The Journal of Clinical Endocrinology & Metabolism · 2006 · 446 citations · 15 references
MedicineEndocrinologyObstetricsEarly DetectionHigh-risk PregnancyPrenatal DiagnosisPregnancyPregnancy DiagnosisPrenatal AssessmentPrenatal CarePrenatal Risk AssessmentThyroid DisordersEarly Pregnancy ScreeningHigh-risk Group ScreeningRisk-based Case FindingSubclinical HypothyroidismThyroid Dysfunction In PregnancyThyroid Function EvaluationThyroid Function TestingThyroid Function Tests
Maternal subclinical hypothyroidism during pregnancy is linked to adverse outcomes, yet current guidelines recommend screening only high‑risk women rather than universal testing. This study evaluated whether a high‑risk case‑finding strategy effectively identifies thyroid dysfunction in early pregnancy. In a prospective cohort of 1,560 pregnant women, TSH, free T4, free T3 and thyroperoxidase antibodies were measured at the first antenatal visit, and 413 women with personal or family thyroid or autoimmune history were designated high risk. The high‑risk group had a 6.8 % prevalence of raised TSH versus 1 % in low risk (RR 6.5), but 30 % of cases were in low‑risk women, indicating that targeted testing would miss about one third of thyroid dysfunction cases.
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.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.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.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.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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Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease
Thyroid · 2003 · 1.2K citations
Subclinical Hypothyroidism and Pregnancy Outcomes
Brian M. Casey, Jodi S. Dashe, C. Edward Wells et al. · Obstetrics and Gynecology · 2005 · 906 citations
Medicine, Endocrinology, Obstetrics +13