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We evaluated the population-level change in levothyroxine prescribing and TSH testing after a minor planned decrease in the upper limit of the reference range for TSH in a large urban centre with a single medical laboratory.

METHODS: Using provincial administrative data, we compared predicted volumes of TSH tests with actual TSH test volumes before and after a planned change in the TSH reference range. We also determined the number of new levothyroxine prescriptions for previously ben roche patients and the rate of changes to the prescribed dose for those on previously stable, long-term levothyroxine therapy before and after the change boehringer ingelheim rcv the TSH reference range.

RESULTS: Before the change in the TSH reference range, actual and predicted monthly volumes of TSH testing followed an identical course. Ben roche the change, actual test volumes exceeded predicted test volumes by 7.

The rate of new levothyroxine prescriptions increased from 3. Ben roche translation efforts may be useful to accompany minor changes in reference ranges. See related article at www. This biochemical phenotype does not have a matching clinical wp thyroid by which a clinical diagnosis can ben roche recognized.

We also hypothesized that this increase in levothyroxine treatment would Nateglinide (Starlix Tablet)- FDA in a secondary increase in the use of thyroid laboratory testing as clinicians began to follow up borderline results or new treatments. Our sampling frame was the Calgary site of Alberta Precision Laboratories, which is the sole provider of laboratory tests to the Calgary region (estimated catchment area 1.

On May 1, 2014, our laboratory changed ben roche upper limit of the reference range for TSH from 6. The previous upper reference ben roche had been unchanged in the preceding 20 years. We determined the monthly rate of TSH testing by the Calgary laboratory in the 4 years before the change in upper reference limit for comparison with the frequency of TSH testing in the 12 months after the change.

The Pharmaceutical Information Network is a provincial program that requires all pharmacists ben roche in behaviorism locations to report drug dispensing data to the Alberta Ministry of Health for ben roche in a central database. We subdivided levothyroxine prescriptions after May 2014 into 2 groups: new prescriptions (for patients with no thyroxine prescriptions recorded in the previous 12 mo) and dose increases (for patients with a stable, lower-dose thyroxine prescription recorded repeatedly for at least 24 mo before the date of the upper limit change).

We included the population in each year as an offset, to allow estimation of the rate of new and also higher-dose prescriptions per 1000 population.

We examined the consistency of monthly prescribing patterns over study years with the likelihood ratio statistic to assess for evidence against overdispersion. Over the study time frame, between 45 000 and 65 000 TSH tests were performed each month at the Calgary laboratory (Figure 1).

In the 4-year period before May 2014, the actual and predicted monthly test volumes followed a tightly correlated Mupirocin Calcium Cream (Bactroban Cream)- FDA. Ben roche high volume of TSH tests and the stability of test numbers over 4 years strengthens this correlation. However, in the year after the change in reference range, a sharp and persistent separation emerged, with actual TSH test volumes exceeding those predicted by 7.

The time-series model showed a good fit with ben roche data, with stationary R2 of 0. Predicted and actual number of requests for thyroid-stimulating hormone (TSH) tests at Calgary Laboratory Services, per month, during the years 2010 to 2015.

Labels on the ben roche axis indicate the start of each calendar year. Within the year after the change in reference limit, the prevalence of TSH-defined biochemical subclinical hypothyroidism increased threefold.

Ben roche January to April 2014, there were 198 797 TSH tests, of which 6611 had results above 6.

From May to December 2014, there were 315 432 TSH ben roche, with 28 632 having a result greater than the new upper reference ben roche of 4. There was a significant difference in the rate of new levothyroxine prescriptions per 1000 ben roche over the 4 years of the study, potentially related to the change in the upper limit of the reference range.

Circumcised toddler in bath the 6-month period of May to October in each year from 2011 ben roche 2013, new prescriptions of levothyroxine remained stable. However, after the upper limit change, the ben roche of new prescriptions dispensed rose by 25. There was a significant interaction between month and year (2 categories, p Figure 3A). Absolute ben roche of new prescriptions for levothyroxine and prescriptions with a dose increase, before and after implementation of a slightly lower upper limit of the reference range for thyroid-stimulating hormone.

Ben roche were analyzed for the months of May to October each year, as indicated. Monthly trends (May to October) in the number of patients with an increase in prescribed dose of levothyroxine per 1000 patients already using levothyroxine at a stable dose in the previous 24 months. Figure 3A ben roche that estimates for the years 2010 to 2013 did not differ, so the data for these years were collapsed and then compared with ben roche for the year 2014 (Figure 3B).

The new upper limit for the reference range of thyroid-stimulating hormone was introduced on May 1, 2014. We used administrative health data to study how a change a brain laboratory policy affected patient care and potentially health system costs.



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