Delays in Diagnosis and Treatment of Hashimoto’s Thyroiditis in Women Over 60: Barriers and Policy Solutions

Abstract

Abstract

Introduction: Hashimoto’s thyroiditis is the leading cause of hypothyroidism in the United States, affecting approximately five percent of the population (Cleveland Clinic, N.D.), with women ages 65 plus experiencing the highest burden (NIDDK, 2021). As an autoimmune disorder that develops gradually, Hashimoto’s often remains undiagnosed for years. Symptoms of Hashimoto’s, such as fatigue, weight gain, and mood changes, are frequently mistaken for normal aging experiences or symptoms of menopause, contributing to widespread diagnostic delays and poorer outcomes among women over sixty.

Background: Despite the availability of effective treatments such as lifelong levothyroxine therapy, systemic gaps in screening and insurance coverage hinder timely diagnosis and care. The U.S. Preventive Services Task Force (USPSTF) does not recommend universal thyroid screening, citing insufficient evidence for population-level benefits. This contributes to many women at high risk being undiagnosed until advanced stages (Becheru, 2025). Additionally, Medicare and Medicaid typically cover thyroid testing only when deemed “medically necessary,” excluding patients in the subclinical phase. These limitations, exacerbated further by socioeconomic disparities, geographic barriers, and low health literacy, deepen inequities in early detection and treatment.

Proposed Framework: Addressing these disparities calls for a comprehensive public health and policy strategy. Four complementary strategies—updating age- and gender-specific screening guidelines, enhancing provider education, improving patient awareness, and reforming insurance coverage—form the foundation of a more equitable thyroid care model. Provider training, including electronic health record (EHR) prompts and ongoing education programs, can minimize diagnostic delays. Meanwhile, patient-centered campaigns and standardized insurance policies can encourage earlier testing and consistent treatment.

Conclusion: Lowering delayed diagnoses among older women with Hashimoto’s thyroiditis requires systemic reform. By strengthening screening policies, enhancing clinician education, and ensuring equitable insurance coverage, healthcare systems can improve early detection, decrease long-term complications, and improve quality of life for this vulnerable population.