Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder (2018) 

This is a revision of the 2010 version of the guideline. The guideline’s scope has expanded to include pediatric and pregnant patients.

Key recommendations:

• Routine thyroid function testing is not recommended in asymptomatic patients (outside of the BC Newborn Screening Program). Testing may be indicated when nonspecific symptoms or signs are present in patients at risk for thyroid disease.
• A TSH value within the laboratory reference interval excludes the majority of cases of primary thyroid dysfunction.
• If initial TSH testing is normal, repeat testing is unnecessary unless there is a change in clinical condition.
• Measurement of fT3 is rarely indicated in suspected thyroid disease.
• Screening for undiagnosed hyperthyroidism or hypothyroidism should not be performed in hospitalized patients or during acute illness unless hyperthyroidism or hypothyroidism is the suspected cause of the clinical presentation or represents a significant comorbidity.
• If a woman is pregnant or planning pregnancy, TSH testing is indicated if she has specific risk factors (see Table 3 in the guideline).

Other key changes:

• A laboratory algorithm has been added to the guideline and outlines changes to ordering. If central hypothyroidism is being investigated “suspicion of pituitary insufficiency” should be included as a clinical indication and a request for fT4 (with or without TSH) should be indicated in the space provided on the standard outpatient laboratory requisition.
• Thyroid function test reports in BC will include trimester-specific reference intervals on all women of childbearing age.

Ultrasound Prioritization (2018) 

This new guideline summarizes suggested wait times for common indications where ultrasound is the recommended first imaging test. The purpose is to inform primary care practitioners how referrals are prioritized by radiologists, radiology departments, and community imaging clinics across the province. In some cases, notes and alternative tests are provided for additional clinical context. This guideline is an adaptation of the British Columbia Radiological Society (BCRS) Ultrasound Prioritization Guidelines (2016).

See also the one-page overview: Ultrasound Prioritization Guideline Summary.

To stay up to date with BC Guidelines, visit the What’s New section at www.bcguidelines.ca.