Screening for and treatment of thyroid dysfunction an evidence review for the U.S. Preventive Services Task Force

BACKGROUND: Screening may lead to detection and treatment of asymptomatic subclinical thyroid dysfunction or undiagnosed overt thyroid disease, potentially resulting in improved clinical outcomes. PURPOSE: To update a 2004 review on screening for thyroid disease for the U.S. Preventive Services Task...

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Main Authors: Rugge, Bruin, Bougatsos, Christina (Author), Chou, Roger (Author)
Corporate Authors: United States Agency for Healthcare Research and Quality, Oregon Health & Science University Evidence-based Practice Center, U.S. Preventive Services Task Force
Format: eBook
Language:English
Published: Rockville, MD Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services 2014, 2014
Series:Evidence synthesis
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:BACKGROUND: Screening may lead to detection and treatment of asymptomatic subclinical thyroid dysfunction or undiagnosed overt thyroid disease, potentially resulting in improved clinical outcomes. PURPOSE: To update a 2004 review on screening for thyroid disease for the U.S. Preventive Services Task Force (USPSTF), expanded to include undiagnosed overt thyroid disease. DATA SOURCES: We searched Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from 2002 to July 2014 for subclinical hypothyroidism and hyperthyroidism, and without a prior date limitation for overt thyroid disease. Searches on electronic databases were supplemented by reviews of reference lists. STUDY SELECTION: Randomized, controlled trials and controlled observational studies on the effects of screening for or treatment of subclinical or overt thyroid disease on clinical and intermediate outcomes.
CONCLUSIONS: Although screening can identify patients with subclinical thyroid dysfunction and undiagnosed overt thyroid disease, direct evidence on the benefits and harms of screening remains unavailable. More research is needed to understand how the effects of treatment of subclinical hypothyroidism on lipid parameters impacts clinical outcomes, and to determine the effects of identification and treatment of subclinical hyperthyroidism and undiagnosed overt thyroid disease
Effects of treatment versus no treatment showed potential beneficial effects on lipid levels, but effects were inconsistent, not statistically significant in most studies, and of uncertain clinical significance (difference, -28 to 0 mg/dL for total cholesterol [nine studies] and -22 to 2 mg/dL for low-density lipoprotein cholesterol [10 studies]). Harms of treatment were poorly studied and sparsely reported. Two studies evaluated treatment of subclinical hyperthyroidism, but they were poor-quality and examined intermediate outcomes. No studies evaluated treatment versus no treatment for screen-detected, undiagnosed overt thyroid disease. LIMITATIONS: We did not include non-English-language articles. None of the eligible studies were conducted in the United States. All studies were small and of short duration. Studies used varying TSH values to define subclinical disease and varying doses of thyroxine treatment. Few treatment studies were conducted in screen-detected populations.
DATA EXTRACTION: Information regarding the population, setting, treatments, and outcomes was abstracted. The quality of each study was assessed using the standard USPSTF criteria. DATA SYNTHESIS (RESULTS): No study directly assessed the benefits and harms of screening versus no screening. For subclinical hypothyroidism (thyroid-stimulating hormone [TSH] levels of 4 to 11 mIU/L), one fair-quality cohort study found that treatment of subclinical hypothyroidism was associated with decreased risk for coronary heart disease events versus no treatment. No studies found that treatment was associated with improved quality of life, cognitive function, blood pressure, or body mass index versus no treatment.
Item Description:Title from PDF t.p. - "October 2014.". - "Update of a 2004 review on screening for thyroid disease." --P iii
Physical Description:1 online resource (1 PDF file (67 pages)) illustrations