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Free the T3: Implementation of Best Practice Advisory to Reduce Unnecessary Orders

Published:September 01, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.07.018
      Thyroid function tests (TFTs) are commonly overused and amount to 1.6 billion dollars annually in health care spending in the United States.
      • Dalal S
      • Bhesania S
      • Silber S
      • Mehta P
      Use of electronic clinical decision support and hard stops to decrease unnecessary thyroid function testing.
      ,
      • Taher J
      • Beriault DR
      • Yip D
      • Tahir S
      • Hicks LK
      • Gilmour JA
      Reducing free thyroid hormone testing through multiple Plan-Do-Study-Act cycles.
      Although national guidelines recommend a thyroid-stimulating hormone (TSH)-centered approach, clinicians often inappropriately order triiodothyronine (T3) and thyroxine (T4).
      • Taher J
      • Beriault DR
      • Yip D
      • Tahir S
      • Hicks LK
      • Gilmour JA
      Reducing free thyroid hormone testing through multiple Plan-Do-Study-Act cycles.
      This may be due to lack of knowledge or ease of ordering all 3 tests at once in premature anticipation of an abnormal TSH.

      Choosing Wisely Canada. Understand the gland: a toolkit for appropriate ordering practice of free thyroid hormone testing. Available at: https://choosingwiselycanada.org/toolkit/understand-the-gland/. Accessed September 5, 2022.

      Additionally, clinicians order free T3 rather than total T3, despite the American Thyroid Association's recommendations to avoid free T3 due to its high rate of variability.
      • Ross DS
      • Burch HB
      • Cooper DS
      • et al.
      2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis.

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        Reducing free thyroid hormone testing through multiple Plan-Do-Study-Act cycles.
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      1. Choosing Wisely Canada. Understand the gland: a toolkit for appropriate ordering practice of free thyroid hormone testing. Available at: https://choosingwiselycanada.org/toolkit/understand-the-gland/. Accessed September 5, 2022.

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