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Screening considered for thyroid disease

By Christian Duffin

Screening for hypothyroidism could lead to early detection and treatment for about 100,000 patients in the UK, leading screening experts have concluded.

Their findings emerge as the UK National Screening Committee told Pulse it has launched a review into a possible screening programme for thyroid disease, and would consider the research as part of its decision on whether to launch a pilot scheme.

The study, led by epidemiologists at the Wolfson Institute of Preventive Medicine and published in the Journal of Medical Screening, showed that about 1% of people screened would benefit from treatment with thyroxine – more than 100,000 people in the UK.

A thyroid-stimulating hormone (TSH) measurement was performed on 341 women aged 50 to 79 and men aged between 65 and 79 attending a BUPA clinical for a general health assessment

Those with ‘high' TSH levels – above 4.0 milliunits per litre (mU/L) – were invited to join a randomised double-blind crossover trial, which involved taking thyroxine for four months followed by placebo for four months, or vice versa.

49 women and 7 men completed the trial. Among the 15 patients with a repeat TSH measurement above 4.5mU/L, 11 reported feeling better on thyroxine than on placebo, while none reported feeling better on placebo than on thyroxine.

There was no significant difference among the 41 individuals with a repeat serum of TSH of 4.5mU/L or less ten who took thyroxine or placebo. Overall patients reported improvements in tiredness and memory loss, and the researchers found no evidence of harm.

Lead researcher Professor Malcolm Law, professor of epidemiology and preventive medicine at Queen Mary University of London concluded: ‘The results indicate that screening for hypothyroidism would be worthwhile. Approximately 1% of people screened would be expected to benefit from screening and subsequent thyroxine therapy. Pilot screening programmes for adult hypothyroidism are justified.'

He added: ‘The number of participants on whom our conclusions are based is small, but the discordance of 11 improving on thyroxine and none on placebo provides compelling evidence of efficacy.'

Professor Law told Pulse: ‘It could be done in general practice. But if there was a pilot it would be a funded programme – you wouldn't just say to GPs: "Go out and do it.".'

Professor Nicholas Wald, director of the Wolfson Institute and co-author, said: ‘It is rare to be able to find chronic diseases in adults that can be identified by screening. We need to focus preventive medicine more on improving quality of life whenever this is achievable at a reasonable cost. The UK National Screening Committee can now consider pilot screening programmes.'

Dr Anne Mackie, director of programmes for the UK National Screening Committee told Pulse: ‘The committee is in the process of conducting its own review into thyroid disease. The UK NSC has not made a recommendation to screen for hypothyroidism, however we welcome all research that will aid our review of current recommendations.'

J Med Screen, published online 24 January 2011

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