Skip Navigation
Menu
Editorials |5 May 2015

Screening and Treating Subclinical Thyroid Disease: Getting Past the Impasse Free

Anne R. Cappola, MD, ScM; David S. Cooper, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published online first at www.annals.org on 24 March 2015.
  • From Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, and The Johns Hopkins University School of Medicine, Baltimore, Maryland.

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0640.

    Requests for Single Reprints: David S. Cooper, MD, Division of Endocrinology, Diabetes, & Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287; e-mail, dscooper@jhmi.edu.

    Current Author Addresses:Dr. Cappola: Perelman School of Medicine at the University of Pennsylvania, 718 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.

    Dr. Cooper: Division of Endocrinology, Diabetes, & Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287.

×
FULL TEXT
Thyroid dysfunction is common, and both insufficient and excess thyroid hormone can cause myriad systemic effects resulting in symptoms and, in extreme cases, serious illness and even death. There are sensitive and specific blood tests to diagnose thyroid dysfunction and readily available therapies to treat it. This supports the potential utility of screening.
In this issue, the U.S. Preventive Services Task Force (USPSTF) presents its findings on screening for thyroid dysfunction (1). Not surprisingly, the USPSTF concluded that evidence is insufficient to assess the balance of potential benefits and harms of screening nonpregnant adults. This conclusion is based on the absence of large prospective randomized, controlled trials (RCTs) demonstrating a benefit of treatment of subclinical hypothyroidism or subclinical hyperthyroidism (2). Indeed, the recommendation is similar to the one made by the USPSTF in 2004 (3), and it is disheartening to see that so little progress seems to have been made in trying to address this important clinical problem.
This leaves the health care provider and the patient in a familiar vacuum of management using the imperfect data available. The current USPSTF statement provides a useful summary of the few short-term clinical trials and highlights the disappointingly small number of new RCTs since the last report, with no trials conducted in the United States. However, it fails to acknowledge the publication in the intervening period of 3 individual-patient data meta-analyses of observational studies (4–6). These meta-analyses provide important information about potential risks from...
FULL TEXT
PDF
Not Available
Citations
Citation

Cappola AR, Cooper DS. Screening and Treating Subclinical Thyroid Disease: Getting Past the Impasse. Ann Intern Med. 2015;162:664–665. doi: https://doi.org/10.7326/M15-0640

Download citation file:

© 2020

×
Permissions

Published: Ann Intern Med. 2015;162(9):664-665.

DOI: 10.7326/M15-0640

3 Citations

Related Articles
Should We Treat for Subclinical Hypothyroidism?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Annals of Internal Medicine; 164 (11): 764-770
Annals for Educators - 6 November 2018
Annals of Internal Medicine; 169 (9): ED9
When Centers for Medicare & Medicaid Services Treats Throat Cancer Like Pharyngitis
Annals of Internal Medicine; 169 (8): 573-574
Much Choice, Much Confusion: Treating Basal Cell Carcinoma
Annals of Internal Medicine; 169 (7): 500-501
View MoreView Less

Journal Club
Guided early deescalation of antiplatelet treatment was noninferior to usual prasugrel care in PCI-treated ACS
Annals of Internal Medicine; 167 (12): JC69
Self-monitoring of blood glucose did not improve HbA1c or QoL at 1 year in non–insulin-treated type 2 diabetes
Annals of Internal Medicine; 167 (8): JC46
In PCI-treated ACS, switching from aspirin + a newer P2Y12 blocker to aspirin + clopidogrel reduced adverse events
Annals of Internal Medicine; 167 (6): JC28
In type 2 diabetes treated with high-dose insulin, liraglutide reduced HBA1c
Annals of Internal Medicine; 165 (8): JC40
View MoreView Less

Related Point of Care
Palliative Care
Annals of Internal Medicine; 168 (5): ITC33-ITC48
Clostridioides difficile Infection
Annals of Internal Medicine; 169 (7): ITC49-ITC64
Systemic Lupus Erythematosus
Annals of Internal Medicine; 159 (7): ITC4-1
Polymyalgia Rheumatica
Annals of Internal Medicine; 166 (9): ITC65-ITC80
View MoreView Less

Related Topics
Endocrine and Metabolism
Thyroid Disorders

Endocrine and Metabolism, Thyroid Disorders.

PubMed Articles
Dominus effect: challenging complications of alemtuzumab-related thyroid autoimmunity.
J Endocrinol Invest 2020.
Medical comorbidities in patients with psychogenic non-epileptic seizures (functional seizures).
Neurol Sci 2020.
View More

Results provided by: PubMed

CONTINUE WITH LIMITED ACCESS
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
acp link acp
silverchair link silverchair

Copyright © 2020 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept
×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×