Background and objectives: Thyroid function tests (TFT) are expensive in Nigeria. The reliability of the test is sometimes called into question when at variance with clinical findings. The Waynes clinical index is an old diagnostic index to facilitate objectivity and improve the accuracy of clinical assessment of thyrotoxicosis. This report highlights the unreliability of a TFT result in a case of thyrotoxicosis and the usefulness of the clinical index.
Subject: A 40-year-old cleaner and mother of three presented with 9 years history of anterior neck swelling. There was heat intolerance, excessive sweating, palpitations, generalized weakness and weight loss despite an increased appetite.
|Test type||Results||Reference values|
|Free T3||1.8||35.2 pg/ml|
|Free T4||1.4||0.71.7 pg/ml|
She had a nodular thyroid swelling. No bruit or eye signs. She had tremors of the hands with moist palms. The pulse rate was 104 beats/min. A diagnosis of toxic multinodular goitre was entertained.
Results: Electrocardiogram: Normal sinus rhythm with ventricular rate of 92 beats/min.
Thyroid ultrasound: Conclusion: multinodular goitre.
Fine needle aspiration Cytology: conclusion: toxic diffuse hyperplasia.
Waynes clinical index: Total score=25.
Conclusions: The Waynes index remains a useful diagnostic tool in resource challenged climes in instances when TFT results are at variance with clinical suspicion. Quality control checks should be ensured in Endocrine function test laboratories.