B1.8: Thyroid Function Testing: Choosing Unwisely in Saskatchewan

Saskatoon Thyroid function testing ordering guideline [works-in-progress]

Background: Thyroid status is associated with longevity. In our province, there are some issues that need to address. 1. Routine thyroid function testing for asymptomatic patients. 2. The next step when TSH testing is normal. 3. Indications to order fT4 and fT3. 4. Tests for subclinical thyroid disorders. 5. Screening suggestions for pregnant women. In addition, setting up and steps to implement the new guideline and financial benefits to our department will be dicussed as well.

Clinical rationales: Routine thyroid function testing is not recommended in asymptomatic patients. The testing is indicated for patients with a clinical presentation consistent with thyroid disease. Tests may be ordered when non-specific symptoms or signs are present in patients with specific risk factors for thyroid disease. There are also steps that need to be taken by GP or specialists: e.g. Only one test needs to be ordered. Laboratory will automatically order fT4 or fT3 if needed.

Further testing recommendations for clinicians: An abnormal TSH level associated with a normal fT4 and fT3 level is likely due to subclinical thyroid disorders. Screening for thyroid disorders should not be performed on hospitalized patients and acute illness phase. The screening should only be done on suspected cases with clinical presentations. The project is still in process. We will include steps to initialize the new guideline and economic significance on our department!