Rx CARE

New campaign seeks to increase thyroid awareness

The American Association of Clinical Endocrinologists (AACE) has launched a new campaign to increase public awareness of thyroid disorders. Entitled "The Neck's Time Is Now," the program is aimed at educating Americans about key periods, from birth to advanced age, when people are at increased risk for developing a thyroid disorder.

More than 13 million Americans are affected by thyroid disease now, yet more than half remain undiagnosed. "Early disease is relatively asymptomatic. But, in addition, early disease may have symptoms that can be mistaken for other problems," said Hossein Gharib, M.D., F.A.C.E, a v.p. of AACE and professor of medicine at the Mayo Medical School.

For example, he said, the elderly patient who comes in complaining of fatigue or trouble concentrating is often dismissed as suffering from the normal process of aging. A simple test for serum thyroid stimulating hormone (TSH) can easily be done to rule out an underlying thyroid condition.

"The important thing that has happened in the past decade, since the early 1990s, has been the development of TSH [testing]. Before the sensitive TSH was available, we had a gray zone between normal and abnormal thyroid. The sensitive TSH test clearly defines thyroid disease," he added.

Complications that can arise if thyroid disease is left untreated include elevated cholesterol levels and subsequent heart disease, infertility, muscle weakness, and osteoporosis. While it may not be economically feasible or necessary to test all patients for thyroid dysfunction, there are instances when thyroid screening is appropriate. This is also an area where pharmacists can counsel patients on the appropriateness of thyroid screening. AACE advises TSH testing during the following times:

Birth through adolescence: Routine screening for cretinism, a growth and mental disorder brought on by a lack of thyroid hormone, is done on all newborns by administering a heel-pad test. But for older children, parents need to be made aware that symptoms such as difficulty concentrating and inattentiveness at school, hyperactivity, unexplained daytime fatigue, delayed puberty, dry and itchy skin, and increased sensitivity to cold and heat may all be symptoms of an underlying thyroid condition. Many parents voice their concerns about the diagnosis of attention deficit disorder and question pharmacists about the treatments available. This would be a good time to mention thyroid screening to rule out that possibility.

The reproductive years (pregnancy): AACE advises expectant mothers to take a TSH test before pregnancy or as part of the standard prenatal blood work. In addition to impairing fertility, some studies have suggested that undiagnosed hypothyroidism in the pregnant patient causes a four times greater risk for miscarriage during the second trimester. It would therefore be crucial to counsel your patients seeking advice on ovulation predictor kits and pregnancy tests about the relevance of thyroid screening.

Midlife (menopause): The symptoms of either hyper- or hypothyroidism, such as skin dryness, hot flashes, mood swings, depression, and weight gain, mimic the symptoms of menopause. If your patients on hormone replacement therapies continue to experience mood swings, depression, or sleep disturbances, it would be appropriate to advise these women to request a thyroid function test. AACE recommends that all women over 40 have a TSH test since studies have shown that 10% of these women have undiagnosed thyroid disease.

The senior years (aging): Many seniors feel that the onset of such symptoms as fatigue, depression, forgetfulness, insomnia, and appetite changes are just part of the natural aging process. They come into the pharmacy seeking advice about what over-the-counter vitamins or herbs can help them alleviate these symptoms. But before you lead them to the ginkgo biloba section, ask them if they have been screened for thyroid disease. One out of every five women over the age of 65 has an increased TSH and approximately 15% of all hyperthyroid patients are over 60.

"There are several points where I think pharmacists can help us," said Gharib. First, he mentioned the brand-generic switch with regard to the gold standard for hypothyroidism, levothyroxine. "We recommend that if someone is on the generic and changes to a brand name or vice versa or even to another brand, the serum TSH be checked to make sure the treatment is adequate. Second, the pharmacist can be a checkpoint for the physician and the patient [when the patient comes in for refills] in terms of saying, 'Have you had your TSH checked this year?'" He also discussed the pharmacists' role in identifying potential drug interactions (e.g., lithium that can disrupt thyroid hormone synthesis and secretion) and bringing them to the attention of the physician.

Finally, Gharib advised pharmacists to be aware of the OTC purchases made by their thyroid patients for items such as ferrous sulfate, which decreases the absorption of thyroxine, and kelp, which contains iodine, known to synthesize thyroid hormones.

Tammy Chernin, R.Ph.

Tammy Chernin. New campaign seeks to increase thyroid awareness.

Drug Topics

2001;4:19.