Hypothyroidism

General Medicine Conference

Screening

• Should it be done?

• Argue for:– Common

• Prevalence = 4-10% for mild thyroid failure in the general population (18% in the elderly)

• Cost effective– Has been estimated to be as cost-effective as

other generally recommended screenings such as mammography

Cost-effectiveness

Screening

• Should it be done?

• Argue for:– Common

• Prevalence = 4-10% for mild thyroid failure in the general population (18% in the elderly)

• Cost effective

• Validated test

Screening

• Argue against:– Does it lower morbidity?

• (especially compared with “high-risk” screening)

Recommendations for Selective Screening

• AACE– Older patients, especially women

• ATA– Women over 60– History of thyroid disease – Autoimmune disease – Unexplained depression – Cognitive dysfunction – Hypercholesterolemia

• ACP/ABIM– Women over 50 years old

Screening

• What about pre-pregnancy or early pregnancy evaluation?

• Hypothyroidism in the mother is associated with:– Placental abruption– Preterm delivery– Perinatal intraventricular hemorrhage– Infant respiratory distress syndrome– Lower child IQ scores

Screening

• An “expert panel” has found insufficient evidence to recommend for or against routine TSH testing in pre/early pregnancy but did recommend “high-risk” screening.– JAMA 2004

• A separate “panel of experts” (AACE and Endocrine Society) strongly disagrees with this and does recommend routine TSH testing in all women for pre/early pregnancy evaluations.– J Clin Endo/Metab 2005