Can a high-risk case-finding approach identify all women with thyroid dysfunction during pregnancy?

ObjectiveDebate about the need for universal screening of thyroid dysfunction in pregnancy is ongoing. The present study aimed to compare universal screening with targeted high-risk case findings for early diagnosis of thyroid disorders in Iranian pregnant women.Study designThis cross-sectional prospective study was carried out on 1600 pregnant women in their first trimester. A checklist, including all related risk factors recommended by The American Thyroid Association, was completed for all participants. Serum concentrations of thyroxine (T4), T-uptake, TSH and thyroid peroxidase antibody (TPOAb) were measured and thyroid status was documented, based on hormonal measurements and clinical examinations.ResultsThere were 656 women (44.3%) that had at least one risk factor for thyroid diseases and were eligible for the targeted high-risk case finding (high-risk group) approach, while 55.7% had no risk factors (low-risk group). Using the universal screening approach, there were 974 women (65.8%) with normal thyroid status and 506 participants (34.2%) with thyroid disturbances, including overt hyperthyroidism (0.7%), overt hypothyroidism (1.1%), subclinical hypothyroidism (30.1%; positive TPOAb (5.5%) and negative TPOAb (24.6%); and euthyroid and positive TPOAb (2.3%). Of women with thyroid dysfunction, 64.4% were in the high-risk group and 35.6% were in the low-risk group (P<0.0001).ConclusionsThe targeted high-risk case finding approach overlooks about one-third of pregnant women with thyroid dysfunction. If ongoing prospective trials provide evidence on the efficacy of treating subclinical hypothyroidism in pregnancy, in populations with a low prevalence of presumed risk factors, the targeted high-risk case finding approach will be proven inefficient.

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SUN-431 Case Finding Versus Routine Screening of Thyroid Dysfunction in Pregnancy

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.805 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Ali Ahmed Al Qarni ◽

Reem Mohammad Alamoudi ◽

Khalida Shahid ◽

Amal Almanei ◽

Muneera Alotaibi ◽

...

Keyword(s):

High Risk ◽

Pregnant Women ◽

Universal Screening ◽

Thyroid Dysfunction ◽

Case Finding ◽

P Value ◽

Chi Square ◽

Saudi Women ◽

In Pregnancy ◽

High Risk Case

Abstract Background: Thyroid dysfunction in pregnancy is associated several adverse outcomes. This has triggered a debate about whether universal screening should be implemented. Despite recommendations against universal screening, the clinical practice of many caregivers may differ. We aimed to assess the sensitivity of using targeted high-risk case finding for diagnosing thyroid dysfunction in pregnancy compared to routine screening in pregnant Saudi women, and to evaluate if gestational diabetes (GDM) specifically affected the risk. Methods: A cross-sectional study in two hospitals under the Ministry of National Guards Health affairs of Saudi Arabia; King Abdulaziz Hospital, Al-Ahsa, and Imam Abdulrahman bin Faisal Hospital, Dammam. Pregnant ladies attending the Family medicine, Obstetrics and Gynecology, and Endocrinology clinics in both hospitals were assessed by the caring physician based on a check list for risk stratification for thyroid dysfunction as per the 2012 Endocrine society clinical practice guidelines for management of thyroid dysfunction in pregnancy. Presence of one risk factor defined high risk. All patients had a routine serum TSH measured as universal screening is commonly practiced in both institutions, the physician doing the risk stratification was not aware of the TSH result. Sensitivity and specificity for the case finding approach was calculated using and abnormal TSH value as the gold standard for presence of thyroid dysfunction. The institutions lab reference TSH 0.35 – 4.94 mIU/L was used as cutoff. Results: 1571 pregnant women were included in the study; mean age 29.3± 6.2 years, 396 (23.5%) were primigravida. The mean TSH value was 1.898 ± 1.459 mlU/L. 1178 (75%) pregnant women had an indication for screening based on presence of at least one risk factor, of which 95 (8.1%) tested abnormal for TSH. 393 women had no risk factors, of which 379 (96.4%) had normal TSH, (Chi square 9.3, p-value 0.002). [Sensitivity 87.2%, (95%CI 79.4% – 92.8%), Specificity 25.9%, (95%CI 23.7% – 28.3%)]. Total abnormal TSH values was 109 (6.9%), 43 were abnormal high (i.e. hypothyroid); of which 40 screened positive by case finding approach [Sensitivity 93.02%, (95%CI 80.9% – 98.5%), Specificity 25.52%, (95%CI 23.4% – 27.8%)]. Moreover, 178 (11.3%) women screened positive for GDM at some stage in pregnancy out of which only 5 (2.8%) had an abnormal TSH value, while of the 1393 pregnant women who screened negative for GDM 1289 (92.5%) had a normal TSH value, (Chi square 5.3, p-value 0.02). [Sensitivity 4.6%, (95%CI 1.5% – 10.4%), Specificity 88.2%, (95%CI 86.4% – 89.8%)]. Conclusion: Targeted high-risk case finding predicts thyroid dysfunction in pregnant Saudi women with high sensitivity supporting its utility in screening our pregnant population. Gestational diabetes is highly prevalent in Saudi women, but does not increase risk of thyroid dysfunction in pregnancy.

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Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-02303 ◽

2019 ◽

Vol 104 (6) ◽

pp. 2346-2354 ◽

Cited By ~ 4

Author(s):

Georgiana Sitoris ◽

Flora Veltri ◽

Pierre Kleynen ◽

Julie Belhomme ◽

Serge Rozenberg ◽

...

Keyword(s):

High Risk ◽

Thyroid Dysfunction ◽

Case Finding ◽

In Pregnancy ◽

High Risk Case

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Detection of Thyroid Dysfunction in Early Pregnancy: Universal Screening or Targeted High-Risk Case Finding?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-1748 ◽

2007 ◽

Vol 92 (1) ◽

pp. 203-207 ◽

Cited By ~ 252

Author(s):

Bijay Vaidya ◽

Sony Anthony ◽

Mary Bilous ◽

Beverley Shields ◽

John Drury ◽

...

Keyword(s):

High Risk ◽

Early Pregnancy ◽

Universal Screening ◽

Thyroid Dysfunction ◽

Case Finding ◽

High Risk Case

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Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding

Acta Endocrinologica ◽

10.1530/eje-10-0516 ◽

2010 ◽

Vol 163 (4) ◽

pp. 645-650 ◽

Cited By ~ 72

Author(s):

Jiri Horacek ◽

Sylvie Spitalnikova ◽

Blanka Dlabalova ◽

Eva Malirova ◽

Jaroslav Vizda ◽

...

Keyword(s):

High Risk ◽

Autoimmune Thyroiditis ◽

Universal Screening ◽

Thyroid Autoimmunity ◽

Case Finding ◽

Thyroid Disorders ◽

Risk Criteria ◽

Risk Criterion ◽

History Of ◽

High Risk Case

ObjectiveScreening of thyroid disorders in pregnancy has been controversial. Recent recommendations favour targeted high-risk case finding, though this approach may miss a significant number of those affected. We aimed to assess the prevalence of accepted high-risk criteria in women with autoimmune thyroiditis and/or hypothyroidism detected from universal screening in an iodine-sufficient population.DesignIn 400 non-selected women in the 9–11th gestational week, thyroid-related tests were performed, and those with abnormalities were offered consultation.MethodsTSH was determined by IRMA, and the upper cut-off value for screening was set at 3.5 mIU/l. For free thyroxine (FT4) and thyroperoxidase antibodies (TPO-Ab), RIAs were used, with cut-offs of <10 pmol/l and >50 IU/ml respectively. Endocrinological consultation included Doppler ultrasonography and was aimed to confirm autoimmune thyroiditis and/or hypothyroidism. The prevalence of consensus high-risk criteria was assessed.ResultsAmong the 400 women, 65 (16.3%) had ≥1 abnormality: higher TSH was found in 10.3%, lower FT4 in 2% and positive TPO-Ab in 8.3%. Fifty-one women were examined and followed up. Levo-T4 treatment was initiated in 49 women for autoimmune thyroiditis (in 42), hypothyroidism (in 34) or both (in 27). Only 22 (45%) of 49 treated women fulfilled ≥1 high-risk criterion: most commonly family history (31%), history of miscarriage or preterm delivery (14%) and personal history (8%).ConclusionsOver half (55%) of pregnant women with abnormalities suggestive of autoimmune thyroiditis and/or hypothyroidism would be missed if only those with high-risk criteria were examined. A more extensive screening of thyroid autoimmunity and dysfunction seems warranted.

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Faculty Opinions recommendation of Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5902956.5893054 ◽

2010 ◽

Author(s):

Luca Persani

Keyword(s):

High Risk ◽

Early Pregnancy ◽

Universal Screening ◽

Case Finding ◽

Thyroid Disorders ◽

High Risk Case

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Developing of a Simple Screening Tool for Opportunistic COPD Case Finding

QJM ◽

10.1093/qjmed/hcaa042.007 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

Y M Mohamed ◽

S H Sharkawy ◽

D I Darwish

Keyword(s):

High Risk ◽

Early Detection ◽

Early Diagnosis ◽

Outpatient Clinic ◽

World Wide ◽

Screening Tool ◽

Case Finding ◽

Screening Questionnaire ◽

Risk Patients ◽

Simple Screening

Abstract Background Under diagnosis of COPD is serious problem in many countries world-wide because there are no generally detection tools available to detect high-risk patients for spirometry, and patients will not go for COPD check-up until a serious issue happens like exacerbation. Objective The aim of the work is trying to assess a new screening tool for early diagnosis of COPD. Patients and Methods The present study was conducted upon 500 subjects during the period from march 2018 to august 2018 who admitted to our chest department or visit our outpatient clinic, employees and visitors to Ain Sham hospitals.All subjects >40yrs who smoker or ex-smoker(≥10pack-years) applied a six variants(age,sex,packed years smoked during life ,dyspnea,chronic phlegmand chronic cohgh)questionnaire modified from PUMA questionnaire Subjects with score ≥5 did spirometry Results 500 subjects shared in the study 497 of them were males ( 99.4% )and 3 were females (.6%). 152of them(30.4%) had score <5 and 348 of them (69.6%)had score ≥5 who did spirometry.152 subjects did not perform spirometry. By spirometry we diagnosed 81(23.3) case COPD (fev1-fvc <.7) out of 348 subjects under gone spirometry and 16.2% of total subjects(500) . Conclusion Modified puma score is a simple and easy screening questionnaire for early detection of COPD cases and spirometry should be done to confirm the diagnosis or rule out.COPD is prevalent in many healthy apparent persons.

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Prevalence and course of thyroid dysfunction in neonates at high risk of Graves’ disease or with non-autoimmune hyperthyroidism

Acta Endocrinologica ◽

10.1530/eje-20-1320 ◽

2021 ◽

Vol 184 (3) ◽

pp. 431-440

Author(s):

Hassina Benlarbi ◽

Dominique Simon ◽

Jonathan Rosenblatt ◽

Cecile Dumaine ◽

Nicolas de Roux ◽

...

Keyword(s):

High Risk ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Genetic Disorder ◽

Care Center ◽

Receptor Gene ◽

High Serum ◽

Pediatric Care ◽

Graves Disease ◽

Neonatal Hyperthyroidism

Objective Neonatal hyperthyroidism may be caused by a permanent non-autoimmune genetic disorder or, more frequently, by maternally transmitted high serum TRAb levels. Variable thyroid dysfunction may be observed in this second context. We aimed to evaluate the prevalence of neonatal non-autoimmune hyperthyroidism and of the different types of thyroid function in neonates with a high risk of hyperthyroidism due to maternal Graves’ disease (GD). Design and methods This observational cohort study included all neonates identified in the database of a single academic pediatric care center, over a period of 13 years, as having non-autoimmune hyperthyroidism or an autoimmune disorder with high TRAb levels (above 6 IU/L) transmitted by their mothers. Patients were classified as having neonatal hyperthyroidism, hypothyroidism, or euthyroidism with a permanent or transient disorder. Results Two of the 34 consecutive neonates selected (6%) had permanent non-autoimmune hyperthyroidism due to germline (n = 1) or somatic (n = 1) mutations of the TSH receptor gene. The patients with high serum TRAb levels at birth had transient hyperthyroidism (n = 23), hypothyroidism (primary n = 2, central n = 3) or persistent euthyroidism (n = 4). Conclusion These original findings highlight the need for careful and appropriate monitoring of thyroid function in the long term, not only for the rare patients with non-autoimmune neonatal hyperthyroidism, but also for repeat monitoring during the first month of life in neonates with maternally transmitted high TRAb levels, to ensure the early identification of thyrotoxicosis in more than two thirds of cases and to detect primary or central hypothyroidism, thereby potentially decreasing associated morbidity.

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