Utility of Thyroid Function Testing in the Inpatient Setting.

Area of Science:

• Endocrinology
• Internal Medicine
• Clinical Pathology

Background:

• Previous research indicates low utility of inpatient thyroid function tests (TFTs).
• Few TFTs result in significant clinical management alterations.

Purpose of the Study:

• To assess the frequency of medication initiation or adjustment following inpatient TFTs.
• To determine if testing indications influence medication change rates.

Main Methods:

• Retrospective observational study of 2278 patients undergoing TFTs during hospitalization.
• Clinical documentation reviewed to ascertain TFT indications.
• Abnormal TFT results analyzed for medication initiation or adjustment.

Main Results:

• 15.1% of abnormal TFTs led to medication changes when indicated by a history of thyroid disease.
• 12.2% of abnormal TFTs led to medication changes when thyroid dysfunction was suspected.
• Only 6.0% of abnormal TFTs led to medication changes for non-thyroid related indications.
• Overall, 2.8% of all tested patients and 10.1% of those with abnormal TFTs experienced medication initiation or adjustment.

Conclusions:

• Abnormal TFTs are common, but a low percentage indicate clinically significant thyroid dysfunction requiring management changes.
• Inpatient providers require education to optimize TFT ordering for clinically indicated scenarios.
• Targeted TFT use is recommended to improve cost-effectiveness and patient outcomes.