J. Bruin Rugge, MD, MPH; Christina Bougatsos, MPH; Roger Chou, MD
Disclaimer: The authors of this article are responsible for its content. Statements in the article should not be construed as endorsement by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Agency for Healthcare Research and Quality Medical Officer Jennifer Croswell, MD, MPH. They also thank the U.S. Preventive Services Task Force Lead Work Group, including Jessica Herzstein, MD, MPH; Wanda Nicholson, MD, MPH, MBA; Timothy Wilt, MD, MPH; and Virginia A. Moyer, MD, MPH. In addition, the authors thank Raj Sehgal, MD; Paul N. Gorman, MD; Howard Balshem, MS; and Rose Relevo, MLS, who were coauthors of a comparative effectiveness review on this same topic, on which this article builds.
Grant Support: By the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (contract HHSA-290-2007-10057-I-EPC3).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1456.
Requests for Single Reprints: J. Bruin Rugge, MD, MPH, Oregon Health & Science University, Mail Code FM, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Rugge: Oregon Health & Science University, Mail Code FM, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239.
Ms. Bougatsos and Dr. Chou: Oregon Health & Science University, Mail Code BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239.
Author Contributions: Conception and design: J.B. Rugge, C. Bougatsos, R. Chou.
Analysis and interpretation of the data: J.B. Rugge, C. Bougatsos, R. Chou.
Drafting of the article: J.B. Rugge, C. Bougatsos, R. Chou.
Critical revision of the article for important intellectual content: J.B. Rugge, R. Chou.
Final approval of the article: J.B. Rugge, C. Bougatsos, R. Chou.
Statistical expertise: R. Chou.
Obtaining of funding: R. Chou.
Administrative, technical, or logistic support: C. Bougatsos.
Collection and assembly of data: J.B. Rugge, C. Bougatsos, R. Chou.
In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend thyroid screening.
To update the 2004 U.S. Preventive Services Task Force review on the benefits and harms of screening and treatment of subclinical and undiagnosed overt hypothyroidism and hyperthyroidism in adults without goiter or thyroid nodules.
MEDLINE and Cochrane databases through July 2014.
Randomized, controlled trials and observational studies of screening and treatment.
One investigator abstracted data, and a second investigator confirmed; 2 investigators independently assessed study quality.
No study directly assessed benefits and harms of screening versus no screening. For subclinical hypothyroidism (based on thyroid-stimulating hormone levels of 4.1 to 11.0 mIU/L), 1 fair-quality cohort study found that treatment of subclinical hypothyroidism was associated with decreased risk for coronary heart disease events versus no treatment. No study found that treatment was associated with improved quality of life, cognitive function, blood pressure, or body mass index versus no treatment. Effects of treatment versus no treatment showed potential beneficial effects on lipid levels, but effects were inconsistent, not statistically significant in most studies, and of uncertain clinical significance (difference, −0.7 to 0 mmol/L [−28 to 0 mg/dL] for total cholesterol levels and −0.6 to 0.1 mmol/L [−22 to 2 mg/dL] for low-density lipoprotein cholesterol levels). Treatment harms were poorly studied and sparsely reported. Two poor-quality studies evaluated treatment of subclinical hyperthyroidism but examined intermediate outcomes. No study evaluated treatment versus no treatment of screen-detected, undiagnosed overt thyroid dysfunction.
English-language articles only, no treatment study performed in the United States, and small trials with short duration that used different dosage protocols.
More research is needed to determine the clinical benefits associated with thyroid screening.
Agency for Healthcare Research and Quality.
Table 1. Classification of Thyroid Dysfunction: Biochemical Definition
Table 2. Subclinical Hypothyroidism Cardiovascular Events and Mortality
Table 3. Subclinical Hyperthyroidism Quality of Life and Cognitive Function
Table 4. Summary of Evidence
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Rugge JB, Bougatsos C, Chou R. Screening and Treatment of Thyroid Dysfunction: An Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. ;162:35–45. doi: 10.7326/M14-1456
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Published: Ann Intern Med. 2015;162(1):35-45.
Endocrine and Metabolism, Prevention/Screening, Thyroid Disorders.
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