The Clinical Consequences and Diagnosis of Hypothyroidism

Vicky A LeGrys; Katherine Hartmann; Joan F Walsh

doi:10.29074/ascls.17.4.203

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Vicky A LeGrys, DrA CLS(NCA)⇑
1. is Professor at University of North Carolina, Chapel Hill NC
Katherine Hartmann, MD PhD
1. is Assistant Professor, Department of Epidemiology, University of North Carolina, Chapel Hill NC
Joan F Walsh, PhD
1. is a Research Assistant, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill NC

Address for correspondence: Vicky A LeGrys DrA, Division of Clinical Laboratory Science, School of Medicine, University of North Carolina at Chapel Hill, Wing E 222H, CB # 7145, Chapel Hill NC 27599-7145. (919) 843-4473, (919) 966-8384 (fax). vlegrys{at}med.unc.edu

Extract

Thyroid dysfunction is the most prevalent endocrine disorder, affecting more than 21 million Americans. The annual healthcare costs known to be associated with thyroid dysfunction exceed 10 billion dollars annually.¹ Manifestations of untreated thyroid dysfunction include coronary heart disease, osteoporosis, atrial fibrillation, cognitive impairment, and depression. These sequelae of undiagnosed thyroid dysfunction are among the major causes of mortality, morbidity, and diminished quality of life among older adults. In addition to the individual costs of such morbidity, including functional limitations and disruption of caring giving responsibilities, the healthcare costs associated with caring for individuals with heart disease, stroke, and hip fracture attributed to uncontrolled thyroid dysfunction are substantial. For example, coronary vascular disease (CVD) is the leading cause of mortality in developed countries, with more than 697,000 deaths in 1999 in the United States. In addition, CVD is a leading cause of morbidity, functional limitations, and reduced quality of life among affected individuals.²

Thyroid dysfunction can be divided into two general categories: 1) hyperthyroidism, characterized by increased thyroid hormones with decreased thyroid stimulating hormone (TSH) and 2) hypothyroidism, characterized by decreased thyroid hormones with increased TSH. Hypothyroidism is more common; between 10% to 20% of postmenopausal women have evidence of hypothyroidism which can have significant clinical consequences.^3-7 Hypothyroidism can be further subdivided into overt and subclinical (mild) disorders. Because the signs and symptoms of hypothyroidism are vague and non-specific, many cases are not identified and go undiagnosed, prompting interest in routine screening for thyroid dysfunction. This article will review thyroid…

ABBREVIATIONS: CVD = coronary vascular disease; FT₃ = free T₃; FT₄ = free T₄; T₃ = triiodothyronine; T₄ = thyroxine; TPO = thyroid peroxidase; TPOAb = thyroid peroxidase antibody; TSH = thyroid stimulating hormone.