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.