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Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for thyroid disease. Methods: The USPSTF reviewed the evidence on the benefits and harms of screening for subclinical and “overt” thyroid dysfunction without clinically obvious symptoms, as well as the effects of treatment on intermediate and final health outcomes. Population: This recommendation applies to nonpregnant, asymptomatic adults. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults. (I statement) [ABSTRACT FROM AUTHOR]

Background: In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend thyroid screening. Purpose: To update the 2004 U.S. Preventive Services Task Force review on the benefits and harms of screening and treatment of subclinical and undiagnosed overt hypothyroidism and hyperthyroidism in adults without goiter or thyroid nodules. Data Sources: MEDLINE and Cochrane databases through July 2014. Study Selection: Randomized, controlled trials and observational studies of screening and treatment. Data Extraction: One investigator abstracted data, and a second investigator confirmed; 2 investigators independently assessed study quality. Data Synthesis: No study directly assessed benefits and harms of screening versus no screening. For subclinical hypothyroidism (based on thyroid-stimulating hormone levels of 4.1 to 11.0 mIU/ L), 1 fair-quality cohort study found that treatment of subclinical hypothyroidism was associated with decreased risk for coronary heart disease events versus no treatment. No study found that treatment was associated with improved quality of life, cognitive function, blood pressure, or body mass index versus no treatment. 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, -0.7 to 0 mmol/L [-28 to 0 mg/dL] for total cholesterol levels and -0.6 to 0.1 mmol/L [-22 to 2 mg/dL] for low-density lipoprotein cholesterol levels). Treatment harms were poorly studied and sparsely reported. Two poor-quality studies evaluated treatment of subclinical hyperthyroidism but examined intermediate outcomes. No study evaluated treatment versus no treatment of screen-detected, undiagnosed overt thyroid dysfunction. Limitation: English-language articles only, no treatment study performed in the United States, and small trials with short duration that used different dosage protocols. Conclusion: More research is needed to determine the clinical benefits associated with thyroid screening. [ABSTRACT FROM AUTHOR]

The authors discuss a strategy proposed by the American Association of Clinical Endocrinologists, American Thyroid Association and Latin American Thyroid Society to define screening of thyroid dysfunction. Topics discussed include adverse effects of subclinical hypothyroidism on cardiovascular consequences, need of investigating subclinical or overt hyperthyroidism, and a table listing recommendations of eight organizations on screening asymptomatic adults for thyroid dysfunction.

Researches the use of thyroid-stimulating hormone in screening for thyroid dysfunction, examining whether screening should focus on detecting subclinical thyroid dysfunction. Examination of guidelines on screening for thyroid dysfunction, published by the American College of Physicians; Description of methodologies used in this research; Statistical data on screening for thyroid dysfunction; Number of persons benefiting from the detection of thyroid dysfunction.

Presents information on a study which evaluated the use of fine-needle aspiration biopsy in the thyroid of patients suspicious on cytologic examination. Materials and methodology of the study; Results and discussion.

We evaluated the efficacy of combining B-scan bistable and gray-scale ultrasound with needle aspiration cytology in assessing and managing solitary hypofunctioning solid and cystic nodules. Of the 150 cases surveyed, 90 had surgical follow-up histology for comparison to preoperative aspiration cytology results. Overall neoplasm rate in these 90 cases was 66%, increasing to 93% if colloid nodules were included. Adequate material for cytology preoperatively was obtained in 83 (92%). In cases with adequate preoperative needle aspiration cytology, there were 66 solid and 17 cystic or mixed lesions. Overall accuracy for differentiating benign from malignant nodules for solid lesions was 63 of 66 (95%), compared to 15 of 17 (88%) for predominantly cystic or mixed lesions. Of the 17 cases of proven carcinoma, correct preoperative cytology diagnosis for malignancy was obtained in 12 (71%). Malignancy was most often correctly diagnosed for solid papillary and metastatic cancer lesions. No false-positives were noted and atypical adenomas and Hürthle-cell adenomas have been correctly diagnosed. The simplicity and safety of these diagnostic procedures justify their use for "selective" surgery and particularly for those cases that have been initially assigned to conservative, nonsurgical therapy. [ABSTRACT FROM AUTHOR]

Part I. Focuses on the method of screening for thyroid disease. Explanation of this process; Details on subclinical hypothroidism; Examination of guidelines on screening for thyroid disease, published by the American College of Physicians.

Emphasizes the importance of serum thyrotropin in assessing thyroid status. Information on sensitive immunoassays for serum thyrotropin; Care for patients receiving antithyroid drug therapy.

A response from the authors of the article on the screening for thyroid dysfunction is presented.

A letter to the editor is presented in response to the article on the screening for thyroid dysfunction.