Choosing Wisely:

Don’t order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order TSH, and if abnormal, follow up with additional evaluation or treatment depending on the findings.

Rationale and Comments: The TSH test can detect subclinical thyroid disease in patients without symptoms of thyroid dysfunction. A TSH value within the reference interval excludes the majority of cases of primary overt thyroid disease. If the TSH is abnormal, confirm the diagnosis with free thyroxine (T4).
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • U.S. Preventive Services Task Force
  • Disciplines:
  • Endocrinologic
  • References: • Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. ATA/AACE guidelines for hypothyroidism in adults. Endocr Pract. 2012;18(6):988-1028.
    • Dufour DR. Laboratory tests of thyroid function: uses and limitations. Endocrinol Metab Clin North Am. 2007;36(3):579-94, v.
    • U.S. Preventative Services Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med. 2004;140(2):125-7.

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