Should a 45-year-old woman with a family history of hypothyroidism undergo thyroid function screening?

From the Guidelines

The patient does not require thyroid screening at this time (option D). This 45-year-old woman has a family history of hypothyroidism, but the most recent and highest quality study, 1, does not support routine screening for thyroid dysfunction in asymptomatic adults. The U.S. Preventive Services Task Force (USPSTF) recommends against routine thyroid screening in asymptomatic patients, citing the potential harms of screening and treatment, including overtreatment and unnecessary lifelong thyroid hormone therapy 1. While some organizations, such as the American Thyroid Association, recommend measuring thyroid function in all adults beginning at age 35 years, the USPSTF's recommendation is based on a more comprehensive review of the evidence and takes into account the potential harms of screening.

The patient's family history of hypothyroidism is a risk factor, but it is not sufficient to justify routine screening in the absence of symptoms. The American Academy of Family Physicians has endorsed the USPSTF recommendation, and other organizations, such as the Canadian Task Force on the Periodic Health Examination, recommend maintaining a high index of clinical suspicion for nonspecific symptoms consistent with hypothyroidism rather than routine screening 1.

Key points to consider include:

• The USPSTF recommends against routine thyroid screening in asymptomatic patients
• The potential harms of screening and treatment, including overtreatment and unnecessary lifelong thyroid hormone therapy
• The patient's family history of hypothyroidism is a risk factor, but it is not sufficient to justify routine screening in the absence of symptoms
• The American Academy of Family Physicians has endorsed the USPSTF recommendation
• Other organizations recommend maintaining a high index of clinical suspicion for nonspecific symptoms consistent with hypothyroidism rather than routine screening.

From the Research

Thyroid Screening Recommendations

The patient is a 45-year-old woman with a family history of hypothyroidism, but she is asymptomatic. The most appropriate recommendation for her is:

• She does not require thyroid screening at this time, as there is no evidence that population screening is beneficial 2
• The American family physician study suggests that symptom relief and normalized thyroid-stimulating hormone levels are achieved with levothyroxine replacement therapy, but this is only recommended for patients with symptoms or elevated thyroid-stimulating hormone levels 2
• The Nature reviews study also notes that hypothyroidism is a common clinical condition, but it does not recommend screening for asymptomatic patients 3
• The Annals of laboratory medicine study discusses the importance of laboratory tests in the management of thyroid conditions, but it also emphasizes the need to consider the clinical context when interpreting results 4

Screening Options

The following options are not recommended:

• Beginning annual free thyroxine screening at this visit, as there is no evidence to support this approach 2
• Beginning annual thyroid-stimulating hormone screening at this visit, as the patient is asymptomatic and there is no evidence to support this approach 2
• Beginning annual thyroid-stimulating hormone screening at the age of 50, as this is not a recommended screening age for asymptomatic patients 2
• Undergoing a thyroid panel today to determine the need, as this is not necessary for asymptomatic patients with a family history of hypothyroidism 4