{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:43:10Z","timestamp":1777444990723,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Biochem"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thyroid function tests (TFTs) are routinely requested by general practitioners (GPs) in the clinical biochemistry laboratory. Hypothyroxinaemia (low fT4) accompanied by TSH within the reference interval (RI) is a discordant pattern which is seen commonly in non-thyroidal illness and also as result of medications. Hypopituitarism is a lot rarer, but a serious condition the laboratory does not want to miss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All thyroid hormone samples from primary care meeting the discordant case definition under investigation [fT4&lt;10 pmol\/L and TSH within RI (0.3\u20134.2 mU\/L)] had partial anterior pituitary profiles [PAPP (cortisol, oestradiol\/testosterone, prolactin, gonadotrophins)] added as reflex tests and results interpreted by a chemical pathologist. From January to June 2023, we conducted structured interviews with the requesting GPs, and, where indicated, requested repeat samples for full anterior pituitary profile [FAPP (PAPP, growth hormone (GH) and insulin-like growth factor 1 (IGF-1)]. We also reviewed the laboratory records of patients with previously known hypopituitarism to determine their fT4 and TSH values at diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the 6 months 41,487 GP TFTs were requested; 54 (0.13%) fitted the discordant case definition and had PAPP reflexed. 13 FAPPs were requested. We identified 3 cases of hypopituitarism. The number of additional tests required to diagnose 1 case of hypopituitarism was 129. In 74% of reflex-tested cases, there was a plausible explanation for the TFT pattern (medications, known thyroid dysfunction, non-thyroidal illness, pregnancy).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights the importance of medical liaison and early intervention in a biochemistry laboratory in identifying cases of unsuspected hypopituitarism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00045632241298891","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T20:28:48Z","timestamp":1730492928000},"page":"118-125","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of a laboratory reflex testing protocol to detect hypopituitarism in primary care presenting as hypothyroxinaemia"],"prefix":"10.1177","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4329-8260","authenticated-orcid":false,"given":"Colleen","family":"Flannery","sequence":"first","affiliation":[{"name":"Department of Chemical Pathology, Tallaght University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Rakovac","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology, Tallaght University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard","family":"Boran","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology, Tallaght University Hospital, Dublin, Ireland"},{"name":"Clinical Biochemistry Unit, School of Medicine, Trinity College Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,11,11]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"Boran G Moran N Mc Gowan A et al. National Clinical Programme for Pathology. A quick reference guide for use of thyroid function tests in primary care. https:\/\/acslm.ie\/wpcontent\/uploads\/2019\/11\/volume12016nationallaboratoryhandbook.pdf (2019 accessed 10 August 2023)."},{"key":"e_1_3_4_3_2","unstructured":"National Institute for Health and Care Excellence. Thyroid disease: assessment and management NICE Guideline [NG 145]. https:\/\/www.nice.org.uk\/guidance\/ng145\/chapter\/Recommendations#investigating-suspected-thyroid-dysfunction (2019 updated 2023 accessed 19 December 2023)."},{"key":"e_1_3_4_4_2","unstructured":"The Association for Clinical Biochemistry; British Thyroid Association; British Thyroid Foundation. UK guidelines for the use of thyroid function tests. https:\/\/www.british-thyroidassociation.org\/sandbox\/bta2016\/uk_guidelines_for_the_use_of_thyroid_function_tests.pdf (2006 accessed 15 September 2023)."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012.0205"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780198870197.003.0041"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2001.01406.x"},{"key":"e_1_3_4_8_2","first-page":"39","volume-title":"Oxford Textbook of endocrinology and Diabetes","author":"Drake WM","year":"2022","unstructured":"Drake WM, Keevil B, Trainer PJ. Pituitary assessment strategy. In: Wass J, Arlt W, Semple R (eds) Oxford Textbook of endocrinology and Diabetes. 3rd ed. Oxford: Oxford Academic, 2022, pp. 39\u201350.","edition":"3"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2005.039768"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0004563219888541"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1500001"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2020-1696"},{"issue":"2","key":"e_1_3_4_13_2","first-page":"e210119","article-title":"Central hypothyroidism related to antipsychotic and antidepressant medications: an observational study and literature review","volume":"8","author":"Keen F","year":"2022","unstructured":"Keen F, Chalishazar A, Mitchem K, et al. Central hypothyroidism related to antipsychotic and antidepressant medications: an observational study and literature review. 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