On March 24, The U.S. Preventive Services Task Force (USPSTF) issued a final recommendation statement on screening for thyroid dysfunction, concluding that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in non-pregnant, asymptomatic adults.
Thyroid function testing is normal practice in caring for patients who have symptoms or signs suggestive of hypothyroidism or hyperthyroidism, or goiter, or a history of thyroid irradiation.
The Endocrine Society does not recommend universal screening for thyroid disorders, but strongly supports screening for thyroid dysfunction in specific situations, especially in relation to pregnancy.
The Society recommends that women who intend to become pregnant and are considered at ‘high risk’ for thyroid illness should be tested. This includes women over age 30 years, with a family history or autoimmune thyroid disease or hypothyroidism, with goiter, with known thyroid antibodies, with symptoms or clinical signs suggestive of thyroid hypofunction, with Type 1 diabetes mellitus, with infertility, with a prior history of preterm delivery, with prior therapeutic head or neck irradiation or prior thyroid surgery, or currently receiving levothyroxine replacement.
Because of the significant incidence of thyroid disorders among pregnant women and the known adverse effects on pregnancy, the Society strongly supports testing all pregnant women for elevated TSH concentrations by the 9th week or at the time of their first visit before and during pregnancy, or at a minimum, aggressive case finding to identify and test high-risk women.
Women with thyroid autoimmunity who are euthyroid in the early stages of pregnancy are at risk of developing hypothyroidism and should be monitored for elevation of TSH above the normal range for pregnancy.
Women known to have thyroid autoantibodies, a history of postpartum thyroiditis or Type 1 diabetes should have TSH measured at 6-12 weeks postpartum and at 6 months postpartum, or as clinically indicated. Patients with elevated TSH levels should be considered for levothyroxine treatment when appropriate.
The Society supports the USPSTF’s call for more research into thyroid disease screening studies, and encourages physicians and their patients to discuss the specific situations when thyroid function testing and treatment may be appropriate.
The Society’s clinical practice guideline, Management of Thyroid Dysfunction during Pregnancy and Postpartum, can be found here.
About Endocrine Society
Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses, and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on X (formerly Twitter) at @TheEndoSociety and @EndoMedia.
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