Faculty Opinions recommendation of Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding?

2006 ◽  
Author(s):  
Ibrahim Bildirici
Keyword(s):  
High Risk ◽  
Early Pregnancy ◽  
Universal Screening ◽  
Thyroid Dysfunction ◽  
Case Finding ◽  
High Risk Case

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

2019 ◽  
Vol 104 (6) ◽  
pp. 2346-2354 ◽  
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

scholarly journals Prevalence of thyroid dysfunction in pregnant women and the need for universal screening: an observational study in Northern Andhra Pradesh population

2017 ◽  
Vol 6 (6) ◽  
pp. 2536
Author(s):  
Krishnamma B. ◽  
Prabhavathi V. ◽  
Prasad D. K. V.
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Universal Screening ◽  
Thyroid Dysfunction ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Overt Hypothyroidism ◽  
Free T4 ◽  
Increased Risk ◽  
Tsh Levels

Background: The maternal thyroid dysfunction is associated with adverse outcomes such as miscarriage, preterm delivery, preeclampsia, postpartum haemorrhage in mother whereas increased risk of impaired neurological development in foetus. The present study was designed with an aim to determine the prevalence of thyroid dysfunction and the need for universal screening in pregnant women.Methods: Three hundred and eighty pregnant women between 8-36 weeks of gestation with age group 20-32 years were recruited. Serum free T3, free T4 and TSH levels were assayed by chemiluminescence method. The pregnant women were classified into euthyroid, subclinical hypothyroid (SH), overt hypothyroid (OH) and overt hyperthyroid groups based on the results obtained in the study.Results: In the present study, the mean ± SD age (in years) and BMI of all pregnant women was 23.9±3.9 and 22.9±1.6 respectively. The maternal age was high in OH and overt hyperthyroid and was statistically significant (p<0.05). Similarly, women with high BMI were prone to OH than normal BMI (p<0.05). The prevalence of thyroid dysfunction was found to be 18.7%. The prevalence of hypothyroidism was 17.4% in which the SH was 13.4% and overt hypothyroidism 3.9%, but overt hyperthyroidism was 1.3%. TSH levels increased with the advancement of gestational age from 2.72±1.85 in first trimester to 3.4±2.05 µIU/mL in third trimester, and the difference was statistically significant (p<0.05). Finally, it was also noticed that the prevalence of raised TSH in high-risk pregnant women was high compared to low-risk women (35.6% vs 5.1%) relative risk (RR) 7.64, 95% confidence interval (CI) 4.62-12.65, (p<0.0001). However, 14 out of 51 (27.5%) with SH were in low-risk group.Conclusions: The present study states that the prevalence of thyroid dysfunction was 18.7% and also emphasizes the importance of screening all pregnant women for thyroid dysfunction rather than targeted high-risk pregnant women to prevent both maternal and fetal morbidity.

scholarly journals Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review

2021 ◽  
Author(s):  
Joana Lima Ferreira ◽  
Mafalda Gomes ◽  
Rosa Maria Príncipe
Keyword(s):  
Early Pregnancy ◽  
Universal Screening ◽  
Thyroid Dysfunction ◽  
Low Cost ◽  
Screening Method ◽  
Point Of View ◽  
Evidence Based ◽  
American Thyroid Association ◽  
Selective Screening ◽  
A Prospective Study

Objective: To evaluate the recommendations on the most adequate screening method (universal or selective) for thyroid dysfunction. Although thyroid dysfunction is a common disorder in fertile women and untreated cases may have negative maternal, fetal and neonatal outcomes, its screening in preconception and early pregnancy is controversial. Materials and methods: An evidence-based review was conducted to identify publications since 2017 of American Thyroid Association (ATA) guidelines, according to the following Population, Intervention, Comparison, Outcomes and Study (PICOS): women in preconception or pregnancy without thyroid disease who underwent universal or selective screening for thyroid dysfunction. Study selection obeyed the PRISMA criteria. Results: We included 15 of 325 publications. The 2017 ATA guidelines recommend selective screening in both preconception and pregnancy. The only two reviews on preconception recommended universal screening. For pregnancy, nine articles suggested universal screening, while a prospective study advocated selective screening. The main benefits advocated for universal screening were easy and low-cost tests; absence of missed diagnosis; safe and inexpensive treatment and its potential in preventing negative outcomes. Iodine deficiency is a decisive indication, but it was not evaluated in all clinical studies. Screening harms and knowledge gaps were the main arguments against universal screening. There are very few cost-effectiveness studies. Conclusion: We recommend universal screening for thyroid dysfunction in early pregnancy, which is a distinct point of view from 2017 ATA guidelines (weak recommendation, low-quality evidence). It is not possible to make a formal recommendation for preconception (insufficient evidence). We strongly suggest an individualized analysis by each country.

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