The National Academy of Clinical Biochemistry (NACB) and the American Thyroid Association (ATA), along with others, are collaborating to update clinical practice guidelines for Laboratory Support for the Diagnosis and Monitoring of Thyroid disease. They are asking for comment on the suggested recommendations. Those interested can find more information on the NACB web site.
Clinical practice guidelines serve as a recognized national standard. That means that insurance companies and physicians can point to these standards and say in effect "that's the way we have to do it."
The recommendations proposed for hypothyroidism include:
- Preliminary testing for hypothyroidism only in high risk populations.
- Over 60 (many rarely show symptoms)
- Female (maybe annual screening may be considered now)
- History of hyperthyroidism (the result of most treatment is hypothyroidism)
- History of thyroiditis
- Family history of thryoid disease
- History of head or neck cancer
- History of other autoimmune diseases
- Certain prescription drugs (lithium, amiodorone)
- dyslipidemia (high cholesterol)
- TSH as the primary screen for thyroid failure.
- TSH as the follow up to monitor L-thyroxine therapy.
- TSH monitoring 1-3 times/year.
The recommendations for hyperthyroidism include:
- TSH as the initial test.
- Serum T4 as the monitor to evaluate treatment.
- Monitor serum T4 and TSH 1-2 times/year for life.
Even if you are not a clinician, this site does give the explanation for the recommendations which may help to clarify the reasons behind the tests that your healthcare practitioner orders.
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