DOCTOR'S VIEW ARCHIVE

Medical Authors and Editors: Barbara K. Hecht, Ph.D. and Frederick Hecht, M.D.

Should everyone have a thyroid test? "Yes" says the American Thyroid Association (ATA). It recommends measuring thyroid function in all adults beginning at age 35 with follow-up testing every five years. "No" says a new report from the U.S. Preventive Services Task Force (USPSTF). The rationale for routine thyroid screening has been that thyroid disease is very common and is best detected early so it can be treated without delay.

Thyroid disease is, indeed, common. Nearly 15 million people in the US have thyroid disease, causing them to be hypothyroid (not enough hormone) or hyperthyroid (too much hormone).

However, the USPSTF found no convincing studies to show that asymptomatic patients do better if they begin treatment before symptoms of thyroid disease develop. Therefore, it concludes that the current evidence is insufficient to recommend for or against routine screening for thyroid disease in adults with no symptoms of thyroid disease.

Evidence-Based Medicine

What is the basis for this difference of opinion between two authoritative bodies as to whether screening thyroid tests should or should not be routine? It is called evidence-based medicine (or practice).

Evidence-based medicine is an approach to health care based on the collection, interpretation, and integration of valid, applicable evidence (patient-reported, clinician-observed, and research-derived evidence). The best available evidence is then applied to improve the quality of clinical judgments.

A Personal Perspective

The jury is out on routine thyroid testing of asymptomatic adults. As we see it, it is perfectly all right to accept the recommendation of the American Thyroid Association and have a thyroid test done every 5 years. And it is equally all right to accept the USPSFT recommendation and not have a thyroid test.

It would help us all, physicians and patients alike, if all the experts would get on the same page and let us know just one thing -- "yes" or "no." Life is not always simple but we keep hoping it will be.

Source: U.S. Preventive Services Task Force (USPSTF) (www.ahrq.gov) January 2004

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