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New Guidelines Place More at Thyroid Risk
Fri Jan 24,11:56 PM ET

By Amanda Gardner
HealthScoutNews Reporter

THURSDAY, Jan. 23 (HealthScoutNews) -- When it comes to thyroid function, what was normal yesterday may not be normal today.

The American Association of Clinical Endocrinologists (news - web sites) (AACE) has announced new guidelines that will probably double the number of people with thyroid disease.

"This means that there are more people with minor thyroid abnormalities than previously perceived," AACE president Dr. Hossein Gharib said this week at a press conference. He added that earlier treatment means a lower likelihood of complications -- including depression and heart disease -- later on.

With the new guidelines, Gharib said, the prevalence of thyroid disease will be about equal to diabetes and cancer combined, affecting 27 million people, up from 13 million under the old guidelines. This would make thyroid disease the most common endocrine disorder in North America.

The announcement was made as the AACE kicked off its annual thyroid awareness month with the 2003 campaign theme: "Hiding in Plain Sight: Thyroid Undercover."

The thyroid is a small, butterfly-shaped gland in the front of the neck that produces thyroid hormone. "The hormone reaches cells through the bloodstream and affects just about every tissue in the body," Gharib said. "If your thyroid doesn't work properly, neither do you."

Basically, two things can go wrong with the thyroid. The gland can become overactive, producing too much hormone (hyperthyroidism), or it can become underactive, producing too little hormone (hypothyroidism).

Although the early symptoms of thyroid disease are often subtle (including fatigue, intolerance to cold and weight changes), long-term complications can range from depression and other psychiatric conditions to bone loss and even coma or death.

"It's important to diagnose this early before problems arise," said Dr. Donald Bergman, an endocrinologist and president-elect of AACE. "The good news is that a readily available, inexpensive blood test, which all physicians can do, provides evidence of early thyroid disease before complications develop."

Physicians use a simple blood test, the thyroid stimulating hormone (TSH) test, to determine if the thyroid is working properly. Previously, normal was between 0.5 and 5.0 micro units per milliliter of blood. The new guidelines, however, stipulate normal to be within a much narrower range: between 0.3 and 3.0.

The impetus for this change came from studies showing that even subclinical (without overt symptoms) hyperthyroidism can be shown to affect the health of untreated patients years down the line.

"If left untreated, thyroid disease can lead to significant problems," Gharib said. "We don't want to overlook signs of early disease."

Hypothyroidism is easily treated with replacement hormone. Overactive thyroid can be treated a number of different ways, including drugs and radioactive iodine.

Standards for healthy cholesterol and blood glucose levels have also been changing, said Dr. Loren Wissner Greene, clinical associate professor of medicine at New York University School of Medicine and a member of the national medical advisory board for the Thyroid Foundation of America.

"We keep on having changes in our normal values," she said. "Generally, the idea is that it is going to help more people by diagnosing them sooner. Our standards are to catch people more readily. It's still going to be a doctor's decision whether or not to treat someone."

The TSH test has also become much more accurate, Greene added. "We can now respond much more appropriately."

Because the incidence of thyroid disease increases as we age, the AACE recommends that women over the age of 35 and men over 60 be screened annually. (Women are up to eight times more likely than men to be diagnosed with thyroid disease, according to the AACE.) In addition, anyone with a family history, anyone with an autoimmune disorder such as anemia, arthritis or certain forms of diabetes, and women who are thinking about getting pregnant should be tested.

"If the TSH falls out of the normal range -- now 0.3 to 3.0 -- then you should seek advice from your physician," Bergman said. Not every single one of these people will be treated, either, he adds: "Each person should be considered on individual basis."

More information

For more on thyroid disease, visit the American Association of Clinical Endocrinologists, which also has a page on how to conduct a "neck check" at home.

The American Thyroid Association also has a wealth of information.

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