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Hypothyroidism Screening Debate: To Test or Not to Test?

Explore the efficacy and controversy surrounding hypothyroidism screening in the general population, analyzing prevalence rates, cost-effectiveness, and recommended guidelines. Delve into the impact on morbidity, selective screening recommendations by medical societies, and the debate over routine testing in pre/early pregnancy evaluations.

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Hypothyroidism Screening Debate: To Test or Not to Test?

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  1. Hypothyroidism General Medicine Conference

  2. 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

  3. Cost-effectiveness

  4. 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

  5. Screening • Argue against: • Does it lower morbidity? • (especially compared with “high-risk” screening)

  6. 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

  7. 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

  8. 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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