{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:43:42Z","timestamp":1778600622767,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T00:00:00Z","timestamp":1655078400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thyroid\u2010stimulating hormone (TSH) is ordered commonly among inpatients, but the possibility of nonthyroidal illness syndrome challenges interpretation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Our objective was to obtain Canadian consensus on appropriate indications for ordering TSH in the first 48\u2009h\u00a0following presentation of a noncritically ill internal medicine patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting and Participants<\/jats:title><jats:p>Canadian endocrinologists with inpatient expertise were invited via snowball sampling to an online 3\u2010round Delphi study. Main Outcome and Measures using a 6\u2010point Likert scale, they rated 58 indications on appropriateness for measuring TSH in medical inpatients. These indications included clinical presentations, signs, and symptoms. Items that reached consensus and agreement (\u226580% of participants selecting a rating of 5 or 6 on the Likert scale) were tabulated and dropped after each round. Qualitative analysis of comments identified additional contextual considerations as themes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 45 participants (academic setting: 84%) representing 8 provinces (Ontario: 64%). Rounds 2 and 3 were completed by 42 and 33 participants, respectively. Nine indications reached consensus and agreement: presumed myxedema coma, presumed thyroid storm, atrial fibrillation\/flutter, euvolemic hyponatremia, proptosis, adrenal insufficiency, hypothermia, thyroid medication noncompliance, and goiter. There was also agreement that two contextual considerations identified in thematic analysis, including a recent abnormal outpatient TSH, and the presence of other findings of thyroid dysfunction, would significantly change some mid\u2010range responses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Canadian experts agreed upon nine specific indications for ordering an inpatient TSH, with others requiring consideration of previous TSH measurement and clinical context.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.12890","type":"journal-article","created":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T04:08:44Z","timestamp":1655093324000},"page":"865-871","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Indications for ordering thyroid\u2010stimulating hormone in noncritically ill adult inpatients\u2014A Delphi consensus recommendation"],"prefix":"10.1002","volume":"17","author":[{"given":"Anasuiya","family":"Surendran","sequence":"first","affiliation":[{"name":"Department of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Lubchansky","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riley","family":"Epp","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meera","family":"Luthra","sequence":"additional","affiliation":[{"name":"Department of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Sovran","sequence":"additional","affiliation":[{"name":"Department of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4894-3617","authenticated-orcid":false,"given":"Zubin","family":"Punthakee","sequence":"additional","affiliation":[{"name":"Department of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.7.658"},{"issue":"8","key":"e_1_2_7_3_1","first-page":"e210","article-title":"Targeted thyroid testing in acute illness: achieving success through audit","volume":"34","author":"Adlan MA","year":"2011","journal-title":"J Endocrinol Invest"},{"key":"e_1_2_7_4_1","unstructured":"DemersLM SpencerCA. 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