Everyone Over 35 Needs Thyroid Test, Group Says
June 16, 2000 -- The next time you go to the doctor, don't be surprised if
he or she gives you a thyroid test. Even if you don't have any symptoms, you
may be one of millions of Americans who have either an underactive or an
overactive thyroid gland.
Many people with thyroid abnormalities have obvious symptoms that cause them
to seek help, but many others do not. Because the symptoms tend to develop
slowly and can mimic other things, thyroid disease is often difficult to
diagnose without lab tests.
Symptoms of underactive thyroid, known as hypothyroidism, can include
fatigue, weight gain, intolerance to cold, dry skin, high cholesterol,
depression, and an enlarged thyroid gland. But some people have thyroid
problems with no obvious symptoms at all.
An estimated 11 million Americans, many of them women over age 50, have
underactive thyroid, and a smaller number -- about 2 million -- have overactive
thyroid. Symptoms of overactive thyroid can include fatigue, weight loss,
profuse sweating, intolerance to heat, nervousness, difficulty sleeping, and an
enlarged thyroid gland.
In a recent issue of the journal Archives of Internal Medicine, a
group of thyroid experts recommends that doctors start screening all adults for
thyroid disease beginning at around age 35, regardless of whether they have
symptoms or risk factors. They also suggest that screening be done every five
years after that.
"Not everyone agrees with starting at age 35," says Gilbert H.
Daniels, MD, one of the experts who helped draft the guidelines. "We think
it's a reasonable thing to do." Daniels is an associate professor of
medicine at Harvard Medical School in Boston.
The guidelines recommend that doctors give everyone age 35 and older a
thyroid test called a serum TSH assay. If the test result is not normal,
treatment varies according to the cause of the abnormal result and whether
there are other related problems.
Treatment for underactive thyroid typically involves giving thyroid hormone
to compensate for the lack of hormone in the body. Treatment for overactive
thyroid is more complex and may involve giving a radioactive substance that
slows down production of thyroid hormone. A last resort is surgical removal of
the gland itself.
One thing that is important to remember is that an abnormal test doesn't
necessarily mean you have thyroid disease. Other illnesses -- and even some
medications -- can temporarily affect thyroid hormone levels.
That is one reason, says endocrinologist Linda Lester, MD, that doctors
should always retest patients with no symptoms who have an abnormal result on a
thyroid test. If the second test still shows evidence of a thyroid problem,
treatment should be started, because even minor thyroid dysfunction can cause
other health problems.
"This is easy to treat and we can treat with really minimal side
effects," says Lester, who is an assistant professor of medicine in the
division of endocrinology at Oregon Health Sciences University. She reviewed
the guidelines for WebMD.
In addition to adults age 35 and older, Lester says there is now new
evidence that women of child-bearing age, who are in their 20s and early 30s,
also should be tested because, left undetected, thyroid disease can affect the
health of their babies.