TSH testing rates for adults without thyroid disease remain steady from 2006 to 2020
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Key takeaways:
- TSH testing rates were mostly unchanged in the U.S. from 2006 to 2020.
- There was a dip in TSH testing in April 2020 due to the COVID-19 pandemic.
- TSH testing rates were higher among women and older adults.
Thyroid-stimulating hormone testing rates remained stable in the U.S. from 2006 to 2020, with about 10% of adults without thyroid disease receiving a test annually, according to study data.
“Our findings suggest that TSH testing is a common practice, particularly in women and with advancing age, with about one of 10 patients undergoing TSH testing annually and, among those episodes, about three of 10 including additional thyroid function tests beyond TSH, presumably for evaluation of nonspecific symptoms or screening,” Earl J. Morris, PharmD, MPH, PhD, research assistant professor in the department of pharmaceutical outcomes and policy at the University of Florida, told Healio. “Our findings suggest a need to better understand the appropriateness of TSH testing and its components as a way to improve quality of care and decrease health care costs.”
Morris and colleagues conducted a retrospective study using data from IBM MarketScan Commercial Claims databases. Adults aged 18 to 64 years who were continuously enrolled from 2006 to July 2020, had no thyroid disease and were not at high risk for developing thyroid disease were included. Demographics and clinical characteristics were obtained from the databases. TSH tests were identified from codes associated with outpatient service claims. Researchers also collected instances of other thyroid function tests.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
Among 67,353,280 adults in the study, there were 15,138,211 who had a TSH test performed from 2006 to 2020. There were 25,606,518 TSH tests conducted during the study period. Annual TSH testing rates remained stable with 11.4 TSH tests per 1,000 person-months in January 2006 and 11.7 tests per 1,000 person-months in July 2020. The only notable change occurred in April 2020, when TSH tests dropped to 4.2 per 1,000 person-months. Within a given year, about 90% of adults received no TSH test and 10% received one TSH test.
“We found that, overall, the testing rate for TSH was stable throughout the 14-year study period in this group of patients without known thyroid disease,” Naykky Singh Ospina, MD, MS, associate professor in the division of endocrinology, department of medicine at the University of Florida, told Healio. “For other thyroid-related diagnostic tests, there have been a general trend toward increased use. It was also interesting to see the dramatic effect of lower TSH testing rates during the first few months of the COVID-19 pandemic.”
Women underwent 16.1 TSH tests per 1,000 person-months compared with 8.6 TSH tests per 1,000 person-months for men. TSH testing rates increased by age, with adults aged 18 to 34 years undergoing 8.2 TSH tests per 1,000 person-months and those aged 55 to 64 years having 15.4 tests per 1,000 person-months performed. Testing rates were similar across different regions of the U.S.
Of all thyroid function tests identified in the study, 70.8% involved TSH testing only. The second most common thyroid function test was a combination TSH and free thyroxine test, which occurred in 14.8% of all tests.
“Additional research is needed to better understand when TSH testing is appropriate and according, to the clinical situation, what additional thyroid function tests are needed in order to balance clinical utility and prevent waste of limited health care resources,” Morris said. “Studies that evaluate health outcomes and downstream consequences of TSH testing across different clinical situations could facilitate the appropriate use of TSH testing in practice. Similarly, qualitative studies focused on clinician and patient perspectives and preferences may help guide the development of interventions aimed at reducing overuse of TSH testing.”
For more information:
Earl J. Morris, PharmD, MPH, PhD, can be reached at earl.morris@ufl.edu.
Naykky Singh Ospina, MD, MS, can be reached at naykky.singhospina@medicine.ufl.edu.
Perspective
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This study ascertained TSH testing rates for adults without thyroid disease between 2006 and 2020 to note trends in testing. This retrospective study examined adults aged 18 to 64 years who had no thyroid disease or greater risk for developing thyroid disease. TSH tests were identified from the outpatient lab codes. Researchers collected data of other thyroid function tests. The study evaluated 67,353,280 adults, of which 15,138, 211 had a TSH test performed in that time. Within any given year, 90% of adults received no TSH test, and 10% only received one TSH test.
The main limitation of the study is that this is retrospective. Many cases of subclinical thyroid disease are missed by poor history, physical exam, incomplete family history and interviewer bias. Additional research should be done to see if increasing testing increases the detected number of patients who have thyroid disease and central hypothyroidism.
The findings showed that TSH testing rates remained stable in the US from 2006 to 2020, with this being common practice, particularly in women who are of advancing age.
To determine the consequences of testing, a larger cohort study should be done. Qualitative studies about health care providers and patient perspectives should also be done. This can help guide whether TSH testing is being overused or not used enough.
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