Thyroid dysfunction.(WOMEN'S HEALTH ADVISER)

Thyroid dysfunction--particularly hypothyroidism--is probably greatly underdiagnosed. The 2001 Colorado health fair screening study found the condition in nearly 10% of 23,000 people not on thyroid medication.

Hypothyroidism is much more common than hyperthyroidism, and women are at greater risk for both disorders than are men. The American Thyroid Association recommends screening for women every 5 years beginning at age 35.

Maternal thyroid disease is associated with adverse pregnancy outcomes and may negatively impact a child's neurocognitive development; for these reasons, the ATA stresses, screening is particularly important in women of childbearing age.

Neither the ATA nor any other group has recommended routine thyroid screening for pregnant women, but all agree that screening is important for women at risk. This includes anyone with an autoimmune disorder, and those with a family history or personal history of thyroid dysfunction. Every routine gynecologic exam should include a neck exam. Thyroid nodules are fairly common in women, increasingly prevalent with age. If a nodule is detected, the woman should be referred for fine needle aspiration.

Symptoms

The classic symptoms of hypothyroidism are fatigue, weight gain, intolerance to cold, dry skin, constipation, and mental slowing. Women may show menorrhagia, amenorrhea, or galactorrhea. Labs will show increased thyroid-stimulating hormone and decreased levels of circulating free T4.

Because some symptoms are similar to those of menopause, a diagnosis can be missed at that time in a woman's life. The similarity of symptoms, plus the increasing prevalence of thyroid disease with age, supports the validity of screening in this population.