18th January 22:59
Screening for Thyroid Disease? (stress hypothyroidism high blood pressure cholesterol heart)
Screening for Thyroid Disease?
Medical Authors and Editors: Barbara K. Hecht, Ph.D. and Frederick
Should everyone have a thyroid test? "Yes" says the American Thyroid
Association (ATA). It recommends measuring thyroid function in all
adults beginning at age 35 with follow-up testing every five years.
"No" says a new report from the U.S. Preventive Services Task Force
(USPSTF). The rationale for routine thyroid screening has been that
thyroid disease is very common and is best detected early so it can be
treated without delay.
Thyroid disease is, indeed, common. Nearly 15 million people in the US
have thyroid disease, causing them to be hypothyroid (not enough
hormone) or hyperthyroid (too much hormone).
However, the USPSTF found no convincing studies to show that
asymptomatic patients do better if they begin treatment before
symptoms of thyroid disease develop. Therefore, it concludes that the
current evidence is insufficient to recommend for or against routine
screening for thyroid disease in adults with no symptoms of thyroid
What is the basis for this difference of opinion between two
authoritative bodies as to whether screening thyroid tests should or
should not be routine? It is called evidence-based medicine (or
Evidence-based medicine is an approach to health care based on the
collection, interpretation, and integration of valid, applicable
evidence (patient-reported, clinician-observed, and research-derived
evidence). The best available evidence is then applied to improve the
quality of clinical judgments.
A Personal Perspective
The jury is out on routine thyroid testing of asymptomatic adults. As
we see it, it is perfectly all right to accept the recommendation of
the American Thyroid Association and have a thyroid test done every 5
years. And it is equally all right to accept the USPSFT recommendation
and not have a thyroid test.
It would help us all, physicians and patients alike, if all the
experts would get on the same page and let us know just one thing --
"yes" or "no." Life is not always simple but we keep hoping it will
Source: U.S. Preventive Services Task Force (USPSTF) (http://www.ahrq.gov)
The symptoms of hypothyroidism are often subtle. They are not specific
(which means they can mimic the symptoms of many other conditions) and
are often attributed to aging. Patients with mild hypothyroidism may
have no signs or symptoms. The symptoms generally become more obvious
as the condition worsens and the majority of these complaints are
related to a metabolic slowing of the body. Common symptoms are listed
Fatigue Depression Modest weight gain Cold intolerance Excessive
sleepiness Dry, coarse hair Constipation Dry skin Muscle cramps
Increased cholesterol levels Decreased concentration Vague aches and
pains Swelling of the legs
As the disease becomes more severe, there may be puffiness around the
eyes, a slowing of the heart rate, a drop in body temperature, and
heart failure. In its most profound form, severe hypothyroidism may
lead to a life-threatening coma (myxedema coma). In a severely
hypothyroid individual, a myxedema coma tends to be triggered by
severe illness, surgery, stress, or traumatic injury. This condition
requires hospitalization and immediate treatment with thyroid hormones
given by injection.
Hyperthyroidism is suggested by a number of signs and symptoms.
Patients with mild disease usually experience no symptoms. In patients
older than 70 years, the classical manifestations may also be absent.
In general, the symptoms become more obvious as the condition worsens.
The symptoms are usually related to an increase in body metabolism.
Common symptoms are listed below:
Excessive sweating Heat intolerance Increased bowel movements
Tremor Nervousness; agitation Rapid heart rate Weight loss Fatigue
Decreased concentration Irregular and scant menstrual flow
In older patients, irregular heart rhythms and heart failure can
occur. In its most severe form, untreated hyperthyroidism may result
in " thyroid storm," a condition involving high blood pressure, fever,
and heart failure.