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Choosing Wisely Campaign Identifies Overused Endocrinology Tests

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November 22, 2013

The Endocrine Society and the American Association of Clinical Endocrinologists (AACE) have joined the Choosing Wisely® campaign, making recommendations for the appropriate use of certain laboratory tests ordered as part of patient care related to hormone disorders and conditions.

In April 2012, the Choosing Wisely® campaign —launched by the American Board of Internal Medicine (ABIM)—first began encouraging health practitioners and their patients to examine the usefulness of certain medical tests and procedures, with an eye to costs of health care and patient health outcomes. The goals of the program are to promote discussions between doctors and patients and to encourage choices of care that are necessary, evidence-based, and not harmful. Tests should not be duplicated by other tests or procedures performed for the same purpose.

Accordingly, the Choosing Wisely® campaign has asked national organizations that represent medical specialists to identify five tests or procedures commonly used in their field that may be unnecessary and should be discussed. Since its launch, more than 50 specialty societies, including Lab Tests Online partners the American Society for Clinical Pathology (ASCP), the American Society of Hematology (ASH), AABB, and the American Academy of Family Physicians (AAFP), have joined the campaign. Now, the Endocrine Society and AACE have identified the following recommendations for Choosing Wisely®:

  • Limit repeated daily glucose self-monitoring tests in adults who have stable type 2 diabetes and are on medications that do not cause low blood glucose (hypoglycemia). The groups commented that there is little information to be gained by frequent testing in these patients. Exceptions are if the person has an acute illness, takes a new medication, has fluctuations in weight, or has changes in A1c levels.
  • To clarify confusion about ordering a vitamin D test as two forms can be measured in the blood, the groups say that the appropriate test for screening for vitamin D deficiency is 25-hydroxyvitamin D. The 1,25-dihydroxyvitamin D test should not be used unless someone has an elevated blood calcium level or decreased kidney function.
  • To avoid overuse of thyroid ultrasound, they recommend against its routine use in people who have abnormal thyroid function tests unless an abnormality can be felt on the thyroid gland, such as a goiter or "lumpy" thyroid.
  • For patients taking levothyroxine (T4) for treatment of hypothyroidism, they recommend against ordering a total or free T3 test to assess the dose as it can be misleading; instead, they recommend the TSH test for most patients.
  • To avoid inappropriate use of testosterone therapy, which can have serious side effects, dysfunction of the testicles in men (hypogonadism) should be first confirmed with a total testosterone test performed in the morning (and repeated another day if low).

Choosing Wisely® expects more specialty groups to continue to join the campaign and over thirty societies are expected to announce new lists by the end of this year or early in 2014. See the Choosing Wisely® web site for a complete list of partners and their selections of potentially overused tests and procedures that should require discussion between doctor and patient.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Tucker, ME. Endocrinologists Issue First 'Choosing Wisely' List. Medscape Medical News. October 18, 2013. Available online at http://www.medscape.com/viewarticle/812793 through http://www.medscape.com. Accessed November 2013.

Endocrine Society and AACE Recommend Best Practices in Choosing Wisely Campaign. Endocrine Insider archives. October 17, 2013. Available online at https://www.endocrine.org/membership/email-newsletters/endocrine-insider/2013/october-17-2013/endocrine-society-and-aace-recommend-best-practices-in-choosing-wisely-campaign through https://www.endocrine.org. Accessed November 2013.

Choosing Wisely®. Available online at http://www.choosingwisely.org/. Accessed November 2013.

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