American Thyroid Association (ATA) Position Statement on Direct Access Testing (DAT) for Thyroid Function

Direct Access Testing (DAT) for thyroid function is now offered by some reference laboratories. Frequently ordered patient-initiated tests include common thyroid function and antibodies tests, such as TSH, T3, T4, free T3, free T4, and TPO and thyroglobulin antibodies.

DAT is becoming an increasingly popular option for patients wishing to monitor their health status and make more decisions about their own health care. However, the American Thyroid Association (ATA) notes several concerns about the safety and utility of making thyroid testing available directly to patients.

• Proper interpretation of thyroid function test results may not be straightforward; results can be ambiguous depending on the timing of the tests and the clinical circumstances in which they were obtained.
• Patients may be offered or advised to obtain thyroid tests out of commercial self-interest and/or in the absence of a qualified individual to interpret them or to render medical advice.
• Interpretation by unqualified individuals, and by those unfamiliar with a patient’s clinical status, may increase the chances of erroneous conclusions and improper recommendations regarding the diagnosis or the initiation/alteration of thyroid hormone therapy or other drugs that may affect thyroid status.
• Testing profiles advised by some DAT sites have unproven utility.
• Thyroid function testing by DAT is likely to be more expensive for patients because third-party reimbursements do not generally cover tests that are not ordered by patients’ physician or health care provider.

The ATA advises patients to seek advice from their healthcare provider when considering thyroid function testing via DAT. Furthermore, patients should always discuss any changes in their treatment with their providers before doing so on the basis of DAT results.