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

2010 ◽  
Vol 163 (4) ◽  
pp. 645-650 ◽  
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.

scholarly journals Comparison of universal screening with targeted high-risk case finding for diagnosis of thyroid disorders

2016 ◽  
Vol 174 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Sima Nazarpour ◽  
Fahimeh Ramezani Tehrani ◽  
Masoumeh Simbar ◽  
Maryam Tohidi ◽  
Hamid AlaviMajd ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pregnant Women ◽  
Universal Screening ◽  
Thyroid Dysfunction ◽  
Risk Group ◽  
Case Finding ◽  
High Risk Group ◽  
Thyroid Status ◽  
High Risk Case

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.

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

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.

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

2007 ◽  
Vol 92 (1) ◽  
pp. 203-207 ◽  
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

scholarly journals Angioedema in a Patient with Autoimmune Thyroiditis – A Case Report

2020 ◽  
Vol 47 (2) ◽  
pp. 34-37
Author(s):  
S. Dermendzhiev ◽  
A. Dzhambov ◽  
T. Dermendzhiev
Keyword(s):  
Autoimmune Thyroiditis ◽  
Hashimoto’S Thyroiditis ◽  
Immunoglobulin E ◽  
Thyroid Autoimmunity ◽  
Hormonal Control ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
History Of ◽  
One Year

AbstractWe present a case of a 29-year-old Bulgarian woman with autoimmune thyroiditis and recurrent angioedema. The patient presented with a one-year-long history of recurrent angioedema and Hashimoto’s thyroiditis. Physical examination showed oedema surrounded by erythema on the forearms, and erythematous, itchy plaques spreading over her face, neck, chest, abdomen, and extremities. Blood tests showed elevated total immunoglobulin E (IgE). The patient had been diagnosed with Hashimoto’s thyroiditis and hypothyroidism. She had been taking levothyroxine 50 μg/d, resulting in a good hormonal control; however, her anti-thyroid peroxidase (anti-TPO) antibodies were high. She was started on methylprednisolone and antihistamines. In three weeks, we observed a good therapeutic response to the treatment and the lesions remitted. IgE dropped within normal range. Levels of anti-TPO antibodies were persistently high. In conclusion, patients with angioedema should be tested for thyroid autoimmunity. Further delve into the pathogenesis of angioedema in them is warranted in order to explore the possibility of an underlying atopy in those not responding to the standard treatment with levothyroxine.

Low Prevalence of Clinically High-Risk Women and Pathological Thyroid Ultrasound among Pregnant Women Positive in Universal Screening for Thyroid Disorders

2011 ◽  
Vol 119 (09) ◽  
pp. 530-535 ◽  
Author(s):  
J. Jiskra ◽  
J. Bartáková ◽  
Š. Holinka ◽  
Z. Límanová ◽  
D. Springer ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Universal Screening ◽  
Screening Program ◽  
Thyroid Volume ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Thyroid Ultrasound

AbstractIt is controversial whether screening program for thyroid disorders in pregnancy should be universal or targeted case-finding.To evaluate the relationship between history, laboratory parameters and thyroid ultrasound (TUS) in pregnant women positive in universal screening.The screening included investigation of serum TSH (thyroid stimulating hormone) and TPOAb (antithyroperoxidase antibodies) in 5 520 unselected pregnant women in the 9–11th gestational week. In 822 the screening was positive: abnormal TSH (> 3.67 or < 0.06 mIU/l) and/or positive TPOAb (> 143 kIU/l). 200 consecutive women with positive screening were included it the study.41 women (21%) had transient gestational hyperthyroidism (TGH) and 159 (79%) had a thyroid pathology: 10 (5%) overt hypothyroidism; 76 (38%) subclinical hypothyroidism, 7 (3.5%) overt hyperthyroidism and 66 (33%) euthyroid TPOAb positivity. After exclusion of TGH, only 74/159 (47%) women were classified as high-risk for thyroid disease according to their history. There were no significant clinical and laboratory differences between the high- vs. low-risk women, except for higher proportion of FT4<75th percentile (P=0.008) and larger thyroid volume in the high-risk group (P=0.04). Finally, only 66/126 (52%) of TPOAb-positive pregnant women had autoimmune pattern in TUS in comparison with 41/49 (84%) TPOAb-positive non-pregnant control women of comparable age (P<0.001).Less than half of the positively screened pregnant women can be classified as high-risk and almost half of them had not autoimmune pattern in TUS. High- and low-risk pregnant women have similar clinical and laboratory characteristics.

scholarly journals Assessment of the simultaneous effect of hypothyroidism and thyroid autoimmunity with gestational diabetes on the incidence of type 2 diabetes

2020 ◽  
Author(s):  
Maryam zahedi ◽  
Elham Kazemian ◽  
Fahimeh Ramezani Tehrani ◽  
Maryam tohidi ◽  
Fereidoun azizi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Incidence Rate ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Thyroid Disorders ◽  
Thyroid Peroxidase Antibody ◽  
Term Delivery ◽  
History Of

Abstract Introduction: Despite the evidence available on the adverse impact of gestational diabetes (GDM) and thyroid disorders on developing type 2 diabetes (T2DM), the concurrent influence of these disorders on the incidence of T2DM has not been reported yet. Methods: In this prospective study, 1894 non-diabetic women aged 20 to 60 years, with a history of at least one term delivery, without diagnosed hyperthyroidism were selected at the initiation of the Tehran Thyroid Study (TTS). Pooled logistic regression analyses were used to investigate the association of GDM, thyroid disorders i.e., hypothyroidism and/or thyroid peroxidase antibody (TPOAb) positivity and interaction between GDM and thyroid disorders with the risk of incident T2DM. Results: Of the 1894 participants of the present study, 346 (18.3%) had a history of GDM, and 832 (43.9%) had thyroid disorders. The total cumulative incidence rate of T2DM at the median follow-up time of ~ 12 years was overall 12/1000 person-years (95% confidence interval (CI): 10/1000–13/1000), with an incidence rate of 16/1000 (95%CI: 13/1000–20/1000) in women with GDM; and 11/100,000 (95%CI: 9/100,000–12/1000) among those without GDM. After adjustment for age, the risk of incident T2DM increased among individuals with the previous GDM compared to women without a history of GDM (odds ratio (OR): 1.54, 95%CI: 1.06, 2.25). No significant associations were found between either thyroid disorders or the interaction between GDM and thyroid disorders with the development of T2DM; (OR: 1.14, 95%CI: 0.82, 1.58) and (OR: 1.27, 95%CI: 0.66, 2.43), respectively.Conclusion: GDM and thyroid disorders have no concurrent impacts on the incidence of T2DM.

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