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Family Med EBM Appraisal UST Thyroid Index
Family Med EBM Appraisal UST Thyroid Index
O Diagnosis of hyperthyroidism
M Cross-sectional study
DECISION ANALYSIS
80%
Pretest
probability
10%
90%
Diagnostic
Treatment
threshold
threshold
LITERATURE SEARCH
LITERATURE SEARCH
LITERATURE SEARCH
LITERATURE SEARCH
1. Is it relevant?
1. Relevance Yes
Case Study
Hormonal assays
Comparison FT4, TSH
(FT4, TSH)
Diagnosis of
Diagnosis of
Outcome hyperthyroidism &
hyperthyroidism
hypothyroidism
LR (+) = Sensitivity/1-Specificity
LR (-) = 1-Sensitivity/Specificity
Will the likelihood
ratio shift the
pretest
probability?
Yes
IV. Can the results help me in caring
for my patients?
1. Will the reproducibility of the test result and
its interpretation be satisfactory in my setting? Yes
2. Are the results applicable to my patient? Yes
Age
Female
Clinical Score – 11
(± fine finger tremor, exophthalmos,
moist skin, hyperkinetic movement)
3. Will the results change my management? Yes
80% 95%
Pretest Post test
probability probability
10%
90%
Diagnostic
Treatment
threshold
threshold
Summary
Using the UST Thyroid index (Sn 67.4, Sp 84.3), physicians in low
resource settings may readily diagnose hyperthyroidism and start
treatment even in the absence of FT4 and TSH levels.