Overlooked, underdiagnosed? Thyroid disease poses a challenge

Thyroid dysfunction is too often untreated, some physicians say, and conflicting screening guidelines muddy the diagnostic waters.

By Susan J. Landers, AMNews staff. March 1, 2004.

For such a small gland, the thyroid is certainly causing a big flap. There is conflicting advice over how widely to screen for asymptomatic thyroid disease: Everyone? Pregnant women? People older than 35? Women older than 60?

When it comes to determining an answer, "there is chaos in the medical community," says Terry Davies, MD, professor of medicine at Mount Sinai School of Medicine in New York and director of the division of endocrinology.

And even when patients complain of symptoms that could signal a dysfunction in the thyroid, the problem is still being missed, some endocrinologists say.

Thus that butterfly-shaped regulator of metabolic processes presents primary care doctors with a peculiar conundrum. They are well aware of the range of disorders that affect the thyroid, but there is still considerable debate about patients who slip through the cracks. Add to this a growing discord over screening, and this small gland becomes more complicated.

For starters, the slow onset of the vague symptoms that can accompany the most common form of thyroid disease, hypothyroidism, trips up many primary care physicians who are swamped every day with patients who are fatigued, depressed or gaining weight, says Paul Ladenson, MD, professor and director of endocrinology and metabolism at Johns Hopkins Medical Institutions. He estimates that almost half the people with thyroid dysfunction are not properly diagnosed.

Donald Bergman, MD, president of the American Assn. of Clinical Endocrinologists, includes a swipe at the nation's health care system. "Why aren't people doing a simple blood test to figure out if patients have mild thyroid disease before they get symptomatic?" he said.