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Thyroid. 2018 Jul;28(7):842-848. doi: 10.1089/thy.2017.0645. Epub 2018 Jun 13.

Does Reverse Triiodothyronine Testing Have Clinical Utility? An Analysis of Practice Variation Based on Order Data from a National Reference Laboratory.

Author information

1
1 The Center for Effective Medical Testing, The Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center , Salt Lake City, Utah.
2
2 Department of Endocrinology, University of Southern California , Los Angeles, California.
3
3 Department of Endocrinology, Metabolism and Diabetes, University of Colorado , Aurora, Colorado.
4
4 Department of Family Medicine, Michigan Medicine, Department of Nutritional Sciences, School of Public Health, University of Michigan , Ann Arbor, Michigan.
5
5 Department of Pathology, University of Utah Health Sciences Center , Salt Lake City, Utah.

Abstract

BACKGROUND:

Clinical laboratories are under pressure to increase value by improving test utilization. The clinical utility of reverse triiodothyronine (rT3) is controversial. A study was conducted to identify order patterns that might suggest inappropriate utilization of rT3.

METHODS:

All orders for thyroid tests placed over a period of one year at a national reference laboratory were reviewed. Order patterns by client (hospital) and by provider were analyzed. A Pareto analysis was conducted to determine the percentage of orders placed as a function of the percentage of providers. A systematic review of the indexed literature and an informal review of the web were conducted to identify indications for rT3 testing.

RESULTS:

There were 402,386 orders for 447,664 thyroid tests, including 91,767 orders for rT3. These orders were placed by 60,733 providers located at 1139 different organizations. Only 20% of providers who ordered thyroid tests placed an order for rT3. Of those who placed an order for rT3, 95% placed two orders or fewer for rT3. One hundred providers (0.1% of the 60,733 providers who placed orders for thyroid tests) accounted for 29.5% of the orders for rT3. Of the 100 providers, 60 with the highest order volumes for rT3 were classified as practitioners of functional medicine. A systematic review of Medline found little evidence to support the high volumes of orders for rT3. A survey of Web sites for functional medicine suggests that rT3 is useful for the diagnosis of rT3 dominance and can be used to direct triiodothyronine replacement therapy.

CONCLUSIONS:

There is wide practice variation in rT3 testing. A high proportion of tests are ordered by a relatively small proportion of providers. There is little evidence to support high volumes of rT3 testing placed by some practitioners.

KEYWORDS:

practice variation; reverse triiodothyronine; thyroid testing; utilization

PMID:
29756541
DOI:
10.1089/thy.2017.0645
[Indexed for MEDLINE]

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