NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women

NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women

NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women

Thyroid Disorder Screening Guidelines for Women

Thyroid disorders are a primary endocrine problem affecting women (Tharpe, Farley, & Jordan, 2017).  The thyroid produces thyroid hormone, which controls how fast your heart beats and how fast you burn calories, amongst other activities in the body (HHS, 2017).  With thyroid disorders, there is either an increase or decrease in thyroid hormone.  Disruption of the thyroid hormone can lead to a multitude of symptoms.  Some thyroid conditions affect women more than men such as hypothyroidism, hyperthyroidism, thyroiditis, goiter, and thyroid cancer (HHS, 2017). NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women.

Screenings can help with early detection of disease and improve patient outcomes.  Current recommendations do not suggest screening for thyroid dysfunctions.  The U.S. Preventative Task Forces (USPSTF) reports that current evidence to support screenings for thyroid dysfunction in asymptomatic, nonpregnant adults, is insufficient (LaFever, 2015).  It bases its recommendations on evidence of benefits and harms of the screening and balance assessment (LaFever, 2015).  The American Thyroid Association and the American Association of Clinical Endocrinologist recommend the consideration of screening hypothyroidism in patients age 60 or older, in persons with an increased risk for hypothyroidism and women planning pregnancy (USPSTF, 2015).  Three British Associations do not recommend routine thyroid screenings in the healthy population (USPSTF, 2015).

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The USPSTF defines thyroid disease as symptomatic or overt hypothyroidism and hyperthyroidism (USPSTF, 2015).  It defines thyroid dysfunction as a spectrum of disorders related to the thyroid gland, beginning with asymptomatic hypothyroidism or hyperthyroidism (USPSTF, 2015).  The USPSTF makes its recommendations based on asymptomatic populations.

The USPSTF found evidence that thyroid dysfunction screening in nonpregnant, asymptomatic adults does not improve quality life nor does it provide meaningful improvements (USPSTF, 2015).  On the other hand, early detection in asymptomatic persons can be beneficial because it may prevent longer-term morbidity and mortality from fractures, cancer or cardiovascular disease (USPSTF, 2015).  They also found inadequate evidence of on the harms of thyroid dysfunction screening (USPSTF, 2015).  The significant potential harms include false-positive results, labeling, over diagnosis, and overtreatment (USPSTF, 2015).  The USPSTF did not find any direct evidence that treatment based on risk level alters outcomes (USPSTF, 2015).

Strengths and Limitations of Thyroid Screening Guidelines

Strengths of the thyroid dysfunction screening guidelines include adequate evidence provided by the USPSTF to support why they do not recommend screening.  American and British associations also do not recommend universal thyroid dysfunction screening.  The American Academy of Family Physicians endorses the USPSTF guidelines. NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women.

Several limitations exist to current thyroid screening recommendations.  First, the guideline only applies to nonpregnant, asymptomatic adults.  Further research and guidelines in those patients at risk for thyroid disease are in need.  Research that evaluates the harms of thyroid dysfunction screening is critically lacking and no research examined these harms directly (LaFever, 2015).  No studies directly evaluated thyroid dysfunction screening effects on morbidity and mortality (LaFever, 2015).  The study used in the USPSTF guidelines did not adjust for the use of medications that reduce risks for cardiovascular disease (LaFever, 2015).  Reliable evidence of the frequency of false-positive that results from Thyroid stimulating hormone (TSH) testing is not available (LaFever, 2015).  TSH values should not be the only mechanism for diagnosing thyroid disease.  Ultimately, the USPSTF concludes that evidence in thyroid dysfunction screening is insufficient.

How Guidelines Can Support Decision Making

Screenings can help with early detection of disease and improve patient outcomes.  Screenings must remain specific to each individual in their current stage of life.  Caring for women requires knowledge and understanding of the physiological and psychological changes that may occur during the aging process (Tharpe, Farley, & Jordan, 2017).  The USPSTF recommends clinicians understand the evidence but also make individualized decision-making specific to the patient or clinical situation (USPSTF, 2015).  Clinical decisions require more than evidence alone (USPSTF, 2015). NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women.

References

LeFevre, M. L. (2015). Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Annals Of Internal Medicine, 162(9), 641-650. doi:10.7326/M15-0483

Retrieved from the Walden Library databases.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th  ed.). Burlington, MA: Jones & Bartlett Publishers.

U.S. Department of Health and Human Services. (2017). Thyroid Disease. Retrieved from https://www.womenshealth.gov/a-z-topics/thyroid-disease

U.S. Preventive Services Task Force. (2015). Final Recommendation Statement Thyroid Dysfunction: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/thyroid-dysfunction-screening  NURS 6551 wk 2 – Thyroid Disorder Screening Guidelines for Women

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