1. The Cost of a Thyroid Test
Brian Becerra, PGY-2

2. How important is a TSH test?

3. How often is TSH ordered?
A cohort of 37 patients at the Long Beach VA were examined
All of the patient’s labs were examined to see how often a TSH test was being ordered
On average, each patient had: screening TSH Ordered
The maximum TSH tests over a 1 year period was: 4
The maximum TSH tests ordered for only screening, without a history of thyroid disease or need to monitor TFT’s: 3

4. How often does TSH come back abnormal?
Amongst the 37 patients, there were: 40 TSH tests ordered
Of the 40 TSH’s ordered: 4 tests were abnormal
These 4 tests were found in 3 patients, that were already being followed due to prior history of thyroid dysfunction or due to certain medication usage
Of these 4 abnormal tests: 0 of the abnormal tests changed management, as Free T4 was normal, and it was just watched with more TSH tests

5. How much does this waste cost?
Though it is hard to determine the exact cost of a TSH test, some estimates online show:

6. Using the cheapest option of $25, for 36 normal tests, a total of $900 was wasted this past year on this panel of patients
If we subtract the 2 other tests used to monitor patients with chronic conditions, $850 was still misused
This is the cheapest option, though on average the price is closer to double this amount

7. Conclusion
On average, every patient has been subjected to at least 1 TSH test per year, though the majority of tests are unwarented
Per the website, there are “over 9 million Veterans enrolled in the VA health care program.”
If we extrapolate this data, that means that about $25 is wastefully spent per patient, per year.
If we take out the 8.1% of patients we were previously monitoring
This translates to $206,775,000 per year, spent on mostly unnecessary TSH tests

8. Thank you for your time