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  • Title: Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding?
    Author: Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, Bilous R.
    Journal: J Clin Endocrinol Metab; 2007 Jan; 92(1):203-7. PubMed ID: 17032713.
    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.
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