Indian Write-Ups
| Diagnosis |
| Screening For Thyroid Dysfunction - Shreerang Godbole, Uday Phadke Consultant Endocrinologists, Institute for Treatment &Research in Diabetes and Endocrinology (INSTRIDE), Pune |
| Screening For Thyroid Disease In High-Risk Groups The American Academy of Family Physicians and the American Association of Clinical Endocrinologists recommend measuring thyroid function periodically in all older women. The Canadian Task Force on the Periodic Health Examination recommends maintaining a high index of clinical suspicion for non specific symptoms consistent with hypothyroidism when examining premenopausal and postmenopausal women. The American College of Physicians recommends screening women over age 50 years with one or more general symptoms that could be caused by thyroid disease. The American College of Obstetricians and Gynaecologists recommends that physicians and patients be aware of the symptoms and risk factors for post partum thyroid dysfunction and evaluate patients when indicated. The American Academy of Paediatrics recommends that children with Down’s syndrome have thyroid screening at 4-6 and 12 months of age and annually thereafter. The American Thyroid Association recommends screening thyroid function in the following :
Women with Type 1 diabetes are three times more likely to develop post partum thyroid dysfunction than non-diabetic controls and may have unsuspected thyroid disease in pregnancy. Ideally, all diabetic women should have thyroid antibody measurement in the first trimester, with careful follow up of those with positive results. Also, any woman who develops postpartum thyroiditis should be offered annual follow up, as about a quarter of these women will develop overt hypothyroidism within the next five years. Though it is generally not advisable to check for thyroid dysfunction in the acutely ill patient, those with bipolar affective disorder with rapid cycling and refractory depression should be screened. In those with complaints like depression, fatigue, tiredness, loss of libido, dry skin, hair loss, tingling, aches and pains, swelling, changes in menstrual flow or irregular menses, it is probably worthwhile screening for thyroid dysfunction. Likewise, those with obstructive sleep apnea should also be screened for hypothyroidism. Other presentations of hypothyroidism are anaemia poorly responding to treatment and raised serum lipids, transaminases and prolactin. Hypothyroidism can lead to oligospermia and anovulation. Thyroid work up is imperative in an infertile couple or in a woman with a bad obstetric history. There is an unexplained association between breast cancer and autoimmune (Hashimoto) thyroiditis, with a three fold increase in the prevalence of thyroid antibodies, and it may be worthwhile screening such patients for thyroid dysfunction. Small pleural and pericardial effusions and ECG changes (including non-specific ST-T changes) can occur in hypothyroidism. A high index of suspicion is needed with such findings. Unexplained nervousness, emotional liability, involuntary movements are some of the nervous manifestations of thyrotoxicosis. Screening for thyrotoxicosis is essential in an elderly patient with cardiac failure, particularly if there is dysrhythmia and poor response to digoxin. Resting tachycardia and weight loss are pointers to thyrotoxicosis. Changes in menstrual flow, menstrual irregularities, failure to conceive and repeated abortions may occur in the thyrotoxic woman. Hypercalcaemia occurs in upto 25% of thyrotoxic individuals. Weetman has recently suggested the following indications for screening for hypothyroidism : Established
Probably Worthwhile
The prevalence of unsuspected thyroid disease in healthy people in the general population is very low. Nonetheless, certain high- prevalence groups do exist. Physicians need to keep in mind the subtle and atypical presentations of thyroid disorders. With the increasing availability of sensitive TSH assays, a single TSH estimation could be used as screening in these high-risk groups. The availability of drugs in different strengths means that we can now tailor doses conveniently to individual requirements. References
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