Detección de la disfunción tiroidea en la población gestante: está justificado el cribado universal

Vila, Lluís; Velasco, Inés; González, Stella Maris; Morales, Francisco J.; Sánchez, Emília; Laïlla, Josep M.; Martínez-Astorquiza, Txantón; Puig-Domingo, Manel

doi:10.1016/j.endonu.2012.06.014

Cited by 58 publications

(13 citation statements)

References 92 publications

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“…In addition, Negro et al ( 4 ) showed that the supplementation of thyroid hormone in pregnant women with subclinical hypothyroidism improved pregnancy outcomes. Following these results, Thung et al ( 8 ), The Spanish Society of Endocrinology and Nutrition ( 9 ), and Dosiou et al ( 10 ) recommended maternal serum screening of thyroid-stimulating hormone in early pregnancy. In addition, the Endocrine Society recommended replacement of levothyroxine in pregnant women with subclinical hypothyroidism ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy

Kim

et al. 2015

J Korean Med Sci

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During the first trimester of pregnancy, thyroid-stimulating hormone (TSH) >2.5 mIU/L has been suggested as the universal criterion for subclinical hypothyroidism. However, TSH levels change continuously during pregnancy, even in the first trimester. Therefore the use of a fixed cut-off value for TSH may result in a different diagnosis rate of subclinical hypothyroidism according to gestational age. The objective of this study was to obtain the normal reference range of TSH during the first trimester in Korean gravida and to determine the diagnosis rate of subclinical hypothyroidism using the fixed cut-off value (TSH >2.5 mIU/L). The study population consisted of pregnant women who were measured for TSH during the first trimester of pregnancy (n=492) and nonpregnant women (n=984). Median concentration of TSH in pregnant women was lower than in non-pregnant women. There was a continuous decrease of median TSH concentration during the first trimester of pregnancy (median TSH concentration: 1.82 mIU/L for 3+0 to 6+6 weeks; 1.53 mIU/L for 7+0 to 7+6 weeks; and 1.05 mIU/L for 8+0 to 13+6 weeks). Using the fixed cut-off value of TSH >2.5 mIU/L, the diagnosis rate of subclinical hypothyroidism decreased significantly according to the gestational age (GA) at TSH (25% in 3+0 to 6+6 weeks, 13% in 7+0 to 7+6 weeks, and 9% for 8+0 to 13+6 weeks, P<0.001), whereas the diagnosis rate was 5% in all GA with the use of a GA-specific cut-off value (P=0.995). Therefore, GA-specific criteria might be more appropriate for the diagnosis of subclinical hypothyroidism.

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Section: Introductionmentioning

confidence: 99%

Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy

Kim

et al. 2015

J Korean Med Sci

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“…Indicative of the controversy surrounding universal screening is the lack of unanimity within the 2012 Endocrine Society guidelines, resulting in a majority opinion advocating selective screening and a minority opinion recommending universal screening (15). It should be noted that other scientific societies are beginning to recommend universal screening, such as the Spanish Society of Endocrinology and Nutrition (SEEN) (16,17,18). Similarly, Stagnaro-Green (19) argued that universal screening is warranted based on the deleterious impact of undiagnosed and therefore untreated overt hypothyroidism on the mother and fetus, and neurocognitive development of the unborn child.…”

Section: Introductionmentioning

confidence: 99%

CONTROVERSIES IN ENDOCRINOLOGY: On the need for universal thyroid screening in pregnant women

Vila

Velasco

González

et al. 2014

European Journal of Endocrinology

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There is a well-known controversy among scientific societies regarding the recommendation to screen for thyroid dysfunction (TD) during pregnancy. Although several studies have shown an association between maternal subclinical hypothyroidism and/or hypothyroxinemia with obstetric problems and/or neurocognitive impairment in the offspring, there is only limited evidence on the possible positive effects of thyroxine (T 4 ) treatment in such cases. Despite the scarcity of this evidence, there is a widespread agreement among clinicians on the need for treatment of clinical hypothyroidism during pregnancy and the risks that could arise due to therapeutic abstention. As maternal TD is a quite prevalent condition, easily diagnosed and for which an effective and safe treatment is available, some scientific societies have proposed to assess thyroid function during the first trimester of pregnancy and ideally before week 10 of gestational age. Given the physiologic changes of thyroid function during pregnancy, hormone assessment should be performed using trimester-specific reference values ideally based on locally generated data as geographic variations have been detected. Screening of TD should be based on an initial determination of TSH performed early during the first trimester and only if abnormal should it be followed by either a free or total T 4 measurement. Furthermore, adequate iodine supplementation during pregnancy is critical and if feasible it should be initiated before the woman attempts to conceive.

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“…These competing considerations have fuelled continued debate on the merits of gestational thyroid screening ( 12 ). While universal thyroid screening is recommended in countries such as Spain ( 13 ), China ( 14 ), and Poland ( 15 ), other countries including the United Kingdom and the United States adopt a case-finding approach targeted at women at high-risk of thyroid dysfunction ( 16 ). In 1968, James Wilson and Gunner Jungner published their classic report on the principles and practice of screening in which they set down a number of pertinent criteria that should be considered before a screening programme is adopted (Box 1 ) ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Thyroid Screening in Early Pregnancy: Pros and Cons

et al. 2018

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Universal thyroid screening in pregnancy is a key debate in thyroidology and obstetrics. It is well-established that thyroid hormones are essential for maintaining pregnancy and optimal fetal development. Thyroid dysfunction is common in women of child-bearing age and also results in substantial adverse obstetric and child neurodevelopmental outcomes. Furthermore, thyroid dysfunction is readily diagnosed with reliable blood tests and easily corrected with inexpensive and available treatments. Screening only high-risk patients appears to miss the majority of cases and economic models show that compared to high-risk screening, universal screening is cost effective even if only overt hypothyroidism was assumed to have adverse obstetric effects. As a result, several countries now implement universal screening. Opponents of universal thyroid screening argue that asymptomatic borderline thyroid abnormalities such as subclinical hypothyroidism and isolated hypothyroxinemia form the bulk of cases of thyroid dysfunction seen in pregnancy and that there is a lack of high quality evidence to support their screening and correction. This review critically appraises the literature, examines the pros and cons of universal thyroid screening using criteria laid down by Wilson and Jungner. It also highlights the growing evidence for universal thyroid screening and indicates the key challenges and practicalities of implementation.

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Detección de la disfunción tiroidea en la población gestante: está justificado el cribado universal

Cited by 58 publications

References 92 publications

Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy

Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy

CONTROVERSIES IN ENDOCRINOLOGY: On the need for universal thyroid screening in pregnant women

Thyroid Screening in Early Pregnancy: Pros and Cons

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