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Cover of Screening for Thyroid Disease

Screening for Thyroid Disease

Systematic Evidence Reviews, No. 23

, MD, MPH.

Oregon Health & Science University Evidence-based Practice Center, Portland, OR

Structured Abstract


This article focuses on whether it is useful to order a thyroid function test in patients who have no history of thyroid disease and have few or no signs or symptoms of thyroid dysfunction.

Data Sources:

A MEDLINE® search, supplemented by searches of EMBASE® and the Cochrane Library, reference lists, and a local database of thyroid-related articles.

Study Selection:

We selected controlled studies of treatment that used thyroid-stimulating hormone (TSH) levels as an inclusion criterion and reported quality of life, symptoms, or lipid level outcomes. We also reviewed observational studies of the prevalence, progression, and consequences of subclinical thyroid dysfunction.

Data Extraction and Synthesis:

Using preset criteria, we assessed the quality of each trial and abstracted information about its setting, patients, interventions, and outcomes.


The prevalence of unsuspected thyroid disease is lowest in men and highest in older women. Evidence regarding the efficacy of treatment in patients found by screening to have subclinical thyroid dysfunction is inconclusive. Several small, randomized trials of treatment for subclinical hypothyroidism have been done, but the results are inconclusive except in patients who have a history of treatment for Graves' disease, a subgroup that is not a target of screening in the general population. No trials of treatment for subclinical hyperthyroidism have been done. Data on the adverse effects of broader use of levothyroxine is sparse.


Large randomized trials of treatment are needed to determine the likelihood that treatment will improve quality of life in otherwise healthy patients who have abnormal TSH levels and normal thyroxine (T4) levels.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018, Task No. 2, Technical Support of the U.S. Preventive Services Task Force. Prepared by: Oregon Health & Science University Evidence-based Practice Center, Portland, OR.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.


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Bookshelf ID: NBK42812PMID: 20722119
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