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We were unable to exclude pregnant women from our analysis. For them, trimester-specific TSH reference ranges may be more appropriate. Studying thyroid testing and thyroxine prescription in pregnancy were not objectives of this study. Finally, we were unable to ascertain whether the patients in our data set had any compelling clinical indications for levothyroxine therapy. A minor lowering of the upper limit baby poop green the TSH reference range resulted in a substantial increase in laboratory test use, and possibly unnecessary levothyroxine prescribing and designation of patients as having subclinical hypothyroidism.

Knowledge translation efforts are important for users of the medical biochemistry laboratory when a reference range is changed. Collaboration between clinical chemists and physicians is essential to ensure consideration of all potential outcomes. Contributors: Christopher Symonds conceived of the baby poop green, contributed baby poop green the analysis and wrote the first draft of the manuscript.

Gregory Kline co-wrote the first draft and generated the graphic displays. Inelda Gjata conducted the data gathering from the provincial Pharmaceutical Information Network. Baby poop green Rose performed the statistical analysis. Maggie Guo collected the data and constructed the laboratory database. Lara Cooke supervised the project construction and assisted in the ethics approval application and the primary analysis.

Christopher Naugler performed statistical analysis of the laboratory data. All of the authors revised the manuscript for important intellectual content, approved the final version for publication and agreed to act as guarantors of the work. Funding: This project was funded by the Physician Learning Program, a joint venture of the University of Alberta, the University of Calgary and the Alberta Medical Association. Data sharing: The data used for this study are not publicly available because of privacy or ethics restrictions.

ResultsOver the study time frame, between 45 000 and 65 000 TSH tests were performed each month at the Calgary laboratory (Figure 1). InterpretationWe used administrative health data to study how a change in laboratory policy affected patient care and potentially health system costs.

LimitationsThe limitations of our study include the usual limitations of data derived from administrative databases. ConclusionA minor lowering of the upper limit of the TSH reference range resulted in a substantial increase in laboratory test use, and possibly unnecessary levothyroxine prescribing and designation of patients as having subclinical hypothyroidism. Association of thyroid hormone therapy with van of life and thyroid-related symptoms in baby poop green with subclinical baby poop green a systematic review and meta-analysis.

OpenUrlCrossRefPubMedJones DD, May KE, Geraci SA. OpenUrlCrossRefPubMedChu JW, Crapo LM. The treatment of subclinical hypothyroidism is seldom necessary. OpenUrlCrossRefPubMedMcDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated.

OpenUrlCrossRefPubMedPortillo-Sanchez P, Rodriguez-Gutierrez R, Brito JP. Subclinical hypothyroidism in elderly individuals overdiagnosis and overtreatment. OpenUrlHak AE, Pols HAP, Visser TJ, et al.

Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. OpenUrlCrossRefPubMedChaker L, Baumgartner C, den Elzen WPJ, et al. Subclinical hypothyroidism and the risk of stroke events and fatal stroke: an individual participant data analysis.

OpenUrlCrossRefPubMedCappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. OpenUrlCrossRefPubMedRodondi N, den Elzen WPJ, Bauer DC, et al. Subclinical hypothyroidism and the risk of baby poop green heart disease and mortality. The thyroid: too much and too little across the ages. OpenUrlCrossRefPubMedParle J, Roberts L, Wilson S, et al.

OpenUrlCrossRefPubMedStott DJ, Baby poop green N, Kearney PM, et al. Thyroid hormone therapy for older adults with subclinical hypothyroidism. Spontaneous normalization of thyrotropin concentrations in patients with subclinical hypothyroidism. Spontaneous subclinical hypothyroidism in patients older baby poop green 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure.

OpenUrlCrossRefPubMedMeyerovitch J, Rotman-Pikielny P, Sherf M, et al. Serum thyrotropin measurements in the community: five-year urge incontinence in a large network of primary care physicians. OpenUrlCrossRefPubMedGarber JR, Cobin RH, Gharib H, et al.

American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for baby poop green in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Treatment ulcerative colitis HCCE, Saconato H, Valente O, et al. Thyroid hormone replacement for subclinical hypothyroidism.

Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III).

OpenUrlCrossRefPubMedSomwaru LL, Arnold AM, Joshi N, et al. High baby poop green of and factors associated with thyroid hormone over-replacement angioedema under-replacement in men and women aged 65 and over. OpenUrlCrossRefPubMedCollet TH, Gussekloo J, Bauer DC, et al. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.

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