Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + DIABETES MELLITUS (DM), TYPE 2 Download Section PDF Listen +++ +++ Population ++ –Adults. +++ Recommendation ++ USPSTF 2015 ++ –Screen as part of cardiovascular risk assessment if age 40–70 y and BMI >25. ++ Source ++ –USPSTF. Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening. 2015. +++ Comment ++ Screen at least every 3 y in asymptomatic adults. + OBESITY Download Section PDF Listen +++ +++ Population ++ –Adults age >18 y. +++ Recommendation ++ AAFP 2012, USPSTF 2012 ++ –Screen all adults and offer intensive counseling and behavioral interventions to promote sustained weight loss in obese adults with BMI ≥30 kg/m2. ++ Source ++ –USPSTF. Obesity in Adults: Screening and Management. 2012. +++ Comment ++ Intensive counseling involves more than one session per month for at least 3 mo. +++ Recommendations ++ VA/DoD 2014 ++ –Measure height, weight, and BMI at least annually. –Consider annual measurement of waist circumference. ++ Source ++ –VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity, Version 2.0. 2014. +++ Comment ++ Offer intensive intervention to promote weight loss to Obese adults (BMI ≥30 or waist circumference ≥40 in. [men] or ≥35 in. [women]). Overweight adults (BMI 25–29.9) with an obesity-associated condition.a + ++ aHTN, DM type 2, dyslipidemia, obstructive sleep apnea, degenerative joint disease, or metabolic syndrome. + THYROID CANCER Download Section PDF Listen +++ +++ Population ++ –Asymptomatic persons. +++ Recommendations ++ USPSTF 2017 ++ –Do not screen asymptomatic people with ultrasound. –Be aware of higher-risk patients: radiation administered in infancy and childhood for benign conditions (thymus enlargement, acne), which results in an increased risk beginning 5 y after radiation and continuing until >20 y later; nuclear fallout exposure; history of goiter; family history of thyroid disease; female gender; Asian race. (Int J Cancer. 2001;93:745) (N Engl J Med. 2015;373:2347) (N Engl J Med. 2012; 367:705) ++ Sources ++ –JAMA. 2017;317(18):1882-1887. –http://www.aafp.org/online/en/home/clinical/exam.html –http://www.cancer.org +++ Comments ++ Neck palpation for nodules in asymptomatic individuals has sensitivity of 15%–38% and specificity of 93%–100%. Only a small proportion of nodular thyroid glands are neoplastic, resulting in a high false-positive rate. Fine-needle aspiration (FNA) is the procedure of choice for evaluation of thyroid nodules. (Otolaryngol Clin North Am. 2010;43:229-238) + THYROID DYSFUNCTION Download Section PDF Listen +++ +++ Population ++ –Adults. +++ Recommendations ++ AAFP 2015, USPSTF 2015 ++ –Insufficient evidence to recommend for or against routine screening for thyroid disease. ++ ATA 2012 ++ –Screen men and women older than age 35 y for hypothyroidism every 5 y. ++ AACE 2012 ++ –Screen older adults with a thyroid-stimulating hormone (TSH) measurement. ++ Sources ++ –Am Fam Phys. 2015;91(11). –Endocr Pract. 2012;18(6):988. –Ann Intern Med. 2015;162(9):641-650. +++ Comments ++ <1% of adults have subclinical hypothyroidism; outcomes data to support treatment are lacking. Individuals with symptoms and signs potentially attributable to thyroid dysfunction and those with risk factors for its development may require TSH testing. Higher risk individuals are those with an autoimmune disorder, pernicious anemia, history of neck radiation, first-degree relative with a thyroid disorder, and those with psychiatric disorders.