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Analysis of current thyroid function test ordering practices.

Joseph K Kluesner1,2, Darrick J Beckman1,2, Joshua M Tate1,2

  • 1Endocrinology Service, San Antonio Military Medical Center, San Antonio, USA.

Journal of Evaluation in Clinical Practice
|November 7, 2017
PubMed
Summary
This summary is machine-generated.

Current guidelines recommend thyroid stimulating hormone (TSH) alone for thyroid dysfunction monitoring. However, free thyroxine (FT4) and free triiodothyronine (FT3) are often unnecessarily ordered, increasing healthcare costs.

Keywords:
laboratory utilizationresource stewardshipthyroid function test

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Area of Science:

  • Endocrinology
  • Clinical Chemistry
  • Health Economics

Background:

  • Current guidelines advocate for thyroid stimulating hormone (TSH) as the primary test for thyroid dysfunction.
  • Free thyroxine (FT4) and free triiodothyronine (FT3) testing are frequently ordered despite not being clinically indicated.
  • Overutilization of thyroid function tests (TFTs) contributes to rising healthcare expenditures.

Purpose of the Study:

  • To assess the current practices of ordering TFTs within the institution.
  • To identify strategies for reducing the inappropriate ordering of FT4 and FT3 tests.

Main Methods:

  • A retrospective analysis of all TFTs ordered over a 3-month period was conducted.
  • Data were extracted from electronic medical records at the San Antonio Military Health System.
  • Tests analyzed included TSH, FT4, FT3, and combinations, categorized by hypothyroidism status.

Main Results:

  • Out of 28,597 laboratory requests, 36.0% of the 38,214 individual TFTs involved free thyroid hormones.
  • TSH alone constituted 52.14% of requests, while FT4 and FT3 testing accounted for significant portions.
  • Projected annual costs for TFTs reached $317,429, with $107,720 attributed to free thyroid hormone testing.

Conclusions:

  • Inappropriate ordering of free thyroid hormone tests is prevalent.
  • Reducing unnecessary TFTs presents an opportunity to decrease laboratory overutilization and associated costs.
  • Further research is needed to implement effective strategies for minimizing excessive thyroid hormone testing.