Optimal Utilization of Laboratory Testing

Thyroid Function Ordering Algorithm

November 2011

The thyroid function ordering algorithm starts with non-hospitalized patients without known or suspected pituitary disease and then the evaluation begins by ordering either the cascade approach, the thyroid function cascade, or each test individually beginning with the thyroid stimulating hormone–sensitive TSH. And you can see it according to the results whether you have hyperthyroid suspect, a borderline low TSH or a hypothyroid suspect. Between .3 and 5 that's indicating that no further testing is clinically indicated.

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• Introduction
• Objectives
• Assumptions to Forego
• Roger's Adopter Categories Based on Degree of Innovativeness¹
• Changes to Manual Requisitions^2,7
• Is This Test Misused?
• Overused/Misused Tests: Good Literature Support
• Bleeding Time³
• Anti–Single–Stranded DNA: Another Misused Test^4,5,6
• Use of Algorithms
• Laboratory Test Utilization
• Thyroid Testing Guidelines
• Thyroid Function Ordering Algorithm
• Pernicious Anemia Testing Guidelines
• Pernicious Anemia Testing Cascade
• Diarrhea Work Up Guidelines
• Parasitic Investigation of Stool Specimens Algorithm
• Obsolete Tests: Laboratory Directors' Opinions⁷
• Overused/Misused Tests — Opinion
• Frequency of Testing
• Newer Tests and Panels on the Horizon
• Hints on Improving Lab Utilization
• Hints on Improving Lab Utilization (2)
• Interventions to Improve Lab Utilization⁷
• Algorithm for Assessing Send–out Tests
• Improved Test Utilization: Assistance from Clinical Practice Committee
• Other Benefits of Clinical Practice Committee
• Summary
• References
• I Welcome Your Questions
• Questions?