Unnecessary Thyroid Testing is Leading to Overtreatment in Manitoba eHealth Services

Thyroid cancer is uncommon (5% of all cancers) and among the least deadly cancers (0.3% mortality). Following key Choosing Wisely Canada recommendations from the Canadian Society of Endocrinology and Metabolism, CWMB is establishing a project that will address the inappropriate use of thyroid related lab and imaging tests and procedures (TSH, free T4, free T3, anti-TPO, ultrasound, fine needle aspirates and biopsies) that lead to unnecessary treatments for patients.

Choosing Wisely Canada/Canadian Society of Endocrinology and Metabolism Recommendations:

  • Don’t order thyroid function tests in asymptomatic patients
  • Don’t routinely order free T4 or T3 to screen for hypothyroidism or to monitor or adjust levothyroxine (T4) dose in patients with known hypothyroidism.
  • Don’t routinely test for Anti-Thyroid Peroxidase Antibodies (anti-TPO)
  • Ultrasound is not recommended as part of routine evaluation of abnormal thyroid cuntion (in the absence of a large goiter or lumpy thyroid); incidentally discovered thyroid nodules are common and can divert clinical attention from the thyroid dysfunction.