• Screening for Hypothyroidism

    The purpose of screening is early diagnosis and treatment. Screening tests are usually given to people who do not have current symptoms, but who may be at high risk for certain diseases or conditions. Screening for hypothyroidism remains is under question because there is no evidence showing that it benefits patients.

    Screening Tests

    A physical exam by your doctor may reveal signs of hypothyroidism. These signs may include dry skin, a slow pulse, or slowed reflexes. A thorough history may reveal symptoms of weight gain, fatigue, and constipation.
    The best screening test is a blood test that measures thyroid-stimulating hormone (TSH). A high level of TSH suggests hypothyroidism. If this is high, then your doctor may order a free thyroxine (FT4).

    Screening Guidelines

    The United States Preventive Services Task Force found insufficient evidence to recommend for or against routine screening of adults for thyroid disease. The American Thyroid Association recommends screening adults every 5 years starting at age 35 years. Other organizations may have different recommendations.
    Screening may be needed in special high risk groups such as:
    • All newborn infants (required in many states)
    • Pregnant women with or without goiter
    • People with:
      • A strong family history of thyroid disease
      • A personal history of thyroid problems
      • An autoimmune disease, such as type 1 diabetes
      • Depression , especially those taking lithium
      • Elevated lipid levels
      • A thyroid nodule
      • Down syndrome

    References

    American Academy of Pediatrics. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics . 2006;117:2290-2303.

    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Thyroid . November 2009;19(11):1167-1214.

    Hypothyroidism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 19, 2012. Accessed November 20, 2012.

    Hypothyroidism. National Endocrine and Metabolic Diseases Information Service website. Available at: http://endocrine.niddk.nih.gov/pubs/Hypothyroidism/ . Updated February 27, 2012. Accessed November 20, 2012.

    Ladenson P, Singer P, Kenneth B, et al. American Thyroid Association Guidelines for Detection of Thyroid Dysfunction. Arch Intern Med . 2000;160:1573-1575.

    Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA . 2004 Jan 14;291(2):228-38.

    The United States Preventive Services Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med . 2004;140:125-127

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