Thyroid disease: challenges in primary care addressed in new program for GPs

NPS MedicineWise

The number of people undergoing thyroid testing in Australia is increasing at a faster rate than the population, and evidence indicates that some of these tests may be clinically unnecessary. Increased testing carries the risk of incidental findings which may lead to further tests and procedures, as well as uncertainty and anxiety for patients.

A new educational program for GPs from NPS MedicineWise is focusing on thyroid disorders in primary care, emphasising that thyroid testing should only be requested after a detailed clinical history and targeted physical examination have suggested thyroid problems.

To support the program, this September NPS MedicineWise is sending an individualised MBS practice review to every GP in Australia to allow them to reflect on their own requests for thyroid tests.

This will be followed by an easy to follow thyroid disorder testing algorithm, to be made available in early October, to help GPs take latest evidence into account when making clinical decisions about thyroid tests.

“Screening for thyroid disorders is not recommended in asymptomatic individuals unless the person is in a high-risk group,” says NPS MedicineWise medical adviser and general practitioner Dr Jill Thistlethwaite.

“When testing for thyroid disorders in symptomatic patients, our new educational program is reminding doctors to first only test thyroid stimulating hormone (TSH), and then based on TSH values either test thyroxine (T4) alone or T4 and triiodothyronine (T3),” she says.

The Medicinewise News to accompany this educational program assesses latest evidence around identifying and managing thyroid disease in general practice. The publication highlights that repeat TSH tests are frequently requested earlier than necessary, and that judicious use of ultrasounds is essential to avoid over treatment of clinically unimportant nodules.

All of the resources, including the new thyroid disorder testing algorithm once available in October, can be found on the NPS MedicineWise information hub on thyroid disease.

The information hub also incorporates a guide to support the quality use of referrals, as well as three Choosing Wisely Australia recommendations around thyroid testing:

• Don’t test thyroid function as population screening for asymptomatic patients (Recommendation from the Royal Australian College of General Practitioners)

• Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland (Recommendation from The Endocrine Society of Australia), and

• Don’t order a total or free T3 level when assessing thyroxine dose in hypothyroid patients (Recommendation from The Endocrine Society of Australia)

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