Screening for Thyroid Disease

Screening for Thyroid Disease

Screen for thyroid disease with a serum TSH measurement. Given the prevalence of thyroid disease in the elderly, screening is valuable. It is clear that all patients benefit to some degree by treatment of subclinical hypothyroidism – elevated TSH with normal hormone values. It was unclear until recently, however, whether all patients with mild to moderate suppression of TSH would benefit from anti-thyroid treatment. Analysis of patients from the Framingham Study showed that older patients (> 60 yrs) with a suppressed TSH and normal thyroid hormone levels had a three-fold higher risk of atrial fibrillation than those patients with normal TSH levels. Thus, subclinical hypothyroidism is a real disease in the elderly and should be treated.

As good as the TSH assay is today, measurement of thyroid hormone levels are still needed in many circumstances. For example, the level of thyroid hormones correlate poorly with the TSH value when the TSH value falls outside a range of approximately 0.1-10 m l/l. Moreover, normalization of the TSH value after treatment of either thyrotoxicosis or hypothyroidism usually lags behind normalization of hormone levels. Finally, patients intermittently complaint with their hormone replacement cannot be identified by a TSH assay alone.

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