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Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

SIPMeL – Study Group on Autoimmune Diseases

In the diagnosis of hyperthyroidism, the research of anti-TPO and anti-Tg is widely requested as a first test, while the diagnostic antibody is the one directed towards the TSH receptor.

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

SIPMeL – Endocrinology and Metabolic Diseases Study Group

The Endocrine Society Guidelines recommend screening in individuals at risk of deficiency and not for assessing the health of the general population, as there is no evidence of its efficacy in terms of health outcomes. Despite the high prevalence of deficiency / insufficiency reported in the literature, awareness and supplementation programs in adults and children are considered more effective than screening. The Endocrine Society recommends the monitoring of 25OH-D levels in subjects at risk ...

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

SIPMeL – Endocrinology and Metabolic Diseases Study Group

Anti-TPO antibodies are useful in the diagnosis of an autoimmune thyroid disease, not in monitoring. Do not retest anti-TPO antibodies when a positive result has already been found. The specificity of anti-Tg antibodies is low. Perform them only when hypothyroidism is suspected and the anti-TPO antibodies are negative. Treatment must be based on TSH concentration not on antibodies concentration.

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

SIPMeL – Endocrinology and Metabolic Diseases Study Group

For diagnosing pheochromocytoma do perform free plasma metanephrines and, if they are not available, fractionated urinary metanephrines. Since plasma or urine metanephrines sensitivity is high, a negative result excludes pheochromocytoma, while the same conclusion is not possible catecholamines and their metabolites (e.g. urinary vanilmandelic acid).

Choosing Wisely Italy. Doing more does not mean doing better (Fare di più non significa fare meglio)

SIPMeL – Endocrinology and Metabolic Diseases Study Group

For screening Cushing syndrome one of the following three tests is recommended: Urinary Free Cortisol (at least two 24-hour collections), night salivary cortisol (two samples collected in two different days), serum cortisol after overnight dexamethasone suppression test, 1mg (oDST) or after dexamethasone suppression test, 2 mg/day for 48 hours.