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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

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Presentation Transcript
hypothyroidism

Hypothyroidism

General Medicine Conference

screening
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
screening1
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
screening2
Screening
  • Argue against:
    • Does it lower morbidity?
      • (especially compared with “high-risk” screening)
recommendations for selective 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
screening3
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
screening4
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
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