Promoting resource stewardship: Reducing inappropriate free thyroid hormone testing

Abstract

Inappropriate testing of free thyroid indices occurs frequently. The implementation of a reflex fT4 strategy after education was feasible in reducing overall testing by 49% and was effective in promoting resource stewardship.

Analysis of current thyroid function test ordering practices

“…TSH is a sensitive assay that allows for accurate evaluation of thyroid function and is often the only test required for screening thyroid dysfunction and managing hypothyroidism . Despite this, studies have shown that ordering free thyroid hormones is common but often inappropriate . Reduction of excess TFTs could offer a distinctive opportunity to assist in stemming the tide of rising healthcare costs.…”

“…These results indicate that providers at our institute are often relying on free thyroid hormones as an adjunct to TSH for screening or management of thyroid disorders. These findings are largely consistent with known literature from other countries, which show similar rates of free or total thyroid hormone testing …”

“…At our institute, the laboratory reflexively performs an FT4 analysis with any TSH that results outside the reference range. Reflex testing has long been used as a means to optimize the use of laboratory tests; automatic addition of FT4 reflexively for abnormal TSH laboratory results has been shown to be accurate and effective at reducing unnecessary testing . Interestingly, our review found that there was widespread use of the thyroid panel order (TSH + FT4), which would negate the benefit of reflex testing.…”

“…Patterns including total triiodothyronine and/or total thyroxine are counted in "other" countries, which show similar rates of free or total thyroid hormone testing. [22][23][24][25] The TSH is very sensitive to even mild changes in serum FT4 and is known to develop abnormal levels before FT4 abnormalities are detectable. 28 The American Thyroid Association (ATA) has recommended that TSH alone is the optimal test for screening for thyroid dysfunction.…”

“…[19][20][21] Despite this, studies have shown that ordering free thyroid hormones is common but often inappropriate. [22][23][24][25] Reduction of excess TFTs could offer a distinctive opportunity to assist in stemming the tide of rising healthcare costs.…”