When You Should Know Your TSH Level

When You Should Know Your TSH Level

By Jeffrey R. Garber, MD, FACP, FACE

Screening
Why screen people for a medical condition when they have no symptoms, risk factors, or a finding on a physical exam? Screening is done because

  • The condition is common
  • The condition is important
  • The condition is hard to diagnose, at least in its early stages
  • The diagnosis is easy to make
  • The diagnosis is accurate
  • Treatment for the condition is effective and safe

Despite this seemingly clear guidance, experts disagree about screening for thyroid-stimulating hormone (TSH) in the general population. The attached table shows the range of screening recommendations.

Though experts don’t agree about population screening for hypothyroidism [hie-po-THIGH-roid-is-m], evidence supports checking your TSH if you

  • have autoimmune disease, such as type 1 diabetes, or pernicious [per-NISH-ous] anemia
  • have a first-degree relative with autoimmune thyroid disease
  • have a history of neck radiation of the thyroid gland, including radioactive iodine therapy for hyperthyroidism [hie-per-THIGH-roid-is-m] and external beam radiotherapy for head and neck malignancies
  • have a prior history of thyroid surgery or dysfunction
  • have an abnormal thyroid examination
  • have psychiatric disorders
  • are taking medicines that may affect the function of your thyroid, such as amiodarone [A-MEE-oh-duh-rone] or lithium
  • have an elevated cholesterol level

Studies are exploring whether or not universal TSH screening should be done in all women planning pregnancy or who are pregnant.

Dr. Jeffrey R. Garber is presently Chief of Endocrinology at Harvard Vanguard Medical Associates and a member of the Beth Israel Deaconess Medical Center and Brigham and Women’s Hospitals endocrine divisions. He is an Associate Professor of Medicine at Harvard Medical School, where he played a substantive role in the clinical training of more than 35 endocrine fellows. Dr. Garber currently serves as Immediate Past President of the American Association of Clinical Endocrinologists (AACE). His book, The Harvard Medical School Guide to Overcoming Thyroid Problems, was written for members of the lay public interested in learning about thyroid disorders.