STORY BYIf you are over 50,
you might benefit from thyroid screening, even if you have no symptoms.
Thyroid disorders are fairly common, especially with increasing age,
and especially in women. Early detection of under-or-overproduction
of thyroid hormones can provide you and your doctor with the information
you need to prevent negative long-term effects.
The thyroid gland, located in front of and on either side of the
trachea in the neck, controls the rate of metabolism in the body,
rather like the timing device that sets your car’s idling
rate. Hyperthyroidism—excessive activity by
the thyroid gland—results in a fast “idle” rate. Hypothyroidism, reduced activity
of the thyroid gland, results in a slow idle rate.
About one percent of Americans have hyperthyroidism, with women
affected five to 10 times more often than men. Up to 10 percent
of women over
50 and three percent of men over 60 may have hypothyroidism.
“Everyone agrees it is important to test an individual with symptoms,” says endocrinologist Shahla Nader-Eftekhari, MD, professor of internal medicine and obstetrics/gynecology at the University of Texas Medical School at Houston. These can include:
“It’s also a great idea to test women over 50 every few years or every year if they have a family history of thyroid disorder,” says Nader-Eftekhari.
“You can make the argument that screening is warranted in the middle-aged
population because even mild hypothyroidism is a risk factor for atherosclerosis,” says
endocrinologist Victor R. Lavis, MD, professor at the UT Medical School at Houston. “Individuals
who have recently been diagnosed with heart problems such as atrial fibrillation
[fast or irregular beat originating in the atrial chamber] or congestive heart
failure should also be tested.”
Others who could benefit from evaluation include:
Thyroid disorders are frequently caused by antibodies produced by the body that
attack its own tissue. The screening test measures the level of thyroid-stimulating
hormone (TSH) in the blood. High levels suggest that the thyroid gland is failing
to produce adequate thyroid hormone. When results are borderline, testing to
determine the level of thyroid hormones can be performed for clarification,
along with other tests.
Individuals at high risk for thyroid disorder include:
Hyperthyroidism is usually treated with radioactive iodine, but
may also involve or rely on antithyroid drugs (methimazole or
propylthiouracil) or, more rarely, surgical removal of the thyroid
Hypothyroidism is treated by replacing thyroid hormone (levothyroxine).
Treating hyperthyroidism often results in the patient’s
becoming hypothyroid, so those patients also often end up eventually
taking levothyroxine.
There is general agreement that some patients—those with clearly
abnormal TSH levels, pregnant women, individuals with obvious
hyperthyroidism—definitely require treatment. Even a slightly
overactive thyroid can make women more prone to post-menopausal
osteoporosis and can increase elderly patients’ risk for
atrial fibrillation and other heart problems.
In addition, slightly under-active thyroid can cause heart problems,
high cholesterol and, for pregnant women, problems for both mother
and baby. When TSH tests are borderline, further testing may be
necessary, as appropriate.
“Treatment for patients with slightly abnormal TSH levels
and no symptoms is slightly controversial,” says Philip
R. Orlander, MD, professor of medicine and director of the Division
of Endocrinology at UT Medical School. “It’s got to
be an individual decision between the patient and her physician.
For a woman trying to get pregnant, it’s sensible to treat.
For a woman over 50 with no or minimal symptoms, it might be desirable
to test further and, if there are antibodies present, implement
a high level of surveillance and/or treatment.“
Lavis says, “The treatment for hypothyroidism is so low risk that my bias
is to treat. It might prevent cardiac disease down the line.”
“More people are being treated now than before,” says Nader-Eftekhari. “The
TSH assay is picking up hypothyroidism earlier now, when the thyroid is stressed,
and testing has become more precise. In the old days we were treating people
truly in thyroid failure. Now we are treating when the thyroid is stressed, and
most agree that is appropriate.”
UPDATED: 10-20-2003
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Dr. Shahla Nader is an endocrinologist and professor of internal medicine at the UT Medical School.
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