Table 8.
Summary of Guidelines on a Screening Program for TD in Patients With T1D and T2D, in the General Population, and in Pregnant Patients
| Guidelines (Ref.) | T1D | T2D | In the General Population | In Pregnant Patients |
|---|---|---|---|---|
| BTA (391) | TSH and TPO Ab at diagnosis and every year | Thyroid function tests at baseline. Routine annual thyroid function testing is not recommended | Not applicable | TSH and Abs are recommended in diabetic patients in pregnancy and postpartum |
| ADA (392–394) | TSH, TPO Ab, and Tg Ab evaluation at diagnosis Measure TSH soon after the diagnosis of T1D and after glucose control. Annual screening when TPO Abs are initially negative and more frequent (up to every 6 mo) when TPO Abs are positive or when there are symptoms of TD such as goiter, abnormal growth rate in pediatric age, or unexplained glycemic variation A1c, islet cell Abs, and glutamic acid decarboxylase Abs at the time of diagnosis of AITD | Thyroid palpation in all diabetic patients TSH in adults >50 y of age or in patients with dyslipidemia | TSH screening at the age of 45 y and in younger adults who are overweight with one or more of the following risk factors: (i) positive family history of diabetes (ii) coming from high-risk minority ethnic/racial groups (iii) presence of hyperlipidemia (iv) being physically inactive (v) experiencing signs/symptoms of insulin resistance and/or (vi) presence of hypertension or treatment of hypertension (vii) women with polycystic ovary syndrome or other clinical conditions associated with insulin resistance (e.g. severe obesity, acanthosis nigricans) | Women who were diagnosed with GDM should have lifelong testing at least every 3 y |
| AACE (395) | Thyroid palpation and TSH at diagnosis and at regular intervals in patients with goiter and AITD | Thyroid palpation and TSH at diagnosis and at regular intervals in patients with goiter and AITD Screening of TD in older patients, especially women | Annual screening for patients with two or more risk factors Individuals at risk for DM whose glucose values are in the normal range should be screened every 3 y | Pregnant females with DM risk factors should be screened at the first prenatal visit for undiagnosed T2D using standard criteria. At 24- to 28-wk gestation, all pregnant subjects should be screened for gestational diabetes Assessment of thyroid function in pregnant patients with diabetes recommended |
| ISPAD (396) | Thyroid Ab tests and thyroid function at close diagnosis and repeated when clinical symptoms suggest the possibility of thyroid disease Annual screening in asymptomatic patients when thyroid function is normal | No specific recommendations | Screening in all children and adolescents at risk for glucose intolerance or diabetes. The risks include: (i) a combination of BMI greater than the 85th percentile for height, (ii) ethnicity, (iii) family history of CVD in first- or second-degree members, and (iv) signs of insulin resistance (as defined by the ADA). Screening should begin at age 10 y or at the onset of puberty (when puberty occurs at an earlier age) using the fasting plasma glucose test, and rescreening should be carried out every 2 y | Not applicable |
| USPTF (397) | No specific recommendations | No specific recommendations | Insufficient evidence to recommend a screening program in nonpregnant asymptomatic adults | Not applicable |
| ATA (398) | More frequent TSH evaluation in patients with T1D | More frequent TSH evaluation in patients with T2D | Evaluation of serum TSH in asymptomatic adults 35 y or age every 5 y and in individuals with symptoms and signs potentially attributable to TD and those with risk factors for its development. More frequent testing in high-risk patients | Not applicable |
Abbreviations: AACE, American Association of Clinical Endocrinologists; ISPAD, International Society for Pediatric and Adolescent Diabetes; Ref., reference; USPTF, US Preventive Task Force.