skip to main content
Language:
Search Limited to: Search Limited to: Resource type Show Results with: Show Results with: Search type Index

Investigating hypothyroidism

BMJ (Online), 2021-04, Vol.373, p.n993-n993 [Peer Reviewed Journal]

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go tohttp://group.bmj.com/group/rights-licensing/permissions2021BMJ ;ISSN: 1756-1833 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.n993 ;PMID: 33906834

Full text available

Citations Cited by
  • Title:
    Investigating hypothyroidism
  • Author: Siskind, Samantha M ; Lee, Sun Y ; Pearce, Elizabeth N
  • Subjects: Amiodarone ; Ascites ; Asymptomatic ; Autoimmune diseases ; Bradycardia ; Celiac disease ; Cognitive ability ; Coma ; Constipation ; Dementia ; Diabetes ; Diabetes mellitus (insulin dependent) ; Edema ; Effusion ; Family medical history ; Female ; Hair loss ; Humans ; Hypertension ; Hypothyroidism ; Hypothyroidism - diagnosis ; Hypothyroidism - etiology ; Hypothyroidism - therapy ; Infertility ; Interferon ; Iodide peroxidase ; Iodine ; Laboratories ; Lithium ; Menstruation ; Mental depression ; Middle Aged ; Obesity ; Patients ; Pregnancy ; Pregnancy complications ; Protein-tyrosine kinase ; Reflexes ; Risk Factors ; Surgery ; Symptom Assessment ; Task forces ; Thyroid ; Thyroid diseases ; Thyrotropin - blood ; Thyroxine - blood ; Vital signs ; Womens health
  • Is Part Of: BMJ (Online), 2021-04, Vol.373, p.n993-n993
  • Description: [...]identification of overt hypothyroidism is important as, if left untreated, it can cause uncomfortable symptoms as well as increased risk for cardiac dysfunction, hypertension, dyslipidaemia, cognitive impairment, complications in pregnancy, and in rare cases, myxoedema coma.1 While professional organisations generally recommend against universal screening for hypothyroidism, discrepancy exists and guidelines remain vague about who to test, generally recommending consideration of testing in patients for whom there is high clinical suspicion of the disease or in populations at increased risk, although they do not always define these populations. In countries that are iodine sufficient, the prevalence of overt hypothyroidism ranges from 1% to 2%, rising to 7% in older adults.5 Hypothyroidism is approximately 10 times more common in women than in men.5Table 1 Guidelines for screening for hypothyroidism Society Recommendation American Association of Clinical Endocrinologists Recommendation for aggressive case finding in patients most likely to have thyroid disease (box 1) that will benefit from its treatment2 Canadian Task Force on Preventive Health Care Strong recommendation against screening for thyroid dysfunction in asymptomatic, non-pregnant adults1 National Institute for Health and Care Excellence (NICE) Consider tests for thyroid dysfunction when thyroid disease is clinically suspected, but bear in mind that one symptom alone may not be indicative of thyroid disease. Consider testing in people with depression or anxiety3* United States Preventive Services Task Force Concludes that evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in asymptomatic, non-pregnant adults4 * In NICE recommendations, the word “consider” is often used where the benefit is less certain, whereas “offer” is used where there is clear and strong evidence of benefit When to suspect hypothyroidism Suspect hypothyroidism in patients with suggestive symptoms, examination findings, and laboratory abnormalities, particularly if they have risk factors such as those listed in box 1.Box 1 Risk factors for hypothyroidism Iodine deficiency5 Female sex5 Age >65 years6 Personal or family history of autoimmune disease (eg, type 1 diabetes mellitus, Addison’s disease, coeliac disease)7 Family history of thyroid disease6 Positive thyroid peroxidase (TPO) antibodies7 Medications including lithium, amiodarone, interferon alpha, interferon gamma, immune checkpoint inhibitors, or tyrosine kinase inhibitors56 Prior surgery or radiation therapy on the thyroid gland, head, or neck area6 Symptoms are non-specific and most commonly include fatigue, shortness of breath, cold sensitivity, weight gain, constipation, change in voice, and dry skin.6 Hair loss, menstrual irregularities, impaired memory, and depression may be seen as well.167 Time course of symptom development and the number of symptoms that patients with hypothyroidism experience can vary greatly from one individual to another. [...]some patients with hypothyroidism present with isolated symptoms or are asymptomatic.1 This is particularly common in older patients, for whom you may consider a lower threshold to test for hypothyroidism.8 On examination, patients may have cool, dry, or coarse skin, yellowed palms, periorbital oedema, puffy face, peripheral oedema, enlarged tongue, and/or goitre.6 Examination may reveal delayed relaxation of deep tendon reflexes.6 Vital signs may reveal bradycardia or diastolic hypertension.6 More severe hypothyroidism may present with pleural effusions, pericardial effusion, or ascites.6 These findings are not present in all patients with hypothyroidism, but their presence should heighten suspicion for the disease.
  • Publisher: England: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1756-1833
    EISSN: 1756-1833
    DOI: 10.1136/bmj.n993
    PMID: 33906834
  • Source: MEDLINE
    ProQuest Central
Back to results list
INSPIRE LIBRARY - TON DUC THANG UNIVERSITY (84-028) 37 755 057 Feedback
19 Nguyen Huu Tho St. Dist.7, HCM thuvien@tdtu.edu.vn

Copyright © 2017 INSPIRE LIBRARY - TON DUC THANG UNIVERSITY

Searching Remote Databases, Please Wait