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Systematic Reviews
Published in: Systematic Reviews 1/2019

Open Access 01-12-2019 | Hyperthyroidism | Research

Screening for thyroid dysfunction and treatment of screen-detected thyroid dysfunction in asymptomatic, community-dwelling adults: a systematic review

Authors: Francesca Reyes Domingo, Marc T. Avey, Marion Doull

Published in: Systematic Reviews | Issue 1/2019

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Abstract

Background

This systematic review was conducted to inform the Canadian Task Force on Preventive Health Care recommendations on screening for thyroid dysfunction (TD). The review sought to answer key questions on the benefits and harms of screening for TD, patients’ values and preferences for screening, and the benefits and harms of treating screen-detected TD.

Methods

This review followed Canadian Task Force on Preventive Health Care methods, which include the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The search strategy used for benefits and harms of screening and treatment was an update to the 2014 review by the US Preventive Services Task Force and searched MEDLINE and the Cochrane Library. MEDLINE, Embase, ProQuest Public Health, and SCOPUS were searched for patients’ values and preferences for screening. Outcomes of interest included all-cause mortality, deaths due to cardiovascular diseases, fatal and non-fatal cardiovascular events, atrial fibrillation, fractures, quality of life, cognitive function, and harms due to TD treatment. Two reviewers independently screened abstracts and full texts according to pre-determined inclusion criteria and assessed the risk of bias for each study included. Strength and quality of the evidence was assessed for each outcome. A narrative synthesis was conducted due to heterogeneity of the included studies.

Results

No studies were found on screening for TD, treatment of subclinical hyperthyroidism, or patients’ values and preferences for screening for TD. Twenty-two studies (from 24 publications) on the treatment of TD in patients with screen-detected subclinical hypothyroidism were included. Results from the included randomized controlled trials suggested no benefit of treatment for subclinical hypothyroidism for the large majority of outcomes. We found very low-quality evidence (from two cohort studies) for a small reduction in all-cause mortality among adults < 65 or 40–70 years who were treated for TD compared to those who were not.

Conclusions

This review found moderate to very low-quality evidence on the benefits and harms of treatment for subclinical hypothyroidism, with most of the evidence showing no benefit of treatment.
Appendix
Available only for authorised users
Footnotes
1
An active beneficiary is an individual with at least one claim accepted by the public drug program, either for reimbursement or applied towards a deductible. In most provinces, individuals 65 years and older account for 49–82% of all active beneficiaries of the provincial public drug program [41].
 
2
The extent of overlap between the cohorts in Andersen 2015 (n = 12,212) and Andersen 2016 (n = 1192) is unknown. Andersen [78] included participants with or without heart disease living in Copenhagen and had a TSH test conducted between 2000 and 2009, while Andersen [79] only included participants with known heart disease living in Copenhagen, Roskidle, and North Region and had a TSH test conducted between 1997 and 2011.
 
3
Represents the total number of participants in the study because n for the outcome was not provided in the published paper.
 
4
Represents the total number of female or male participants in the study because n for the outcome was not provided in the published paper.
 
5
Standard definitions are those recommended in the International Conference on Harmonization’s Harmonized Tripartite guideline on clinical safety data management [81].
 
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Metadata
Title
Screening for thyroid dysfunction and treatment of screen-detected thyroid dysfunction in asymptomatic, community-dwelling adults: a systematic review
Authors
Francesca Reyes Domingo
Marc T. Avey
Marion Doull
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2019
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-019-1181-7

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