0
Clinical Guidelines |

Screening for Thyroid Disease: Recommendation Statement FREE

U.S. Preventive Services Task Force*
[+] Article and Author Information

From the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland.


Disclaimer: The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

Requests for Single Reprints: Reprints are available from the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295).


Ann Intern Med. 2004;140(2):125-127. doi:10.7326/0003-4819-140-2-200401200-00014
Text Size: A A A

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for thyroid disease and updates the 1996 recommendations on this topic. The complete USPSTF recommendation statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (www.preventiveservices.ahrq.gov), the National Guideline Clearinghouse (www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. The recommendation statement and article are also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse.

*For a list of the members of the U.S. Preventive Services Task Force, see the Appendix.

The U.S. Preventive Services Task Force (USPSTF) concludes the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults. This is a grade I recommendation . (See Appendix Table 1 for a description of the USPSTF classification of recommendations.)

The USPSTF found fair evidence that the thyroid-stimulating hormone (TSH) test can detect subclinical thyroid disease in people without symptoms of thyroid dysfunction but poor evidence that treatment improves clinically important outcomes in adults with screen-detected thyroid disease.(See Appendix Table 2 for a description of the USPSTF classification of levels of evidence.) Although the yield of screening is greater in certain high-risk groups (for example, postpartum women, people with Down syndrome, and the elderly), the USPSTF found poor evidence that screening these groups leads to clinically important benefits. There is the potential for harm caused by false-positive screening tests; however, the magnitude of harm is not known. There is good evidence that overtreatment with levothyroxine occurs in a substantial proportion of patients, but the long-term harmful effects of overtreatment are not known. As a result, the USPSTF could not determine the balance of benefits and harms of screening asymptomatic adults for thyroid disease.

Table Jump PlaceholderAppendix Table 1.  U.S. Preventive Services Task Force Grades and Recommendations
Table Jump PlaceholderAppendix Table 2.  U.S. Preventive Services Task Force Grades for Strength of Overall Evidence

Subclinical thyroid dysfunction is defined as an abnormal biochemical measurement of thyroid hormones without any specific clinical signs or symptoms of thyroid disease and no history of thyroid dysfunction or therapy. This includes individuals who have mildly elevated TSH and normal thyroxine (T4) and triiodothyronine (T3) levels (subclinical hypothyroidism) or low TSH and normal T4 and T3 levels (subclinical hyperthyroidism). Individuals with symptoms of thyroid dysfunction, or those with a history of thyroid disease or treatment, are excluded from this definition and are not the subject of these recommendations.

When used to confirm suspected thyroid disease in patients referred to a specialty endocrine clinic, TSH has a high sensitivity (98%) and specificity (92%). When used for screening primary care populations, the positive predictive value of TSH in detecting thyroid disease is low; furthermore, the interpretation of a positive test result is often complicated by an underlying illness or by frailty of the individual. In general, values for serum TSH level below 0.1 mU/L are considered low and values above 6.5 mU/L are considered elevated.

Clinicians should be aware of subtle signs of thyroid dysfunction, particularly among those at high risk. People at higher risk for thyroid dysfunction include the elderly, postpartum women, those with high levels of radiation exposure (>20 mGy), and patients with Down syndrome. Evaluating for symptoms of hypothyroidism is difficult in patients with Down syndrome because some symptoms and signs (for example, slow speech, thick tongue, and slow mentation) are typical findings in both conditions.

Subclinical hyperthyroidism has been associated with atrial fibrillation; dementia; and, less clearly, osteoporosis. However, progression from subclinical to clinical disease in patients without a history of thyroid disease is not clearly established.

Subclinical hypothyroidism is associated with poor obstetric outcomes and poor cognitive development in children. Evidence for dyslipidemia, atherosclerosis, and decreased quality of life in adults with subclinical hypothyroidism in the general population is inconsistent and less convincing.

The American Thyroid Association recommends measuring thyroid function in all adults beginning at age 35 years and every 5 years thereafter, noting that more frequent screening may be appropriate in high-risk or symptomatic individuals (1). The Canadian Task Force on the Periodic Health Examination recommends maintaining a high index of clinical suspicion for nonspecific symptoms consistent with hypothyroidism when examining perimenopausal and postmenopausal women (2). The American College of Physicians recommends screening women older than age 50 years with 1 or more general symptoms that could be caused by thyroid disease (3). The American Association of Clinical Endocrinologists recommends TSH measurement in women of childbearing age before pregnancy or during the first trimester (4). The American College of Obstetricians and Gynecologists recommends that physicians be aware of the symptoms and risk factors for postpartum thyroid dysfunction and evaluate patients when indicated (5). The American Academy of Family Physicians recommends against routine thyroid screening in asymptomatic patients younger than age 60 years (6).

Appendix

Members of the U.S. Preventive Services Task Force are Alfred O. Berg, MD, MPH, Chair, (University of Washington, Seattle, Washington); Janet D. Allan, PhD, RN, CS, Vice-Chair(University of Maryland Baltimore, Baltimore, Maryland); Paul Frame, MD (Tri-County Family Medicine, Cohocton, and University of Rochester, Rochester, New York); Charles J. Homer, MD, MPH (National Initiative for Children's Healthcare Quality, Boston, Massachusetts); Mark S. Johnson, MD, MPH (University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey); Jonathan D. Klein, MD, MPH (University of Rochester School of Medicine, Rochester, New York); Tracy A. Lieu, MD, MPH (Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts); C. Tracy Orleans, PhD (The Robert Wood Johnson Foundation, Princeton, New Jersey); Jeffrey F. Peipert, MD, MPH (Women and Infants' Hospital, Providence, Rhode Island); Nola J. Pender, PhD, RN (University of Michigan, Ann Arbor, Michigan); Albert L. Siu, MD, MSPH (Mount Sinai School of Medicine, New York, New York); Steven M. Teutsch, MD, MPH (Merck & Co., Inc., West Point, Pennsylvania); Carolyn Westhoff, MD, MSc (Columbia University, New York, New York); and Steven H. Woolf, MD, MPH (Virginia Commonwealth University, Fairfax, Virginia). This list includes members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.

Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos ST, Levy EG, et al..  American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000; 160:1573-5. PubMed
CrossRef
 
Canadian Task Force on the Periodic Health Examination.  Canadian Guide to Clinical Preventive Health Care. Ottawa: Canada Communication Group; 1994; 611-8.
 
.  Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med. 1998; 129:141-3. PubMed
 
AACE Thyroid Task Force.  American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Prac. 2002; 8:457-69. Accessed athttp://www.aace.com/clin/guidelines/hypo_hyper.pdfon 20 November 2003.
 
American College of Obstetricians Gynecologists.  Thyroid Disease in Pregnancy. Technical Bulletin no. 37. Washington, DC: American Coll of Obstetricians and Gynecologists; 2002.
 
American Academy of Family Physicians.  Summary of Policy Recommendations for Periodic Health Examinations. Reprint no. 510. Leawood, KS: American Academy of Family Physicians; 2002.
 

Figures

Tables

Table Jump PlaceholderAppendix Table 1.  U.S. Preventive Services Task Force Grades and Recommendations
Table Jump PlaceholderAppendix Table 2.  U.S. Preventive Services Task Force Grades for Strength of Overall Evidence

References

Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos ST, Levy EG, et al..  American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000; 160:1573-5. PubMed
CrossRef
 
Canadian Task Force on the Periodic Health Examination.  Canadian Guide to Clinical Preventive Health Care. Ottawa: Canada Communication Group; 1994; 611-8.
 
.  Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med. 1998; 129:141-3. PubMed
 
AACE Thyroid Task Force.  American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Prac. 2002; 8:457-69. Accessed athttp://www.aace.com/clin/guidelines/hypo_hyper.pdfon 20 November 2003.
 
American College of Obstetricians Gynecologists.  Thyroid Disease in Pregnancy. Technical Bulletin no. 37. Washington, DC: American Coll of Obstetricians and Gynecologists; 2002.
 
American Academy of Family Physicians.  Summary of Policy Recommendations for Periodic Health Examinations. Reprint no. 510. Leawood, KS: American Academy of Family Physicians; 2002.
 

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Screening for Thyroid Disease: A Recommendation from the U.S. Preventive Services Task Force

The summary below is from the full reports titled “Screening for Thyroid Disease: Recommendation Statement” and “Screening for Subclinical Thyroid Dysfunction in Nonpregnant Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force.” They are in the 20 January 2004 issue of Annals of Internal Medicine (volume 140, pages 125-127 and pages 128-141). The first report was written by the U.S. Preventive Services Task Force; the second report was written by M. Helfand.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)