Hypothyroidism screening
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Hypothyroidism Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Farman Khan, MD, MRCP [2]
Overview
Screening
Screening for hypothyroidism means measurement of thyroid function tests in asymptomatic patients at risk of developing thyroid disease. Early detection and treatment with thyroxine (T4) does not improve important outcomes. The American Thyroid Association and the American Association of Clinical Endocrinologists guidelines recommend measurement of TSH in any individual at risk for hypothyroidism. The United States Preventive Services Task Force does not recommend routine screening for hypothyroid in children or adults.
According to one study The cost-effectiveness of screening for mild thyroid failure compares favorably with other generally accepted preventive medical practices. Physicians should consider measuring serum TSH concentration in patients aged 35 years and older undergoing routine periodic health examinations. [1]
Who to screen
Thyroid function should be measured in patients with the following:
- Pituitary or hypothalamic disorders
- History of autoimmune diseases
- Previous radioactive iodine therapy
- Head and neck irradiation
- Family history of thyroid disease
- Use of medications that may impair thyroid function
- Substantial hyperlipidemia
- Hyponatremia
- High serum muscle enzyme concentrations
- Macrocytic anemia
- Pericardial or pleural effusions
- Previous thyroid injury
Best Test for Screening
Newer TSH assays are both more sensitive and specific than serum free T4 measurements for detecting primary hypothyroidism.Primary thyroid disorder is responsible for more than 95 percent of the cases of hypothyroidism. Therefore serum TSH is an excellent screening test for hypothyroidism than free T4 or total T4 in outpatient settings [1]
There are certain situations in which measurement of serum TSH may not be a useful for the diagnosis of hypothyroidism and these include Hypothalamic disease or pituitary disease,Hospitalized patients, and Patients on drugs such as amiodarone, dopamine, glucocorticoids, octreotide, metochlopramide.