Women's College Hospital - Health Care for Women, Revolutionized

Jump to body content

When less is more: reducing unnecessary thyroid testing

October 2, 2017

By Hayley Baranek and Jennifer Lee

Lab testing for thyroid hormone levels is used to diagnose thyroid disease and to understand how patients respond to treatment. The most commonly ordered tests are thyroid stimulating hormone (TSH) and free thyroid hormones, namely triiodothyronine (fT3) and thyroxine (fT4).

One issue identified by Choosing Wisely Canada, a national campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments and procedures, is that testing for free thyroid hormone levels (fT3 and fT4) occurs often and doesn’t actually help clinicians diagnose or treat thyroid disease in the majority of cases. Rather, the TSH test on its own can provide doctors with enough information.

To understand if it would be possible to reduce some of this unnecessary testing, Dr. Geetha Mukerji, WIHV Clinical Lead in Quality and endocrinologist at Women's College Hospital (WCH), along with a group of engaged post-graduate endocrine trainees, spearheaded a quality improvement initiative. By educating healthcare providers on when fT3 and fT4 tests should be ordered and setting up a system in the lab whereby requests for free thyroid hormone tests would only be processed if there was a stated clinical reason for it, the team looked at whether this would help.

The results were dramatic. Over a period of six months, the team found that fT4/fT3 testing was reduced by 54 per cent. At the same time, WCH benefited from cost-savings, providers reported higher levels of satisfaction with testing and there were no adverse issues. Due to the success of this intervention, St. Michael’s Hospital (SMH) and University Health Network (UHN) have now started using a similar approach.

“When you can find a solution that requires limited resources to implement and leads to sustainable changes, there is an opportunity to spread it to other centers to promote high-value care,” says Dr. Geetha Mukerji.

Results were published in the Journal of Evaluation in Clinical Practice earlier this year and a toolkit co-authored by Dr. Geetha Mukerji and Dr. Julie Gilmour called Less is More with T3 and T4, is now available from Choosing Wisely Canada. The hope is that the new toolkit will support scaling this approach further across the healthcare system.

Jump to top page

More News & Media »

Media inquiries

Please contact Media Relations

Email: media@wchospital.ca

Phone: 416-323-6400 ext. 4054


Media Kit

Please visit our Media Kit page for resources such as images, B-roll video and backgrounders on Women's College Hospital.

  • Fully affiliated with:
  • University of Toronto
  • A member of:
  • Council of Academic Hospitals of Ontario (CAHO)