Dr. Richard Birtwhistle, Professor Departments of Family Medicine and Community Health and Epidemiology Director of the Centre for Studies, Primary Care, Department of Family Medicine Queen’s University

Is There A Clinical Benefit To Asymptomatic Thyroid Function Screening?

MedicalResearch.com Interview with:

Dr. Richard Birtwhistle, Professor Departments of Family Medicine and Community Health and Epidemiology Director of the Centre for Studies, Primary Care, Department of Family Medicine Queen’s University

Dr. Birtwhistle

Dr. Richard Birtwhistle, Professor
Departments of Family Medicine and Community Health and Epidemiology
Director of the Centre for Studies, Primary Care, Department of Family Medicine
Queen’s University

MedicalResearch.com: What is the background for this study?

Response: Testing for thyroid dysfunction is a commonly done by primary care practitioners. While the Thyroid stimulating hormone (TSH) test is an easy blood test to perform results outside the normal range are often found and will revert to normal over time without treatment in patients without symptoms.

We wanted to see if there was any clinical benefit to patients by screening for thyroid dysfunction. 

MedicalResearch.com: What are the main findings? What are the potential harms of over-testing for thyroid dysfunction? 

Response: We did a systematic review of studies related to screening for thyroid dysfunction. We found no trials of screening for thyroid dysfunction. We analyzed studies (19 randomized trials and 3 cohort studies) of treatment of apparently screen detected patients. We looked for differences in mortality (total and cardiovascular), cardiovascular events (fatal and nonfatal MI, atrial fibrillation), fractures, thyroid specific quality of life, cognitive function and some intermediate outcomes such as blood pressure and cholesterol. Overall, the studies found no differences in these outcomes.

The potential harms of screening for thyroid dysfunction are related to the need for patients to have repeated followup blood tests, medical appointments and potentially unnecessary lifelong treatment. These potential harms can result in unnecessary worry for the patient, and use of resources (time and money) for both patients and the single payer health system.

We did not do any formal assessment of cost benefit because there appears to be no clinical benefit to patients.

MedicalResearch.com: What should readers take away from your report?

Response: We found several gaps in knowledge.

  1. There have been no direct screening trials for thyroid dysfunction (both hypo and hyperthyroidism).
  2. There have been no studies of screening patients with other chronic conditions such as cardiovascular disease, type 1 diabetes or autoimmune disease. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The task force uses the GRADE approach to assessing the evidence and making recommendations. No members of the working group had competing interests and one member of the task force reported developing an educational video on thyroid dysfunction but did not vote on the 

Citation:

Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care

Richard BirtwhistleKate MorissetteJames A. DickinsonDonna L. ReynoldsMarc T. AveyFrancesca Reyes DomingoRachel Rodin and Brett D. Thombsfor the Canadian Task Force on Preventive Health Care
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Last Modified: Nov 18, 2019 @ 5:54 pm

 

 

 

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