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 –Has been estimated to be as cost-effective as other generally recommended screenings such as mammography

Cost-effectiveness

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

Screening Argue against: –Does it lower morbidity? (especially compared with “high-risk” 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

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

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