Screening for Thyroid Disease

Screening for asymptomatic thyroid disease is controversial, although screening in specific populations may be beneficial. Women over age 50 have the highest incidence of spontaneous hypothyroidism compared with all males and mixed younger populations, approaching 5% per year. Thus, screening has a good chance of finding disease early. However, the evidence supporting benefit from early intervention is weak and probably does not justify cost. Patients who present with paroxysmal atrial fibrillation should be routinely screened for hyperthyroidism, although the incidence of positive findings is low (AACE, 2002).

One area where screening is advantageous is patients with newly diagnosed dementia. This is especially true if the clinical course is atypical or accelerated. Both hypothyroidism (myxedema) and hyperthyroidism (apathetic thyrotoxicosis) can present with dementia-like symptoms, and in these patients, timely intervention can completely reverse the signs and symptoms of dementia or depression caused by thyroid dysfunction. If screening is undertaken, the test of choice is sTSH. When coupled with FT4, the vast majority of clinically significant hyperthyroidism and hypothyroidism can be diagnosed. If symptoms are present, or there are overt signs of disease, the initial testing should include sTSH, FT4, and FT3. Thyroid panels providing T4, T3, T7, FT4 index, and T3 uptake are no longer advocated (AAFP, 2009; Helfand, 2004; Ladenson et al., 2000).

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