This question often worries patients. So one of the patients asked me again at the FB: “In which laboratory is it better and more reliable to take tests for thyroid hormones? I have passed everything in several and the results are all different. In one clinic, the AT to TPO is within normal limits, in the other AT to Thyroglobulin and etc. " What are the signs of a better lab? Or which labs are better? Where is the list?
Introduction. About what allows me, the doctor, to make a conclusion about the laboratories.
Somewhere since 2006, I almost every weekday (and even during the vacation period, as now) constantly study the forms of various laboratories from patients with thyroid diseases. And it's not about the years (period) of experience. I analyze each case, trying to be sure to understand what each blood indicator and all of them together indicate. Of course, all laboratory information must be understood together with the essence of the development of the disease, and changes in the thyroid gland, detected by ultrasound, which I spend on my own.
During the direct diagnosis in our Clinic of the thyroid gland, I study the history of changes in hormonal metabolism, according to the numerous forms and medical records that patients bring to the reception.
Of course, at the same time I always pay attention to the characteristics of each laboratory - standards (reference values), dates, dynamics of blood parameters, and so on.
This allowed us to become a leading specialist in this direction and transfer this knowledge to colleagues and patients. In this case, through monographs and popular science publications (for example, the patient’s book “Blood Test for Thyroid Diseases” (another such book does not exist on this topic all over the world; which indicates the primitiveness and stereotyped diagnosis - only for TSH) ).
(All this I’m writing is not for advertising. Many readers are cautioned about advertising and see it in everything. All this information is provided so that the reader who first learned about our Clinic and our direction in medicine can orientate itself).
As a result, 26 clinical variants of euthyroidism were revealed, up to 16 variants of hypothyroidism and 4 variants of hyperthyroidism, based on three blood parameters - TSH, T3fr. and T4fr. The classification оf these hormonal conditions and the structure of the clinical (not general, formal) diagnosis are created.
How other doctors diagnose according to a blood test
Almost all specialists (endocrinologists) in our country carry out a routine diagnosis. Very many determine only one blood indicator - TSH, and the state is called by its value (only 5 options: euthyroidism, subclinical or manifest hypothyroidism / hyperthyroidism; these names have been repeatedly criticized in the scientific press as not corresponding to reality).
Some doctors determine TSH and T4fr., but also uses the indicated 5 names of the conditions, and prescribe the drug according to TSH.
A very small amount along with TTG and T4fr. determine T3fr. or general fractions of hormones, but, as you can see, all the same, in its conclusions and appointments, it uses mainly the TSH value.
How was and still is in my medical practice
In my many-year practice (more than 10 years of intensive analytical and diagnostic activity in the field of thyroid diseases), I only twice met blood test data, which he could interpret as a laboratory error or negligence. In all other cases, when patients and even doctors had questions about what, in their opinion, the laboratory assistants had "screwed up", my careful analysis of the clinical situation revealed facts in the lives of patients that affected the result of the blood test, which is sensitive under certain conditions of the body to overburdens and diseases, which affected the changes in the values of TSH, T4fr., T3fr. and antibodies - AT-TPO, AT-TG, AT-rTTG.
Almost all of these cases were during consultations, when each patient explained why laboratories gave such a result.
OUTPUT.
Almost all modern laboratories provide reliable blood test data.
There are particular qualities. For example, the leading private laboratory “Invitro” and some others do not determine the number of antibodies AT-TPO more than 1000 units, which limits the accuracy of my medical assessment (for example, with the present treatment, leading to regenerative restoration of thyroid tissue, the number of antibodies decreases; If AT-TPO was 2500, then a decrease to 1100 will not be visible).
Unit laboratories formed an inconvenient location of the data on the form. In particular, this applies to very small print and date layout.
Personally, I, as a practicing doctor, have a proposal (on a Health Ministry level) to create a uniform for all laboratories and convenient for practice sample laboratory form of blood analysis, which will create convenience in orientation during diagnosis.
A considerable part of state laboratories do not have the ability to determine important blood parameters (in particular, T3fr.). Or perform them longer than this requires the capabilities of modern laboratory equipment.
I suggest that all patients specify in advance the possibility of determining the set of blood parameters necessary for the diagnosis and the timing of their implementation. Use all modern laboratories without fear of unreliable research results.