Paul W. Ladenson, MD; Peter A. Singer, MD; Kenneth B. Ain, MD; Nandalal Bagchi, MD, PhD; S. Thomas Bigos, MD; Elliot G. Levy, MD; Steven A. Smith, MD; Gilbert H. Daniels, MD
Objective To define the optimal approach to identify patients with thyroid dysfunction.
Participants The 8-member Standards of Care Committee of the American Thyroid Association prepared a draft, which was reviewed by the association's 780 members, 50 of whom responded with suggested revisions.
Evidence Relevant published studies were identified through and the association membership's personal resources.
Consensus Process Consensus was reached at group meetings. The first draft was prepared by a single author (P.W.L.) after group discussion. Suggested revisions were incorporated after consideration by the committee.
Conclusions The American Thyroid Association recommends that adults be screened for thyroid dysfunction by measurement of the serum thyrotropin concentration, beginning at age 35 years and every 5 years thereafter. The indication for screening is particularly compelling in women, but it can also be justified in men as a relatively cost-effective measure in the context of the periodic health examination. Individuals with symptoms and signs potentially attributable to thyroid dysfunction and those with risk factors for its development may require more frequent serum thyrotropin testing.
Arch Intern Med. 2000;160:1573-1575
THYROID dysfunction is common in adults1-5 and frequently has significant clinical consequences. Hypothyroidism and hyperthyroidism can be accurately diagnosed with laboratory tests6, 7 and are readily treatable. (Although hyperthyroidism can be narrowly construed as those causes of thyrotoxicosis that result from glandular hyperactivity, the term here refers to all conditions causing thyroid hormone excess, including certain forms of thyroiditis and exogenous thyroid hormone administration.)
Clinical manifestations of thyroid dysfunction vary considerably among patients in their character and severity. Associated symptoms and signs are often nonspecific and progress slowly. Consequently, the accuracy of clinical diagnosis is limited. Physicians must consider and exclude thyroid dysfunction much more often than they will establish a diagnosis. If only patients presenting with clearly suggestive symptoms and signs are evaluated, many affected individuals will remain undiagnosed. For these persons, appropriate treatment for thyroid dysfunction or conservative monitoring to anticipate its potential future consequences can only be implemented when routine laboratory screening identifies them (see the "Screening for Thyroid Dysfunction" section below).