Dr. A. Velumani’s Personal Blog

Is Thyroid in Clinical Laboratory an Android?

Friends,

I heard the word, Thyroid in 1982 for the first time after reaching adulthood. I was asked in my BARC interview, where is Thyroid and I could not answer. However, I got a job because I answered majority of other questions asked; and was posted in RMC, a division of BARC that was specialising in diagnosis and treatment of Thyroid disorders, in Sept 1982. I got fascinated to read – Anatomy, physiology, biology, biochemistry, biotechnology – all for learning and understanding – Thyroid as an endocrine gland and its relationship with Pituitary and also all living cells in body. That institute permits, facilitates and promotes “Research in Thyroid” and that helped me to do MSc in Thyroid Biochemistry and PhD in Thyroid Pathophysiology – Both from Mumbai University. It says – in 1982 I did not know where is Thyroid, in 1992, I finished my PhD in Thyroid and in 2002, I run world’s Largest Thyroid testing laboratory. My entry into “Thyroid” as domain for learning science and technology while working, and my entry in “Thyroid” as focused business for learning business and growing – is all fortunately – Time and Timing.

Let us analyse in what way Thyroid disorders and Thyroid testing technology were unique or demanding.

Thyroid hormones were not easy to test in 1995 because it used Radioactivity in the technology (Radioimmunoassay, RIA) which demanded training, licensing and also manual, cumbersome procedures for a pathologist compared to autoanalysers for photometry tests or cell counter for hematology. Also, RIA is a quantitative test (not a qualitative test) that needs calibrators and controls to be run every time even if just 2 samples are to be tested. Without 50 samples in the same batch, testing was proved to be costly without compromising on quality. Problem was Thyroid testing was not as popular as Sugar testing – only 2 samples per day per 5 km radius needed Thyroid testing. Even awareness was too low for Thyroid disorders in 1990s. Thus, laboratory managers had to pool samples for a fortnight or a month – or give it to other laboratories who are pooling for the region. Thus, a support of 50 laboratories were needed for the 100 samples per day for RIA to be a cost-effective method. Instruments were cheaper to buy and maintain, so pooling for 50 labs proved to be viable.

Then, came Chemiluminescence based Immunoassay – popularly known as CLIA – a fully automated analyser. This instrument is costly to buy – good and new machine costs around a crore, and to maintain it costs a fortune. It also has a capacity to produce 200 tests per hour. But a limitation now is, it needs 1000 tests per day to make it viable and that needs support of 200 labs without which it is a white elephant. India has as on today around 2500 CLIA analysers. Only 300 of them do more than 2000 tests a day (out of which 80 are with Thyrocare); remaining with national players and some regional players. Also, for hospitals one needs 500 beds to produce 1000 tests per day (if all are forced to undergo Thyroid tests) and hence 100 or less bedded hospitals find it difficult to justify.

Thus, the technology is forcing to outsource them from “P” – a laboratory owner who is compelled to pool for producing the prosperity out of the asset. Now comes, where to outsource – Local P or Regional P or National P. Thyroid fortunately is not an acute illness. It is metabolic in nature and thus has enough time. Same day reporting was used as a tool to get a better load – against cost and quality issues. However, customer today has understood quality is more important than speed.

There are around 5000 Thyroid testing laboratories in the country in 2016, (it was only 150 in 1995) in which 4000 of them have less than 50 tests per day, 400 of them have 500 tests per day, 40 of them have around 5000 tests per day and only 4 of them have around 50,000 tests per day. Thyrocare, since the focus is on Thyroid, processes in a night around 100,000 thyroid tests. All laboratories fight for Thyroid volumes so much, today TSH has becomes cheaper than blood sugar in many laboratories. In fact the definition goes like this:  “If TSH is single largest in volume” it is called as big laboratory – whereas if “Blood sugar is the single largest in volume” it is said to be a small laboratory. It is not only in India, be it any country – developed or developing – Asians or Americans – in all big laboratories single largest test is “TSH” and that makes – Thyroid as tall as Android.

Why only laboratories study the Vendors for their Thyroid volumes – for Siemens or Abbott or Roche or Beckman – all have it leading from front. What makes it so tall is, there are “no” reports, I had read in last 30 years of focused Thyroid journey, that say people die because of Thyroid Dysfunction. Thyroid does a simple job of converting mass into energy in the body. Scientifically – it helps AMP (discharged battery) to become ATP (charged battery) by catalysing phosphorylation (charging). Thus, man becomes stamina less and energy less when Thyroid does not function adequately. In human population, 2% have Thyroid disorders and since the symptoms are vague, we need to screen 20% population to identify this 2% and also because once Thyroid deficiency is seen, there are 90% chances he/she will be lifelong deficient and therefore needs lifelong monitoring too.

Any individual goes to a hospital with either metabolic illness, pregnancy, infertility or dozens of other reasons for Thyroid testing. And, Wellness testing means – without Thyroid testing, it is not at all a wellness testing, that is why it occupies an “Android” position. I did focus on Thyroid thinking, that I only know Thyroid, let me do it better – but today a 3300 crore brand in National stock exchange – for a Brand around a Gland makes me to reaffirm, it is indeed an “Android” effect in Pathology.

Be Focused. Be Blessed. Be Connected.

Scroll to Top