Detection of Thyroid Dysfunction in Early Pregnancy: Universal Screening or Targeted High-Risk Case Finding?
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Open Access
- 1 January 2007
- journal article
- other
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 92 (1), 203-207
- https://doi.org/10.1210/jc.2006-1748
Abstract
Context: Maternal subclinical hypothyroidism during pregnancy is associated with various adverse outcomes. Recent consensus guidelines do not advocate universal thyroid function screening during pregnancy but recommend testing high-risk pregnant women with a personal history of thyroid or other autoimmune disorders or with a family history of thyroid disorders. Objective: The objective of the study was to assess efficacy of the targeted high-risk case-finding approach in identifying women with thyroid dysfunction during early pregnancy. Design/Setting: This was a single-center cohort study. Patients/Outcome Measures: We prospectively analyzed TSH, free T4 and free T3 in 1560 consecutive pregnant women during their first antenatal visit (median gestation 9 wk). We tested thyroperoxidase antibodies in 1327 (85%). We classified 413 women (26.5%), who had a personal history of thyroid or other autoimmune disorders or a family history of thyroid disorders, as a high-risk group. We examined whether testing only such a high-risk group would pick up most pregnant women with thyroid dysfunction. Results: Forty women (2.6%) had raised TSH (>4.2 mIU/liter). The prevalence of raised TSH was higher in the high-risk group [6.8 vs. 1% in the low-risk group, relative risk (RR) 6.5, 95% confidence interval (CI) 3.3–12.6, P < 0.0001]. Presence of personal history of thyroid disease (RR 12.2, 95% CI 6.8–22, P < 0.0001) or other autoimmune disorders (RR 4.8, 95% CI 1.3–18.2, P = 0.016), thyroperoxidase antibodies (RR 8.4, 95% CI 4.6–15.3, P < 0.0001), and family history of thyroid disorders (RR 3.4, 95% CI 1.8–6.2, P < 0.0001) increased the risk of raised TSH. However, 12 of 40 women with raised TSH (30%) were in the low-risk group. Conclusion: Targeted thyroid function testing of only the high-risk group would miss about one third of pregnant women with overt/subclinical hypothyroidism.Keywords
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