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USPSTF finds insufficient evidence to support routine thyroid screening
After a systematic review, the U.S. Preventive Services Task Force took the position that evidence does not support routine screening for thyroid dysfunction in nonpregnant adults who are not experiencing symptoms, according to a recommendation statement published in the Annals of Internal Medicine.
The current dearth of research does not allow for an adequate assessment of the benefits and harms of such screening, according to the task force. The statement reaffirms the U.S. Preventive Services Task Force (USPSTF) position published in 2004.
“The USPSTF concludes that the evidence is insufficient and that the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults cannot be determined,” Michael L. LeFevre, MD, MSPH, wrote on behalf of the task force.
R. Mack Harrell
Screening for thyroid dysfunction in this population has not been demonstrated to reduce cardiovascular disease or CV-related morbidity and mortality, but has been shown to result in no meaningful improvements in quality of life, blood pressure, BMI, bone mineral density or lipid levels, according to the task force.
Further, direct evidence is lacking that screening is harmful, but the statement cites the risks of false-positive test results, labeling patients with an illness, overdiagnosis and overtreatment as potential harms. The task force found little evidence of benefit or harm in treating subclinical thyroid dysfunction, but noted that inappropriate treatment could result in dependence on hormone therapy.
“Given the widespread practice of screening for and treatment of thyroid dysfunction in asymptomatic persons and the absence of high-quality evidence on the effectiveness of this approach, a pressing research need for this field is well-designed randomized treatment trials of subclinical and ‘overt’ thyroid dysfunction versus watchful waiting (with the important caveat that patients would be provided therapy if they became notably symptomatic),” LeFevre wrote.
The American Association of Clinical Endocrinologists responded to the statement by affirming that the organization supports “aggressive case finding” among patients with risk factors for thyroid dysfunction.
“My fear is that USPSTF’s statement about ‘lack of data’ to justify thyroid disease screening will be incorrectly interpreted as a ‘lack of clinical need’ to find and treat thyroid disease. We’ve come a long way with diagnosis and treatment of thyroid disease over the past 90 years, and we don’t need to return to the bad old days,” AACE President R. Mack Harrell, MD, FACP, FACE, ECNU, said in a press release.
The Endocrine Society issued a news release supporting the statement: “The Endocrine Society does not recommend universal screening for thyroid disorders, but strongly supports screening for thyroid dysfunction in specific situations, especially in relation to pregnancy.” – by Jill Rollet
Disclosure: The researchers report no relevant financial disclosures.