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News from Annals of Internal Medicine March 24, 2015

March 23, 2015

1. Task Force finds insufficient evidence to recommend routine screening for thyroid dysfunction

The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to recommend for or against screening for thyroid dysfunction in nonpregnant, asymptomatic adults. The recommendations are published in Annals of Internal Medicine.

Thyroid gland disorders are among the most common endocrine conditions evaluated and treated by clinicians and may be asymptomatic. If left untreated, thyroid dysfunction could lead to fractures, cancer, or cardiovascular disease. Researchers reviewed randomized controlled trials and observational studies of screening and treatment published through July 2014 to inform an updated recommendation. No trials directly assessed the benefits and harms of screening for thyroid dysfunction versus no screening. While screening can identify patients with subclinical thyroid dysfunction or undiagnosed overt thyroid disease, the researchers concluded that more evidence is needed to understand the effects of treatment. The USPSTF did find adequate evidence that screening for and treatment of thyroid dysfunction in nonpregnant, asymptomatic adults does not improve quality of life or provide clinically meaningful improvements in blood pressure, body mass index, bone mineral density, or lipid levels, and does not improve cognitive function.

A systematic review of published evidence was published in October in Annals of Internal Medicine. In 2004, the USPSTF found insufficient evidence to recommend for or against routine thyroid screening in asymptomatic adults. A draft recommendation statement on screening for thyroid dysfunction will be posted to the USPSTF website for public comment at http://www.uspreventiveservicestaskforce.org.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To interview a member of the USPSTF, please contact Ana Fullmer at newsroom@uspstf.net or 202-350-6668.


2. 2015 diabetes care recommendations: 3 things primary care physicians need to know

New evidence-based clinical practice recommendations from the American Diabetes Association (ADA) cover three important topic areas that may affect how primary care physicians care for their patients with diabetes. According to a commentary being published in Annals of Internal Medicine, the ADA's Standards of Medical Care in Diabetes puts the patient 'center stage' with individualized recommendations. Three revisions or new topics are of substantial interest to nonedocrinologists who care for patients with diabetes. First, new body mass index (BMI) cut points for prediabetes and type 2 diabetes screening are being recommended for Asian patients, who tend to have more visceral fat, even at lower BMIs. Second, blood glucose targets should be based on the individual patient's age, comorbid conditions, life expectancy, and the patient's motivation and preferences. Finally, physicians should treat the patient's cardiovascular risk with statins, and not just focus on number goals, such as systolic and diastolic blood pressure.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To interview the author, please contact Jeff Bright at Jeff.Bright@joslin.harvard.edu.
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American College of Physicians

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