The consensus group guideline referred to above, went a step further, perhaps, by making a recommendation “against population-based screening for thyroid disease” including women who are pregnant or planning to become pregnant (consonant with the position of the American College of Obstetrics and Gynecology). “Aggressive case finding”, however, was recommended in the absence of signs or symptoms of thyroid disease for patients with the following features:

• female over 60;
• type 1 diabetes mellitus;
• atrial fibrillation;
• family history of thyroid disease;
• history of radioiodine therapy for hyperthyroidism; and
• history of external beam radiotherapy overlapping the thyroid region.

Other professional societies recommendations, however, differ with the USPSTF and the consensus group:

• The American Association of Clinical Endocrinologists (AACE) recommends screening pregnant patients (1999) and older women (2002).
• The American Thyroid Association recommends screening those who are age 35 and every five years thereafter (2000).
• The American College of Physicians recommends case finding in women older than 50 with one or more symptoms possibly caused by thyroid disease.
• The American Academy of Family Physicians recommends screening those older than 60.

These conflicting recommendations may place policy makers and third-party insurers in a quandary about whether to promote thyroid screening for large populations of patients. However, the consensus group recommendation “to make individual patient assessments when determining the need for testing and treatment” and to test those with “signs or symptoms suggestive of thyroid dysfunction” enables clinicians to easily justify ordering a TSH measurement for most patients in these subgroups.This is because symptoms of hypothyroidism are common in euthyroid patients— being present in approximately 60% of those surveyed in the Colorado Thyroid Disease Prevalence Study published in 2000.