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Thyroid Cascade

Wednesday, January 31, 2018

In support of the Choosing Wisely1 campaign, the American Society for Clinical Pathology (ASCP) released a recommendation in 2015 stating:

Don’t order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order thyroid-stimulating hormone (TSH), and if abnormal, follow up with additional evaluation or treatment depending on the findings.

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).2

This position is also supported by the Endocrine Society.3

Laboratory Alliance offers a Thyroid Cascade which offers benefits to both providers and patients. The cascade begins with TSH and if abnormal, reflexively orders Free T4. If the Free T4 is normal, the cascade reflexively orders Free T3. For the provider, an order placed for Thyroid Cascade simplifies the mechanism to order the correct first test and the subsequent additional tests required for follow up of patients with abnormal TSH. For the patient, up to three sequential tests can be performed from a single phlebotomy without the need for return visits or additional blood to be drawn for follow-up testing.

Test Name:

Thyroid Cascade

Test Code:

THCS

Test Description:

TSH is performed.

If TSH is abnormal, Free T4 is performed.

If Free T4 is normal, then Free T3 is performed.

Specimen Requirements:

One 5 mL gold (SST) top tube.

Also acceptable: heparinized plasma.

Stability:

Refrigerated: 7 days.

Testing Schedule:

Daily

Billing Code:

1010102

CPT Code:

84443 (If reflexed, 84439 and 84481)

Method:

LOCI (Local Oxygen Capture Immunoassay)

 

 

 

 

 

 

 

 

 

 

 

 

 

References:

1.  Choosing Wisely: An Initiative of the ABIM Foundation, http://www.choosingwisely.org/

2.  ASCP Choosing Wisely recommendations, http://www.choosingwisely.org/societies/american-society-for-clinical-pathology/

3.  Endocrine Society Choosing Wisely recommendations, http://www.choosingwisely.org/societies/endocrine-society/

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