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Related Experiment Video

Updated: Sep 20, 2025

Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
05:41

Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis

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Improving laboratory stewardship through benchmarking: A focus on thyroid function tests ordering.

Ka Keung Chan1, Suhhyun Kim2, Patrick C Mathias3

  • 1Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA 98195, United States; Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, United States.

Clinical Biochemistry
|May 28, 2025
PubMed
Summary
This summary is machine-generated.

Thyroid function testing efficiency improved with a TSH-first reflex algorithm, stabilizing test ratios. However, specialty-specific ordering patterns for thyroid-stimulating hormone (TSH) and free thyroxine (fT4) tests indicate persistent differences.

Keywords:
BenchmarkingLaboratory stewardshipMetricTSH reflex algorithmThyroid function testsUtilization

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Area of Science:

  • Endocrinology
  • Laboratory Medicine
  • Health Services Research

Background:

  • Thyroid function tests, including TSH and fT4, are frequently ordered.
  • Understanding utilization trends and optimizing ordering patterns is crucial for efficient healthcare.

Purpose of the Study:

  • To evaluate longitudinal trends in thyroid testing utilization (2009-2023).
  • To assess the impact of a TSH-first reflex testing algorithm on fT4 ordering.
  • To examine specialty-specific differences in thyroid test ordering under PLUGS guidelines.

Main Methods:

  • Analysis of TSH and fT4 test volumes from 2009-2023.
  • Evaluation of TSH/fT4 ratio and fT4 tests linked to abnormal TSH.
  • Assessment of specialty-specific ordering patterns and adherence to reflex testing.

Main Results:

  • Significant increases in both TSH and fT4 test volumes observed.
  • TSH-first reflex algorithm implementation stabilized TSH/fT4 ratio around 3.7.
  • Percentage of fT4 tests with abnormal TSH increased from 26% to 39%; primary care showed higher adherence.

Conclusions:

  • Reflex testing improved thyroid test utilization efficiency, aligning with PLUGS benchmarks.
  • Specialty-specific variations in thyroid testing persist, requiring tailored approaches.
  • Laboratory stewardship and consensus benchmarks enhance appropriate thyroid function testing.