Why Routine Thyroid Screening Should Extend Beyond Family History

The thyroid gland, a small butterfly-shaped organ located at the base of the neck, plays a vital role in regulating metabolism, energy levels, mood, and overall health. Despite its importance, thyroid disorders often remain undetected, quietly affecting millions of people. In India alone, over 42 million individuals are estimated to be living with thyroid-related conditions, many without knowing it.

This silent burden exists largely because early symptoms are subtle and often mistaken for everyday fatigue, stress, or ageing. Another key reason is the over-reliance on family history as the primary trigger for screening. While genetic predisposition is an important risk factor, limiting thyroid testing to those with a known family history excludes

a vast population that could benefit from early diagnosis. As “thyroid disorders can significantly impact quality of life when left untreated,” explains Dr Chirag Tandon, Director, Internal Medicine, ShardaCare Healthcity, advocating for a more proactive screening approach.

Understanding the wide spectrum of thyroid disorders further reinforces the need for broader testing. The two most common conditions are hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid). Both can disrupt daily functioning, yet their symptoms are often non-specific and develop gradually. “Patients frequently live with symptoms for years before a diagnosis is made, as the signs are easily attributed to lifestyle issues or other illnesses,” says Dr Tandon.

Beyond genetics, multiple factors increase the risk of thyroid dysfunction. Autoimmune diseases such as Type 1 diabetes, rheumatoid arthritis, pernicious anaemia, and coeliac disease commonly coexist with autoimmune thyroid conditions. Certain medications including lithium, amiodarone, antipsychotics, some weight-loss drugs, and even unregulated gym supplements can interfere with thyroid function. Iodine imbalance, whether deficiency or excess, is another contributor. The post-partum period places women at risk of thyroiditis, while advancing age naturally alters thyroid regulation. Environmental factors such as radiation exposure and chemical pollutants also play a role.

Symptoms often appear slowly and vary widely. Hypothyroidism may present as persistent fatigue, unexplained weight gain, brain fog, constipation, cold intolerance, hair loss, dry skin, depression, or menstrual irregularities. Hyperthyroidism, on the other hand, may cause weight loss, anxiety, palpitations, heat intolerance, tremors, irritability, and in some cases, eye changes associated with Graves’ disease. “Because these symptoms overlap with many common conditions, thyroid disease is frequently misdiagnosed or overlooked,” notes Dr Tandon.

Certain groups are particularly vulnerable. Women are five to eight times more likely than men to develop thyroid disorders, especially during reproductive years, after childbirth, and during perimenopause and menopause. In older adults, symptoms such as fatigue or memory changes are often dismissed as normal ageing. Individuals with autoimmune disorders, chromosomal conditions such as Down syndrome or Turner syndrome, and those experiencing persistent unexplained symptoms should also consider screening. “Anyone dealing with chronic fatigue, unexplained weight changes, or ongoing mood disturbances should not ignore the possibility of a thyroid imbalance,” advises Dr Tandon.

The encouraging news is that diagnosis is simple and treatment highly effective. A basic blood test measuring Thyroid Stimulating Hormone (TSH) serves as the first screening step, often followed by free T3 and T4 tests for confirmation. “Early diagnosis allows us to manage thyroid disorders effectively and prevent long-term complications,” says Dr Tandon. Treatment options range from synthetic thyroid hormones to anti-thyroid medications, radioactive iodine, or surgery, depending on the condition.

Unchecked thyroid disease can lead to serious complications, including heart disease, infertility, osteoporosis, nerve damage, and life-threatening emergencies such as myxedema coma. “Routine screening, especially for adults with persistent unexplained symptoms, can dramatically improve outcomes,” emphasises Dr Tandon.

Moving beyond family history and embracing a more inclusive screening strategy is essential. By encouraging individuals to discuss thyroid testing with their doctors and supporting broader screening guidelines, we can shift from reactive care to preventive health ensuring timely treatment, better quality of life, and long-term wellbeing.