Screening for Hypothyroidism

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions. Screening for hypothyroidism remains controversial due to the lack of definite evidence for a benefit.

Screening Tests

A physical exam by your doctor may reveal signs of hypothyroidism, such as 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 found to be elevated, your doctor may order other a free thyroxine (FT4).

Screening Guidelines

The United States Preventive Services Task Force found insufficient evidence to recommend for or against routine screening for thyroid disease. It is recommended for the following high-risk groups:

• All newborn infants (mandatory in many states)
• Downs syndrome
• Pregnant women with or without goiter
• Have a strong family history of thyroid disease
• A personal history of thyroid dysfunction
• Have an autoimmune disease, such as type 1 diabetes
• Are taking lithium
• Have depression
• Have elevated lipid levels
• Are found to have a thyroid nodule

Several other professional organizations such as the American Association of Clinical Endocrinologist (AACE), American Academy of Family Physicians (AAFP), The American College of Physician (ACP) and the American Thyroid Association (ATA) vary greatly in their recommendations with the ATA recommending routine screening at age 35 then every five years. High risk populations can include those:

• Over 60 years old
• With a history of thyroid disease, thyroid surgery, radiation to the neck
• With a heart disease history, specifically atrial fibrillation
• With other autoimmune disease

References:

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

American Association of Clinical Endocrinologists website. Available at: http://www.aace.com/ .

American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/ .

The American College of Physicians website. Available at: http://www.acponline.org/ .

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

National Guideline Clearinghouse website. Available at: http://www.guideline.gov/ .

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