Thyroid Conditions: Should You Have Your Thyroid Checked?

In 1998, the American College of Physicians published guidelines on how and when the thyroid gland should be checked as part of the medical evaluation in patients who are not suspected as having thyroid conditions. These guidelines specify who should be screened for thyroid disease.

Patients with health problems of many kinds should undergo thyroid testing to rule out the thyroid as the cause of these problems. Of course, it is important to note that all the known findings in thyroid disease can also be associated with other diseases.

Effects of High Thyroid Function & Low Thyroid Function

Patients with obvious high thyroid function (hyperthyroidism) experience such problems as agitation, heat intolerance, bulging of the eyes, weight loss, trouble sleeping, impatience and a number of other unpleasant effects. Patients with low thyroid function may experience weight gain, listlessness, cold intolerance, pudgy skin, fatigue and sleepiness, among other things.

When Is Thyroid Screening Necessary?

Thyroid screening in the average "healthy" patient might be done if the patient had radiation to the head and neck as a child and/or has a family history of thyroid cancer. A sensitive thyroid-stimulating hormone (TSH) test is recommended as a screening test, but only in women 50 years of age or older. A TSH test is not recommended for men unless it appears that the thyroid is causing the patient's problems.

If low thyroid function is found, then a test called the free thyroxine (T4) should be ordered. Patients with low thyroid function have a higher risk for elevated cholesterol and, depending on the level of T4 (>10), they may need treatment. Patients found to have low T4 require a replacement thyroid medicine called levothyroxine.

If high thyroid function is found, it should be followed by free T3 test. These patients can develop heart disease and bone disease, so the high thyroid function must be observed, if not actively treated. Patients with hyperthyroidism (high levels of T3) should be treated with antithyroid drugs.

Thyroid Nodules & Cancer

It is possible to have thyroid nodules that do not produce symptoms. Only five percent of thyroid nodules that were small (regardless of whether they could be felt) and not suspicious on thyroid ultrasound, were found to be cancer.

Most patients who are found to have tiny nodules should just be observed, unless they are at high risk for cancer. Tiny thyroid nodules are usually very slow-growing even if they might be cancer. Some medical professionals believe that physicians should try to suppress the nodules with medicines if the patient is young, but this is still controversial.

Thyroid nodules that are large, growing, involving the lymph nodes or causing symptoms require a more aggressive approach that may include biopsy, surgery and/or medication. If you have thyroid problems that are causing symptoms, or cancer is found, you will need treatment.