Like routine screenings for high blood pressure and breast cancer, screening for an underactive thyroid gland is cost-effective and should be part of periodic examinations for people over age 35, especially women, a Johns Hopkins-led study suggests. The findings contradict current recommendations by most physician groups that such thyroid screenings are unnecessary in the general population.
Routine thyroid screenings may prevent a mild problem from becoming severe, reverse severe symptoms that have gone undiagnosed and lower thyroid-related high blood cholesterol, a major factor in heart disease, according to the results. The study, which used a computer model and statistical analysis to make cost-and-benefit predictions for mild thyroid failure screenings for the U.S. population, was supported by the National Institutes of Health, Forest Laboratories and Corning Clinical Laboratories.
"Early detection and treatment of mild thyroid failure can enhance the quality and even the duration of life," says Paul W. Ladenson, M.D., lead author and director of endocrinology and metabolism at Hopkins. "Our findings suggest that the health benefits are worth the costs and that these screenings could be as safe, inexpensive and effective as other common preventative tests in detecting early or hidden problems."
The results are published in the July 24 issue of the Journal of the American Medical Association.
Researchers calculated the cost-effectiveness and impact on quality of life when people were screened every five years beginning at age 35 and received four decades of follow-up medication and care. The results show the average screening costs to improve quality of life for people with mild hypothyroidism, or underproduction of thyroid hormones, are comparable to screening costs for other disorders such as high blood pressure, breast cancer and high blood cholesterol.
The results show that quality of life for hypothyroid patients improves through the relief of symptoms, such as fatigue, weight gain and depression, while the greatest cost savings come from lowering cholesterol and the related risk of heart disease. The hypothyroidism screenings become more cost-effective as the patients grow older, especially for women.
The quality of life formula took into account direct costs, such as examinations, tests, medications and long-term care, and intangible factors, such as the number of lives saved, years of life saved, complications and their severity, and years spent with the disorder undiagnosed or diagnosed and treated.
Mild hypothyroidism increases with age and affects up to 15 percent of older women and 10 percent of older men. The thyroid gland, a butterfly-shaped organ in the neck and a key part of the endocrine system, produces hormones and helps regulate the body's metabolism. The screening measures the level of thyroid-stimulating hormone (TSH) in the blood.
The study's other authors were Mark D. Danese, B.A., and Neil R. Powe, M.D., of Hopkins and Clark T. Sawin, M.D., of the Department of Veterans Affairs Medical Center and the Boston University School of Medicine.