Clinical review

Fortnightly review: Hypothyroidism: screening and subclinical disease

^a Department of Medicine, University of Sheffield Clinical Sciences Centre, Northern General Hospital, Sheffield S5 7AU

	Introduction

At first sight there could hardly be a more simple disorder to diagnose and treat than hypothyroidism. Now that we have robust hormone assays and reliable preparations of thyroxine in tablet sizes sufficiently small to tailor doses to an individual's requirement, what issues remain? The purpose of this review is to flesh out some of the recently published consensus views on hypothyroidism,^{1 2} in particular regarding the role of screening for hypothyroidism and the need for treatment in subclinical hypothyroidism. Table 1) gives the definitions of hypothyroidism.

	Methods

I have conducted a monthly Medline search for all articles on hypothyroidism for five years. For this review I scanned these papers and background papers for a recent consensus statement,² together with their references, for those focusing on screening and subclinical hypothyroidism. In addition, as part of my 15 years of thyroid related . . . [Full text of this article]

	Frequency of hypothyroidism

	Screening for hypothyroidism

General population screening
Screening in special groups
Summary points

	Treatment of subclinical hypothyroidism

Effect on neuropsychiatric and other symptoms
Effect on lipids
Other effects

	Disadvantages of treatment

	Conclusions

	References

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Relevant Article

Thyroxine should be tried in clinically hypothyroid but biochemically euthyroid patients

Gordon R B Skinner, R Thomas, M Taylor, M Sellarajah, S Bolt, S Krett, and A Wright
BMJ 1997 314: 1764. [Extract] [Full Text]

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• Kendall-Taylor, P, Price, A., Weetman, A P, Toft, A D, Beckett, G J, Bulusu, S., Eales, M., O'Reilly, D. (2000). Thyroid function tests. BMJ 321: 1080-1080 [Full text]  
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• Newman, C M, Price, A, Davies, D W, Gray, T A, Weetman, A P (1998). Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart 79: 121-127 [Full text]  
• Beckett, G J, Toft, A D, Williams, G., Shepherd, C. (1997). Giving thyroid hormones to clinically hypothyroid but biochemically euthyroid patients. BMJ 315: 813-814 [Full text]  
• Beastall, G. H, Thomson, J. A, Cassar, J (1997). Treating hypothyroidism. BMJ 315: 490-491 [Full text]  
• Skinner, G. R B, Thomas, R, Taylor, M, Sellarajah, M, Bolt, S, Krett, S, Wright, A (1997). Thyroxine should be tried in clinically hypothyroid but biochemically euthyroid patients. BMJ 314: 1764-1764 [Full text]  

Rapid Responses:

Read all Rapid Responses

TSH has no clinical correlation

David Derry
bmj.com, 17 Oct 1999 [Full text]

50 years of commercially motivated fraud relating to thyroid

Raymond Peat
bmj.com, 16 Nov 1999 [Full text]

Useful Data

Dawn Brighton
bmj.com, 5 Feb 2000 [Full text]

Re: TSH has no clinical correlation

Candie Freeman
bmj.com, 16 Jul 2001 [Full text]

Thanks for useful thyroid info

Phyllis Kasper
bmj.com, 31 Oct 2001 [Full text]

Personal symptomology count for something

Nancy L. Adams, et al.
bmj.com, 15 Sep 2002 [Full text]

This information needs to go to the Pathology Labs.

Donald F Hughes
bmj.com, 5 Oct 2002 [Full text]