Abstract
Background
Previous studies of thyroid stimulating hormone (TSH) levels in Emergency Department
(ED) patients largely have centered on patients with atrial fibrillation (AF). In
our ED patients with AF as well as patients with Psychiatric diagnoses (psych) are
screened. The purpose of the present study was to compare TSH levels in the 2 groups.
Our hypotheses were that an abnormal TSH and/or AF predicted the need for hospital
admission and that TSH is more likely decreased in AF and increased in psych patients.
Methods
Our goal in the study was to compare the use of TSH testing in two ED populations,
AF vs. psych patients. The study was a cross sectional cohort of AF vs. psych patients
who had TSH levels drawn in the ED over a two year period. Our laboratory ranges were
used to determine high vs. low TSH. Two chart examiners collected data after a training
process. Charts were reviewed extracting demographic data, TSH levels, outcome (admit
vs. discharge), history of AF, thyroid disease, psych diagnoses, presence of CHF,
diabetes, hypertension. We compared AF vs. Psych groups using chi square and t-tests for parametric data. Odds ratios were calculated for comparisons between the
2 groups. For non-parametric data Mann Whitney U was used. A logistic regression was
performed with the outcome of admission vs. discharge to find predictors of hospital
admission. Kappa was calculated for inter-rater agreement. An a priori power analysis
showed 80% power with 2 groups of 100 with an absolute difference of 20% between the
2 groups.
Results
252 patients were included, 101 with AF and 152 Psych. Demographics differed in age
only with AF patients being older. Mean TSH for AF vs. 2.4 for AF, 2.9 for psych (NS)
with no differences in percentages with high or low TSH in the 2 groups. Fifty-three
patients had abnormal TSH levels (21%), 27% of AF and 17% of Psych patients (NS).
There were significant differences in incidence of CHF, DM, HTN, and tachycardia with
more in the AF group (P < 0.001). Significantly more of the psych patients had a history
of hypothyroidism (OR 2.28). Our logistic regression showed that taking into account
demographics including age, the only predictors of admission were the presence of
CHF (aOR 18.6) and having a diagnosis of AF (aOR 4.0).
Conclusion
There were no differences in TSH levels between the 2 groups. Twenty-one percent had
an abnormal level. CHF and AF predicted hospital admission on regression analysis.
Many with these AF or Psych diagnoses had abnormal ED TSH levels that could be useful
in diagnosis, maintenance, or continuous treatment for their conditions diagnoses.
Keywords
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Article Info
Publication History
Published online: August 29, 2018
Accepted:
August 28,
2018
Received in revised form:
August 20,
2018
Received:
May 30,
2018
Footnotes
☆Presented at Western Regional SAEM
Identification
Copyright
© 2018 Published by Elsevier Inc.
