对于是否在普通人群中进行甲状腺功能障碍筛查,不同的专家小组有不同的建议。比如,美国甲状腺协会 (ATA) 建议每 5 年对所有新生儿和超过 35 岁的成年人进行一次筛查。[48]Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160:1573-1575.http://www.endo.org/club/ata.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10847249?tool=bestpractice.com[49]Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18:988-1028.http://www.thyroid.org/thyroid-guidelines/hypothyroidism/http://www.ncbi.nlm.nih.gov/pubmed/23246686?tool=bestpractice.com然而,美国预防医学工作组 (USPSTF) 并不推荐对非妊娠无症状成年人进行常规筛查,因为目前尚无充分的证据表明这种做法的利与弊。[50]LeFevre ML; US Preventive Services Task Force. Screening for thyroid dysfunction: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;162:641-650.http://annals.org/article.aspx?articleid=2208599http://www.ncbi.nlm.nih.gov/pubmed/25798805?tool=bestpractice.com
在英国,所有新生儿都要接受甲状腺功能减退症的筛查。但目前并没有针对成人的筛查项目。大多数筛查先天性甲状腺功能减退症的项目均是测量血清 TSH水平,当婴儿 TSH 测量值升高时再补充测量 T4水平。用这种方法,中枢性甲状腺功能减退症可能会漏诊。以血清 T4 为主,辅以血清 TSH 或联合测量血清 TSH 、 T4可以发现患有中枢性甲状腺功能减退症的婴儿。[51]Rose SR, Brown RS, Foley T, et al; American Academy of Pediatrics. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics. 2006;117:2290-2303.http://pediatrics.aappublications.org/cgi/content/full/117/6/2290http://www.ncbi.nlm.nih.gov/pubmed/16740880?tool=bestpractice.com
下丘脑/垂体功能障碍的患者应定期进行甲状腺功能检测。