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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.

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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...
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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

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

DOI: 10.7326/M15-0640

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