Coventry area people, this is why you can’t get a full TFT!

Taken straight from the Pathology Department’s current Handbook:

"TSH only. If the TSH is outside set limits (>10 mU/L or <0.1mU/L then a free thyroxine (FT4) will be automatically undertaken. FT4 on other samples and FT3 will be added if the clinical details and TSH/FT4 results warrant it. Full clinical details are essential for this algorithm to work. If you regularly request a certain group of tests to monitor certain patients, we may be able to set up a special profile for you. Please contact Biochemistry to discuss."

It does rather sound as if the Lab makes the decision of what tests you get, which is what we always suspected, but equally it seems that a GP may be able to get round this with the will and the determination.

What I don’t understand is why they can talk about ‘the set limits’ and ‘>10mU/L’ in the same breath when the reference range for TSH at this hospital is!


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5 Replies

  • Ask them how on that criteria they will diagnose patients with Central / 2ndary hypothyroid or tertiary hypothyroid that most GPs do not even know exists

  • My local hospital is setting up a similar algorithm (code on the equipment). I have hassled the biochemist over recent years and they now do the full test. It sounds like your hospital also uses an automated decision process, untouched by human hands. The only way to prevent this is to complain, very politely at first and then forcefully.

  • I have complained repeatedly over the years, but they still insist that the FT3 test is of, and I quote, "little diagnostic value."

  • the way I circumnavigated the attitude of the lab was to recruit our gp [ who is superb ] who then informed the lab directly that ANY TESTS that he had requested that were not carried out [ and remember he pays for within his own trust fund ] that they do not carry out and then leads to further medical complications THEY WOULD BE HELD LEGALY RESPONSIBLE FOR ....... that put the fear of Christ up them so much that EVERY TIME OUR GP REQUESTS ANY BLOOD TEST THEY ARE CARRIED OUT TO HIS EXACT INSTRUCTIONS has helped him enormously to actually treat his patients optimally for his and their betterment [not only in thyroid problems -- because this also happens in other conditions ] ........just proves that there are ways and means if ALL are singing from the same songsheet........ another good reason to have a good , understanding gp ......alan x

  • how has it reached the stage that Labs make the decisions that overrule Doctors requests or instructions?

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