THE SCOPE AND IMPACT OF THYROID-DISEASE

Aspects of the incidence and demographics of common thyroid disorders in the US (and elsewhere, to a lesser extent) are reviewed. The impact of healthcare reform and the efforts of managed care organizations to impose cost-effective management for the diagnosis and treatment of t hyroid disorders are bringing unusual pressures to bear on both clinic al laboratories and practicing endocrinologists. I discuss the potenti al dangers of utilization of suboptimally focused diagnostic approache s and of the inefficiencies in clinical management by primary-care pro viders, who often lack sufficient expertise, as opposed to endocrinolo gists. More than dollars are at stake, and the suboptimal management o f common thyroid disorders presents several significant risks. Finally , I propose a general blueprint for the ongoing development of a struc ture for continuing quality improvement of the laboratory and clinical diagnosis, treatment, and long-term follow-up of patients with thyroi d disease.