UBC CPD and the UBC Therapeutics Initiative at the UBC Faculty of Medicine have worked together to provide medical education on practical approaches for navigating thyroid testing in primary hypothyroidism.

Designed for health professionals responsible for ordering thyroid tests, this self-paced eLearning module provides an overview of thyroid physiology and testing and shares tools to improve patient care and outcomes in clinical settings.  

“[I’m] better able to interpret labs that patients have completed” and “advise prescribers on what labs are most appropriate for unique patients,” says a course participant.

Symptoms, risk factors and epidemiology of hypothyroidism

Primary hypothyroidism is the most common form of hypothyroidism, often caused by destruction of tissue in the thyroid gland and lower levels of T3 and T4 excretion.

Common symptoms that span across body systems include:

  • neurological and psychological: cognitive dysfunction, slow speech, depression and/or impaired memory
  • endocrine: goiter and/or sensitivity to cold
  • pulmonary: pleural effusion and/or shortness of breath
  • cardiovascular: bradycardia, pericardial effusion, reduced left ventricular function and/or diastolic hypertension
  • reproductive: heavy and/or irregular menstrual cycles, loss of libido and/or subfertility
  • musculoskeletal: muscle cramps, muscle and joint pain and/or muscle fatigue and weakness.

Hypothyroidism and thyroid dysfunction can arise from personal or family history of thyroid disease, in men over 60 or women over 50 years of age, certain chromosomal or genetic disorders (Turner Syndrome, Down Syndrome and mitochondrial disease) and more.  

While the prevalence of hypothyroidism is 4.6%, according to a USA National Health and Nutrition Examination Survey, Thyroid Function (TSH) Tests are still one of the most ordered laboratory tests worldwide.

Testing for thyroid dysfunction

A study published in BMJ Journals measured the proportion of Thyroid Function (TSH) tests ordered for a sample of patients that followed test-ordering guidelines.  

While nearly one quarter of tests did not conform to recommended guidelines, 96% of results also returned as normal, with a greater number of patient-physician interactions being the strongest predictor of test orders.

Before ordering a TSH test, health professionals are encouraged to review thyroid antibody indicators, such as Thyroperoxidase antibodies (Anti TPO antibodies), clinical algorithms for TSH tests and key recommendations based on BC Guidelines for TSH testing.

Shared decision making in clinical settings

To enhance outcomes of patient-physician interactions in clinical settings and prevent unnecessary Thyroid Function (TSH) testing, health professionals are advised to explain to patients why they have or have not decided to move forward with TSH testing.

When asked how the educational tools in the Navigating Thyroid Testing in Primary Hypothyroidism: Practical Approaches for Health Professionals online module will impact their practice, participants say they have a “better understanding of when to start treatment and how to monitor” and that it “will allow me to be more mindful when managing subclinical hypothyroid patients."

Learn more about navigating thyroid testing in primary hypothyroidism in our eLearning module to earn credits.

Acknowledgements

The Navigating Thyroid Testing in Primary Hypothyroidism: Practical Approaches for Health Professionals online module is a collaboration between the UBC Therapeutics Initiative, UBC Continuing Professional Development and UBC Faculty of Medicine’s Strategic Investment Fund.