Aggressive Case Finding: A Clinical Strategy for the Documentation of Thyroid Dysfunction
Authors: James V. Hennessey, Irwin Klein, Kenneth A. Woeber, Rhoda Cobin, Jeffrey R. Garber
Journal: Annals of Internal Medicine (2015)

Ideas and Opinions18 August 2015Aggressive Case Finding: A Clinical Strategy for the Documentation of Thyroid DysfunctionJames V. Hennessey, MD, Irwin Klein, MD, Kenneth A. Woeber, MD, Rhoda Cobin, MD, and Jeffrey R. Garber, MDJames V. Hennessey, MDFrom Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, Massachusetts; New York University School of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York; University of California, San Francisco Medical School, San Francisco, California; and American Association of Clinical Endocrinologists Thyroid Scientific Taskforce, Jacksonville, Florida., Irwin Klein, MDFrom Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, Massachusetts; New York University School of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York; University of California, San Francisco Medical School, San Francisco, California; and American Association of Clinical Endocrinologists Thyroid Scientific Taskforce, Jacksonville, Florida., Kenneth A. Woeber, MDFrom Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, Massachusetts; New York University School of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York; University of California, San Francisco Medical School, San Francisco, California; and American Association of Clinical Endocrinologists Thyroid Scientific Taskforce, Jacksonville, Florida., Rhoda Cobin, MDFrom Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, Massachusetts; New York University School of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York; University of California, San Francisco Medical School, San Francisco, California; and American Association of Clinical Endocrinologists Thyroid Scientific Taskforce, Jacksonville, Florida., and Jeffrey R. Garber, MDFrom Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, Massachusetts; New York University School of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York; University of California, San Francisco Medical School, San Francisco, California; and American Association of Clinical Endocrinologists Thyroid Scientific Taskforce, Jacksonville, Florida.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0762 Annals Author Insight Video - James V. Hennessey, MD In this video, James V. Hennessey, MD, offers additional insight into his Ideas and Opinions piece, "Aggressive Case Finding: A Clinical Strategy for the Documentation of Thyroid Dysfunction." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Thyroid dysfunction is common, is readily diagnosed, and is treated in a cost-effective manner. Recently, the U.S. Preventive Services Task Force did not recommend screening for thyroid dysfunction in nonpregnant adults because of a lack of evidence that screening of asymptomatic patients affects clinical outcomes (1, 2). In contrast, over the last decade, 7 professional organizations, including the American Association of Clinical Endocrinologists, American Thyroid Association, and Latin American Thyroid Society, have given guidance on how and when to use thyroid-stimulating hormone (TSH) testing for the millions of Americans with undiagnosed thyroid dysfunction (Table) (3, 4).Table 1.Recommendations of 8 ...References1. Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162:35-45. [PMID: 25347444] doi:10.7326/M14-1456 LinkGoogle Scholar2. LeFevre ML; U. S. Preventive Services Task Force. Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;162:641-50. [PMID: 25798805] doi:10.7326/M15-0483 LinkGoogle Scholar3. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al; American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22:1200-35. [PMID: 22954017] doi:10.1089/thy.2012.0205 CrossrefMedlineGoogle Scholar4. Brenta G, Vaisman M, Sgarbi JA, Bergoglio LM, Andrada NC, Bravo PP, et al; Task Force on Hypothyroidism of the Latin American Thyroid Society (LATS). Clinical practice guidelines for the management of hypothyroidism. Arq Bras Endocrinol Metabol. 2013;57:265-91. [PMID: 23828433] CrossrefMedlineGoogle Scholar5. Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease? J Gen Intern Med. 1997;12:544-50. [PMID: 9294788] CrossrefMedlineGoogle Scholar6. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P. Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study. Eur J Endocrinol. 2014;171:593-602. [PMID: 25305308] doi:10.1530/EJE-14-0481 CrossrefMedlineGoogle Scholar7. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al; American Thyroid Association. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17:456-520. [PMID: 21700562] CrossrefMedlineGoogle Scholar8. Razvi S, Shakoor A, Vanderpump M, Weaver JU, Pearce SH. The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a meta-analysis. J Clin Endocrinol Metab. 2008;93:2998-3007. [PMID: 18505765] doi:10.1210/jc.2008-0167 CrossrefMedlineGoogle Scholar9. Razvi S, Weaver JU, Butler TJ, Pearce SH. Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality. Arch Intern Med. 2012;172:811-7. [PMID: 22529180] doi:10.1001/archinternmed.2012.1159 CrossrefMedlineGoogle Scholar10. National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421. [PMID: 12485966] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard Vanguard Medical Associates, Boston, Massachusetts; New York University School of Medicine and Icahn School of Medicine at Mount Sinai, New York, New York; University of California, San Francisco Medical School, San Francisco, California; and American Association of Clinical Endocrinologists Thyroid Scientific Taskforce, Jacksonville, Florida.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0762.Corresponding Author: James V. Hennessey, MD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Gryzmish 619, Boston, MA 02215; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Hennessey: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Gryzmish 619, Boston, MA 02215.Dr. Klein: New York University School of Medicine, 935 Northern Boulevard, Suite 106, Great Neck, NY 11021.Dr. Woeber: University of California, San Francisco at Mount Zion, 1600 Divisadero Street, San Francisco, CA 94115.Dr. Cobin: 75 North Maple Avenue, Ridgewood, NJ 07450.Dr. Garber: Harvard Vanguard Medical Associates, 133 Brookline Avenue, Boston, MA 02215.Author Contributions: Conception and design: J.V. Hennessey, I. Klein, K.A. Woeber, R. Cobin, J.R. Garber.Analysis and interpretation of the data: J.V. Hennessey, I. Klein, K.A. Woeber, R. Cobin, J.R. Garber.Drafting of the article: J.V. Hennessey, I. Klein, K.A. Woeber, R. Cobin, J.R. Garber.Critical revision of the article for important intellectual content: J.V. Hennessey, I. Klein, K.A. Woeber, R. Cobin, J.R. Garber.Final approval of the article: J.V. Hennessey, I. Klein, K.A. Woeber, R. Cobin, J.R. Garber.Administrative, technical, or logistic support: J.V. Hennessey.Collection and assembly of data: J.V. Hennessey, I. Klein, K.A. Woeber. PreviousarticleNextarticle Advertisement Annals Author Insight Video - James V. Hennessey, MD In this video, James V. Hennessey, MD, offers additional insight into his Ideas and Opinions piece, "Aggressive Case Finding: A Clinical Strategy for the Documentation of Thyroid Dysfunction." FiguresReferencesRelatedDetails Metrics Cited byCommentary on Clin Endo Schypo and CVD PredictionThyroid Abnormalities in Heart FailureSubclinical HyperthyroidismShould We Treat for Subclinical Hypothyroidism? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterRisa B. Burns, MD, MPH, Carol K. Bates, MD, Pamela Hartzband, MD, and Gerald W. Smetana, MDAmerican Association Of Clinical Endocrinologists And American College Of Endocrinology Position Statement On Thyroid Dysfunction Case Finding 18 August 2015Volume 163, Issue 4Page: 311-312KeywordsAtrial fibrillationCardiovascular disease riskHypercholesterolemiaHyperthyroidismHypothyroidismThyroidThyroid diseasesThyroid-stimulating hormone ePublished: 18 August 2015 Issue Published: 18 August 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...