Twenty-seven million Americans have thyroid disease--and more than eight out of 10 of them are women, reports the American Thyroid Association. The thyroid, a butterfly-shaped gland in the neck, regulates your metabolism. Sometimes it goes awry, resulting in hypothyroidism (when it's underactive) or the more serious hyperthyroidism (when it's overactive). Whether or not to test if the thyroid is really off kilter is the subject of debate in the medical community, stirred up by a report in the Journal of the American Medical Association.
Checking for early signs of thyroid disease is easy, accurate and cheap: All it takes is a simple blood test. Yet the screening guidelines are all over the map. The main reason is that there's limited science available to help guide doctors. After reviewing data on mild thyroid disease,the JAMA study concluded that there's no evidence to justify widespread thyroid screening. The focus, it said, should be on people at high risk for the disease. And because large randomized controlled clinical trials have not been conducted to see if the effects of mild thyroid failure are serious, the panel felt that there was not enough evidence to justify treatment or recommend screening for everyone.
The report has its critics, especially among endocrinologists who regularly diagnose and treat thyroid disorders. "The findings do not present a consensus from various endocrine organizations, which share a different view" says Hossein Gharib, M.D., professor of medicine at the Mayo Clinic College of Medicine, in Rochester, Minn. Gharib estimates that up to 5 percent of the patients who walk through the doors of the Mayo Clinic have thyroid problems that are found by doctors there.
Discovering thyroid disease early can spare a patient needless discomfort, say many physicians. Slightly low or high thyroid levels can worsen over time, so even a mild deviation from normal is to be taken seriously. So how do you know if you should have your thyroid tested? And if your levels are just below or above normal, should you start medication or take a wait-and-see approach? What remains paramount, concluded the panel, is "clinical judgment and patients' preferences."
"When a patient has symptoms, there is no controversy about checking for thyroid disease," says panelist Rhoda H. Cobin, M.D., F.A.C.E., clinical professor of medicine at Mount Sinai School of Medicine in New York City. But not everyone who has a mild thyroid problem displays symptoms. The panel agreed that aggressive case finding in people at high risk (those with family histories of the condition, or women over 50) is appropriate.