the guidelines and question others. These issues are reviewed in this article.