Joint UK guideline (2006) recommends that routine testing of thyroid function (TFT) in patients admitted acutely to hospital is not warranted unless specific clinical indications exist. Despite this, TFT is frequently requested during acute medical admission. In our previous audit in 2002, during a 1 month period from 18th September, 458 subjects were admitted to medical assessment unit (MAU) and 183 (40%) were offered TFT. 39 (29%) results were beyond the laboratory reference range but this changed management only in 2 (1.1%) subjects. We recommended that TFT during acute medical admission should not be checked routinely as it known to alter transiently during acute illness. To implement this, the tick box for TFT was removed from the standard pathology request form but could be requested in the free text box without restriction. We re-audited the effect of the change in 2005 in the same MAU over the same month starting 18th September, and found that there had been a 55% reduction (P<0.0001) in request for TFT during acute medical admission. Out of 698 subjects admitted to MAU during this period, only 127 (18.2%) had TFT checked and 30 (23.6%) had results beyond the laboratory reference range. When these notes were reviewed, 7 (5.5%) had their management changed (P=0.03). In comparison to the previous audit, the removal of TFT tick box from the standard pathology form reduced routine testing by 3 fold (odds ratio 3.0 & 95% Confidence Interval 2.3 to 3.9), and improved efficiency by 5 fold (OR 5.3 & 95% CI 1.1 to 25.9). Our audit suggests that it is possible to reduce unnecessary TFT request during acute medical admission simply by removing tick boxes from the standard pathology request form. This helped reduce unnecessary TFT requests, in keeping with the 2006 UK guidelines for thyroid function tests.