THYROID EVALUATION OF HOSPITALIZED PSYCHIATRIC-PATIENTS - THE ROLE OFTSH SCREENING FOR THYROID-DYSFUNCTION

The incidence and pattern of changes in thyroid function tests were st udied in acutely hospitalized psychiatric patients and the cost effect iveness of a systematic screening program for thyroid dysfunction was estimated. Thyroid testing was performed on 1275 of 1424 (90%) admissi ons to the psychiatric wing of Strong Memorial Hospital between April 1, 1993 and March 30, 1994. Discharge samples were obtained in 232 pat ients who were hospitalized at least 2 days; 163 patients were admitte d multiple times. Psychiatric diagnosis was coded using DSM-III-R crit eria. TSH, T-4, free T-4, and T-3 levels were measured within 48 h of admission. TSH values were most frequently abnormal (7.8%) and free T- 4 the least (1.3%). Admission and discharge thyroid tests were similar . Significant differences in the four parameters of thyroid function w ere present among the psychiatric groups. By analysis of variance ever y 1 mu U/mL increase in TSH levels was associated with a 2.5% increase in length of stay (LOS) (95% confidence intervals: 0.21%, 4.75%), hol ding psychiatric diagnosis, age, and gender constant. For patients wit h elevated TSH levels, the average LOS was increased by 10.7 days (95% confidence intervals: 2.8, 18.7 days). It is concluded that patients hospitalized for psychiatric illness have an incidence of thyroid dysf unction at or slightly higher than the general population. However, pa tients with elevated TSH levels are hospitalized longer than those wit h normal or suppressed values.