Thyroid disease is very common. There is ongoing debate as to whether we should screen everybody, or just wait until people complain of symptoms before we do thyroid blood tests. And then, which blood tests should we do?
A recent study from the Netherlands published online in Clinical Endocrinology adds weight to the argument for not just waiting for patients to complain of symptoms. The authors found that symptoms of hypothyroidism in pregnancy were an unreliable guide as to whether the patient was hypothyroid or not. It is important in pregnancy as the presence of an under-active thyroid can affect the outcome of pregnancy - both for the mother and for her baby.
Whether during pregnancy or not, the symptoms of an under-active thyroid are non-specific and vary greatly from one person to another. Thyroid disease affects one in 20 of the population - more if you are older, especially if you are female. If you wait until typical hypothyroid symptoms develop, there may be a preceding prolonged spell of relatively poor health, and it may be all the harder to get back on track.
If we do not screen everybody for thyroid disease (and current guidelines suggest we do not), then we should at least have a low threshold for ordering thyroid tests. At present, TSH alone is recommended as the initial screening test. However, cases of subclinical thyroid disease will be missed if thyroid hormone and antibody tests are not requested. The antibody tests are important as they will identify individuals at risk of hypothyroidism or hyperthyroidism, even if they do not currently have symptoms.
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