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).|
|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.