Hypo- and hyper-thyroidism: algorithm for screening and diagnosis

Screening, diagnosing, and managing hypothyroidism:

ATA/AACE guidelines recommend screening for all patients with symptoms of hypothyroidism. For patients who
are asymptomatic, recommendations vary widely. However, a thyroid-stimulating hormone (TSH) test is generally
recommended for patients ≥50–60 years old, especially women.

Guidelines also state that there is compelling evidence to support screening in patients with:

• Autoimmune disease (e.g., type 1 diabetes)
• Pernicious anemia
• Family history
• History of neck radiation
• History of thyroid surgery
• Abnormal thyroid examination
• Psychiatric disorders, including patients taking amiodarone or lithium
• Hypertension, cardiac dysrhythmia, or congestive heart failure
  

Hypothyroidism: algorithm for screening and diagnosis:

Signs or symptoms of hypothyroidism include:

• Poor memory and concentration
• Hoarseness
• Slow pulse rate
• Delayed reflex relaxation
• Cold extremities/feeling cold
• Carpal tunnel syndrome
• Fatigue
• Weight gain and poor appetite
• Hair loss
• Shortness of breath
• Constipation

Screening, diagnosing, and managing hyperthyroidism:

In 2016, the ATA updated the ATA/AACE guidelines for hyperthyroidism, a form of thyrotoxicosis. Updates include
new approaches and changing paradigms for:

• Evaluating and managing Graves’ disease with antithyroid drugs (ATDs)
• Managing hyperthyroid patients planning pregnancy
• Managing calcium metabolism prior to thyroid surgery
• Re-evaluating the long-term toxicity of antithyroid drugs
  

The guidelines recommend screening for all patients with symptoms of hyperthyroidism. Once a diagnosis is made,
the etiology should be determined.

Hyperthyroidism: algorithm for screening and diagnosis

Signs or symptoms of hyperthyroidism include:

• Nervousness or irritability
• Fatigue/muscle weakness
• Heat intolerance
• Trouble sleeping
• Hand tremors
• Irregular heartbeat
• Weight loss
• Frequent bowel movements/diarrhea
• Goiter
• Graves’ ophthalmopathy

Test results may vary depending on your age, gender, health history, the method used for the test, and other things. Your test results may not mean you have a problem. Ask your healthcare provider what your test results mean for you. 

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