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A 33-year-old woman presents to her family doctor complaining of gaining weight (5 kg in 6 months) and feeling tired all the time. There is no relevant family history and examination is normal. We recommend the following.
- •Thyroid testing (TSH and FT4 if TSH outside reference interval) is recommended in all patients presenting with goitre or thyroid nodule, atrial fibrillation, osteoporosis, subfertility or dyslipidaemia (particularly if total cholesterol >8 mmol/l).
- •Thyroid testing (TSH, FT4 and anti-thyroperoxidase (anti- TPO) antibodies) is recommended pre-conception, at booking and at 3 months post partum in all women with type 1 diabetes.
- •Patients with type 1 diabetes should have annual TSH testing, and those with type 2 diabetes should be tested at the time of diagnosis.
- •Annual TSH screening (and screening before and 6–8 weeks after subsequent pregnancies) is recommended in all women who have suffered post-partum thyroiditis.
- •Annual TSH screening is recommended in all patients with Down or Turner syndrome.
- •Patients taking specific drugs (eg, amiodarone, lithium) should be tested according to established guidelines.
- Targeted thyroid function testing is recommended on the basis of the relatively high prevalence of thyroid dysfunction in selected groups. In particular, thyroid function testing at diagnosis is considered to be cost-effective in type 2 diabetic patients. Routine testing in patients acutely admitted to hospital is not recommended because of the high prevalence of non-thyroidal illness, producing lowered or raised TSH concentrations in the absence of thyroid disease.
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Adrenal & Reproductive
