1. A Question of Quality Improvement
In response to Guideline recommendations from the ATA either recommending against universal screening in pregnancy (2012) or providing no recommendation for or against screening (2017), due to insufficient evidence
Identify if TSH over testing for pregnant patients without thyroid disease is present at our family practice centre
Explore the perspective of frequent testers; understand TSH testing by physicians at our family practice centre.

2. What the Researchers Did
Quantitative analysis of TSH testing done at a Canadian Family Practice Clinic
Focusing on physicians with high TSH ordering frequency
Qualitative deductive analysis exploring the perspectives of physicians’ most frequently prescribing the test
Major themes identified

3. What the Researchers Found
In 2016, 411 unique pregnant women at the clinic were sent for TSH testing; 200 of these tests were requested by 28 staff physicians
In terms of highest TSH testing frequency, six family physicians ordered between 10 and 48 tests.
Major Themes to explain or justify screening for subclinical hypothyroidism in pregnancy include: Clinical uncertainty, prior education, cognitive bias, openness to change, guideline directed, and lack of urgency to change

4. What This Means for Clinical Practice
Adherence to most recent findings
Reduction of over diagnosis and overtreatment
Reduction in false positive results
Avoiding psychological effects of labelling
Cost/Savings