Things We Do for No Reason™: Routine Thyroid-Stimulating Hormone Testing in the Hospital

Wootton, Taylor; Bates, Ruth

doi:10.12788/jhm.3347

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…In the Baladi registry [ 81 ], sinus tachycardia was found in 60.2% of patients, and AF was found in 11.7% of patients. For patients with palpitations and, especially, with de novo AF, thyroid function tests are recommended due to the previously mentioned association and prognostic value [ 82 ].…”

Section: Hyperthyroidism and Cardiac Arrhythmiasmentioning

confidence: 99%

Cardiac manifestations in hyperthyroidism

Navajas¹,

Cruz²,

Ordoñez³

et al. 2022

Rev. Cardiovasc. Med.

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Thyroid hormones have a fundamental impact on cardiac function that is mediated by genomic and nongenomic effects, alterations that condition physiological repercussions that lead to changes in frequency, contractility, rhythm and cardiac output as well as an increase in the incidence and prevalence of different cardiovascular diseases. This document presents an updated review of the implications that hyperthyroidism has in different cardiac conditions, including its importance in the evaluation of perioperative cardiovascular risk.

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Section: Hyperthyroidism and Cardiac Arrhythmiasmentioning

confidence: 99%

Cardiac manifestations in hyperthyroidism

Navajas¹,

Cruz²,

Ordoñez³

et al. 2022

Rev. Cardiovasc. Med.

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“…6 These are among the reasons why the Choosing Wisely initiative dissuades routine TSH testing in hospital. 7 Reduction in testing at a systems level has been studied, 8 but systematic solutions to guide clinicians in appropriate testing are lacking.…”

Section: Introductionmentioning

confidence: 99%

Indications for ordering thyroid‐stimulating hormone in noncritically ill adult inpatients—A Delphi consensus recommendation

Surendran

Lubchansky

Epp

et al. 2022

Journal of Hospital Medicine

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Background: Thyroid-stimulating hormone (TSH) is ordered commonly among inpatients, but the possibility of nonthyroidal illness syndrome challenges interpretation. Objective: Our objective was to obtain Canadian consensus on appropriate indications for ordering TSH in the first 48 h following presentation of a noncritically ill internal medicine patient. Design, Setting and Participants: Canadian endocrinologists with inpatient expertise were invited via snowball sampling to an online 3-round Delphi study. Main Outcome and Measures using a 6-point Likert scale, they rated 58 indications on appropriateness for measuring TSH in medical inpatients. These indications included clinical presentations, signs, and symptoms. Items that reached consensus and agreement (≥80% of participants selecting a rating of 5 or 6 on the Likert scale) were tabulated and dropped after each round. Qualitative analysis of comments identified additional contextual considerations as themes. Results: There were 45 participants (academic setting: 84%) representing 8 provinces (Ontario: 64%). Rounds 2 and 3 were completed by 42 and 33 participants, respectively. Nine indications reached consensus and agreement: presumed myxedema coma, presumed thyroid storm, atrial fibrillation/flutter, euvolemic hyponatremia, proptosis, adrenal insufficiency, hypothermia, thyroid medication noncompliance, and goiter. There was also agreement that two contextual considerations identified in thematic analysis, including a recent abnormal outpatient TSH, and the presence of other findings of thyroid dysfunction, would significantly change some mid-range responses. Conclusions: Canadian experts agreed upon nine specific indications for ordering an inpatient TSH, with others requiring consideration of previous TSH measurement and clinical context.

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Diagnostic stewardship: Improving use of diagnostic tests for better quality and value in hospital medicine

Vaughn,

Morgan

2024

Journal of Hospital Medicine

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Things We Do for No Reason™: Routine Thyroid-Stimulating Hormone Testing in the Hospital

Cited by 3 publications

References 22 publications

Cardiac manifestations in hyperthyroidism

Cardiac manifestations in hyperthyroidism

Indications for ordering thyroid‐stimulating hormone in noncritically ill adult inpatients—A Delphi consensus recommendation

Diagnostic stewardship: Improving use of diagnostic tests for better quality and value in hospital medicine

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