What questions should be asked to screen a patient for hypothyroidism (underactive thyroid)?

From the Guidelines

To screen for hypothyroidism, ask patients about symptoms such as fatigue, unexplained weight gain, cold intolerance, dry skin, constipation, muscle weakness, joint pain, depression, menstrual irregularities, and hair loss, as these are common manifestations of the condition 1. When taking a patient's history, it is essential to inquire about their family history of thyroid disorders, as hypothyroidism often has a genetic component. Ask about neck discomfort or visible swelling that might indicate goiter. Question patients about their medication history, particularly lithium, amiodarone, or recent radiation therapy, which can affect thyroid function. Also, ask about previous thyroid conditions or surgeries. Some key points to consider when screening for hypothyroidism include:

• Risk factors for an elevated TSH level, such as 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 1.
• 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 1.
• While these questions help identify potential cases, diagnosis requires laboratory testing, typically TSH and free T4 levels. It is crucial to remember that symptoms can be subtle and develop gradually, so a comprehensive history is essential for identifying patients who need further evaluation.

From the FDA Drug Label

In patients with hypothyroidism, assess the adequacy of replacement therapy by measuring both serum TSH and total or free-T4. Monitor TSH and total or free-T4 in pediatric patients as follows: 2 and 4 weeks after the initiation of treatment, 2 weeks after any change in dosage, and then every 3 to 12 months thereafter following dosage stabilization until growth is completed The general aim of therapy is to normalize the serum TSH level Failure of the serum T4 to increase into the upper half of the normal range within 2 weeks of initiation of levothyroxine sodium therapy and/or of the serum TSH to decrease below 20 IU per litre within 4 weeks may indicate the patient is not receiving adequate therapy

To screen for hypothyroidism, you should ask patients questions that can help identify clinical symptoms and laboratory parameters. Some key questions to ask include:

• Do you have any symptoms such as fatigue, weight gain, or cold intolerance?
• Have you experienced any changes in your menstrual cycle or fertility?
• Have you noticed any changes in your hair, skin, or nails?
• Do you have any family history of thyroid disease?
• Have you had any previous thyroid problems or treatments? You should also ask about medication adherence and lifestyle factors that may affect thyroid function. However, the FDA drug label does not provide specific questions to ask patients to screen for hypothyroidism, it provides guidance on monitoring and treatment. 2

From the Research

Screening Questions for Hypothyroidism

To screen for hypothyroidism, the following questions can be asked:

• Do you experience fatigue or lethargy? 3, 4, 5
• Have you noticed any weight gain or difficulty losing weight? 3, 4
• Are you sensitive to cold temperatures or do you feel cold even in warm environments? 3, 4
• Do you have constipation or irregular bowel movements? 3, 4
• Have you noticed any changes in your skin, such as dryness or dry skin (xeroderma)? 3
• Have you experienced any voice changes? 4
• Do you have any difficulty with mental functioning, such as memory problems or difficulty concentrating? 3, 5

Additional Questions

Additional questions can be asked to further assess the patient's symptoms and potential underlying causes of hypothyroidism:

• Have you had any previous thyroid problems or thyroid surgery? 3
• Are you taking any medications that may affect thyroid function? 3
• Do you have a family history of thyroid problems? 3
• Have you experienced any other symptoms, such as hair loss, muscle weakness, or heavy or irregular menstrual periods? 5