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Don't routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland. Setting: abnormal TSH or thyroid function tests without a palpable thyroid nodule or goiter Why: Thyroid ultrasound for abnormal function tests without a palpable nodule detects clinically insignificant nodules and drives unnecessary biopsies. Consider instead: ultrasound only when a nodule is palpable or incidentally found Source: American Association of Clinical Endocrinology (Choosing Wisely, US, 2013).

Don't repeat thyroid function testing in a clinically euthyroid, stable patient sooner than the recommended interval. Setting: clinically euthyroid, stable patient with a recent thyroid function result, re-tested sooner than the recommended interval without new symptoms, pregnancy, or a change in therapy; does not apply to planned recheck of a previously abnormal result Why: TSH moves slowly; early re-testing in stable euthyroid patients yields no actionable change and generates false-positive cascades. Consider instead: use the prior result; retest at guideline intervals (e.g. ~6 weeks after a dose change, then annually once stable) or when symptoms change Source: American Association of Clinical Endocrinology (Choosing Wisely, US, 2013).

Don't routinely test vitamin D levels (25-hydroxyvitamin D) in asymptomatic adults without a specific risk factor or indication. Setting: asymptomatic adult with no specific risk factor or indication for vitamin D deficiency (e.g. malabsorption, chronic kidney disease, osteoporosis or fragility fracture, medications affecting vitamin D metabolism) Why: Population vitamin D testing in asymptomatic adults is high-volume and low-yield; results rarely change management compared with empiric advice. Consider instead: lifestyle advice and empiric supplementation where appropriate; reserve testing for patients with a specific indication Source: American Association of Clinical Endocrinology (Choosing Wisely, US, 2013).

Don't routinely test vitamin B12 levels in patients without symptoms or risk factors for deficiency. Setting: no symptoms (unexplained anaemia, neuropathy, cognitive change, glossitis) and no risk factors (metformin or long-term PPI use, vegan diet, malabsorption, gastric surgery) for vitamin B12 deficiency Why: Routine B12 testing in asymptomatic low-risk patients yields borderline results that trigger cascades without improving outcomes. Consider instead: test only when symptoms or risk factors for deficiency are present Source: American Association of Clinical Endocrinology (Choosing Wisely, US, 2013).