Should a female patient over 35 years old with a family history of thyroid disease, a past medical history of Guillain-Barré Syndrome (an autoimmune disorder), and difficulties conceiving have undergone routine screening for thyroid function, according to the American Thyroid Association (ATA) guidelines?

From the Guidelines

The patient should undergo thyroid function screening based on her specific risk factors, including family history of thyroid disease, female gender, autoimmune history with Guillain-Barré syndrome, and fertility issues, rather than routine age-based screening. The American Thyroid Association, U.S. Preventive Services Task Force, and American Academy of Family Physicians do not recommend routine screening for thyroid dysfunction in non-pregnant, asymptomatic adults [ 1 ]. Instead, a case-finding approach is preferred, where testing is done when patients present with symptoms or have specific risk factors. For this patient, thyroid testing would be appropriate as part of her fertility workup and due to her family history, but not simply because she is over 35 [ 1 ]. The rationale is that universal screening has not been shown to improve outcomes in asymptomatic individuals, and may lead to overdiagnosis and unnecessary treatment [ 1 ].

Some key points to consider in this patient's case include:

• The patient's family history of thyroid disease and autoimmune history with Guillain-Barré syndrome increase her risk for thyroid dysfunction [ 1 ].
• The patient's fertility issues may also be related to thyroid dysfunction, making screening a reasonable part of her fertility workup [ 1 ].
• The American Thyroid Association recommends measuring thyroid function in women of childbearing age before pregnancy or during the first trimester [ 1 ].
• The U.S. Preventive Services Task Force found fair evidence that the thyroid-stimulating hormone (TSH) test can detect subclinical thyroid disease in people without symptoms of thyroid dysfunction, but poor evidence that treatment improves clinically important outcomes in adults with screen-detected thyroid disease [ 1 ].

Overall, thyroid function screening is recommended for this patient based on her individual risk factors, rather than as a routine screening measure [ 1 ].

From the Research

Thyroid Function Screening

• The American Thyroid Association (ATA) 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 2.
• 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 2.
• The patient in question is over 35 years old and has a family history of thyroid disease, which may be considered a risk factor for thyroid dysfunction.

Risk Factors and Screening

• A past medical history of Guillain-Barré Syndrome, an autoimmune disorder, may increase the risk of thyroid dysfunction, as there is a reported case of transition from Hashimoto's to Graves' disease triggered by the onset of Guillain-Barré syndrome 3.
• Difficulties conceiving may also be related to thyroid dysfunction, as subclinical hypothyroidism has been associated with ovulatory dysfunction and infertility 4.
• The combination of these risk factors may justify more frequent screening for thyroid dysfunction.

Screening Recommendations

• The ATA recommends screening for thyroid dysfunction in adults with risk factors, such as a family history of thyroid disease 2.
• The American College of Physicians suggests that screening may be indicated in women older than 50 years of age, but the evidence for screening in younger women is less clear 5.
• In this case, the patient's age, family history, and past medical history may justify routine screening for thyroid function, according to the ATA guidelines 2.