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Five-Year Follow-up in a Large Network of Primary Care Physicians

Joseph Meyerovitch, MD; Pnina Rotman-Pikielny, MD; Michael Sherf, MD, MPH; Erez Battat, MBA; Yair Levy, MD; Martin I. Surks, MD

Arch Intern Med. 2007;167(14):1533-1538.

Background  Subclinical thyroid disease is common; however, screening recommendations using serum thyrotropin (TSH) level determinations are controversial.

Methods  To study the use of serum TSH by primary care physicians and define populations at risk for having an abnormal TSH level at follow-up, based on initial TSH levels, we conducted an observational study of a large health care database in the setting of a health management organization. All outpatients without thyroid disease or pregnancy or taking medication that may alter thyroid function in whom the TSH level was measured in 2002 and during 5-year follow-up were included in this study. Repeated TSH level determinations were compared with the initial TSH level values.

Results  In 422 242 patients included, 95% of the initial serum TSH concentrations were within normal limits (0.35-5.5 mIU/L), 1.2% were decreased (<0.35 mIU/L), 3.0% were elevated (>5.5 to 10 mIU/L) and 0.7% were highly elevated (>10 mIU/L). In 346 549 patients without thyroid-specific medications, the TSH levels became normal in 27.2%, 62.1%, and 51.2%, whose initial serum TSH level was highly elevated, elevated, and decreased, respectively, and remain normal in 98% of the patients with normal initial TSH levels. When the initial serum TSH level was elevated, patients in the highest quintile of this group, who had a shorter interval between the first and second measurements, had a higher probability of a second highly elevated TSH concentration (P < .001).

Conclusions  When the serum TSH level is normal, the likelihood of an abnormal level within 5 years is low (2%). More than 50% of patients with elevated or decreased serum TSH levels have normal levels in repeated measurements.

Author Affiliations: Research & Health Planning Department, Health Planning and Policy Wing, Clalit Health Services (Drs Meyerovitch and Sherf and Mr Battat), Institute for Endocrinology and Diabetes (Dr Meyerovitch), and National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Tel Aviv University, Sackler School of Medicine (Drs Meyerovitch, Rotman-Pikielny, and Levy), Tel Aviv, Israel; Department of Medicine E, Meir Medical Center, Kfar-Saba, Israel (Drs Rotman-Pikielny and Levy); Department of Family Medicine, Ben-Gurion University, Beer-Sheva, Israel (Dr Sherf); and Division of Endocrinology, Departments of Medicine and Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York (Dr Surks).

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