Should a 42-year-old female with recent weight gain, fatigue, menorrhagia (abnormal uterine bleeding), and fertility problems, and a family history of hypothyroidism, undergo thyroid function screening?

From the Guidelines

This patient should undergo thyroid function screening due to her symptoms and risk factors, as recommended by the US Preventive Services Task Force and supported by the study published in the Annals of Internal Medicine 1. The patient's symptoms, including weight gain, fatigue, menorrhagia, and fertility problems, are suggestive of hypothyroidism, and her family history of hypothyroidism increases her risk.

• The serum TSH test is the primary screening test for thyroid dysfunction, and multiple tests should be done over a 3- to 6-month interval to confirm or rule out abnormal findings, as stated in the study 1.
• The initial screening should include measurement of thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels to differentiate between subclinical and "overt" thyroid dysfunction.
• If hypothyroidism is confirmed, treatment typically involves levothyroxine replacement therapy, and early detection and treatment can improve symptoms, restore fertility, regulate menstrual cycles, and prevent long-term complications such as cardiovascular disease and dyslipidemia.
• The study highlights that risk factors for an elevated TSH level include female sex, advancing age, white race, type 1 diabetes, Down syndrome, family history of thyroid disease, goiter, previous hyperthyroidism, and external-beam radiation in the head and neck area, all of which support the decision to screen this patient 1.
• Although the optimal screening interval for thyroid dysfunction is unknown, the US Preventive Services Task Force recommends screening for patients with symptoms suggestive of hypothyroidism, which this patient exhibits 1.

From the Research

Patient Profile

• Age: 42 years old
• Sex: Female
• Recent weight gain
• Fatigue
• Menorrhagia (abnormal uterine bleeding)
• Fertility problems
• Family history of hypothyroidism

Indications for Thyroid Function Screening

• The patient's symptoms, such as fatigue, weight gain, and menorrhagia, are consistent with hypothyroidism 2, 3, 4
• The patient's family history of hypothyroidism increases her risk of developing the condition 2, 3
• The patient's fertility problems may be related to hypothyroidism, as hypothyroidism can affect menstrual cycle regularity and fertility 5, 6

Screening Recommendations

• The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against screening for hypothyroidism in the general population 2
• However, some organizations support screening in special populations, such as those with a family history of hypothyroidism or symptoms consistent with the condition 2, 3
• The patient's symptoms and family history suggest that thyroid function screening may be warranted 2, 3, 4, 5, 6

Diagnostic Evaluation

• Initial laboratory evaluation should consist of a serum thyrotropin (TSH) measurement with reflex testing of free thyroxine (T4) 2, 3, 4
• Thyroid function tests must be interpreted carefully, as acute illness, diet, and drugs may alter values 2
• If hypothyroidism is suspected, further evaluation and management should be guided by the results of the diagnostic tests 2, 3, 4, 5, 6