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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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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