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

Jiskra, Jan; Bartáková, Jana; Holinka, Štepán; Límanová, Z; Springer, Drahomíra; Antošová, Marie; Telicka, Zdenek; Potluková, Eliška

doi:10.1055/s-0031-1284369

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…Finding of five articles showed that case-finding screening would miss between 30 and 55 % of pregnant women with thyroid dysfunction [18][19][20][21][22] and only one study did not support the feasibility of universal screening in pregnant women [23]. All studies showed that the prevalence of thyroid dysfunction (especially hypothyroidism) was higher in the group of pregnant women with risk factors for thyroid disease.…”

Section: Resultsmentioning

confidence: 99%

“…One study on universal screening showed that less than half of the women with positive pregnancy tests could be classified as high risk [23].…”

Section: Resultsmentioning

confidence: 99%

“…Jiskra et al [23] concluded that universal screening was not superior as less than half of the positively screened pregnant women can be classified as high risk, which is not significant.…”

Section: Discussionmentioning

confidence: 99%

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Universal screening versus selective case-based screening for thyroid disorders in pregnancy

et al. 2014

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Thyroid dysfunction in pregnancy is associated with significant maternal, fetal, and neonatal complications. Early treatment of thyroid disorders can effectively reduce the risk of such complications. The results of different clinical trials have demonstrated that screening pregnant women for thyroid dysfunctions is cost-effective and should be encouraged. However, there is no consensus over the advantages of universal versus case-finding screening for thyroid disorders during pregnancy. A systematic review was performed by searching PubMed, Scopus, and Web of Science databases for studies having been carried out to make a comparison between universal and case-finding screening methods during pregnancy in terms of the loss rate. The main search criteria were related to thyroid function, pregnancy, and adverse outcomes. All articles in English language are included. We analyzed by random effect method due to between-study heterogeneity. Among 241 articles found using the search terms, 40 articles were included out of which 10 were considered as acceptable and relevant. Five articles showed that case-finding screening missed between 30 and 55% of pregnant women with thyroid dysfunction. 4 studies demonstrated that universal screening and detection of thyroid dysfunction may lead to less miscarriage and pregnancy complications. The results of 2 studies demonstrated that universal screening in pregnancy with a focus on hypothyroidism would be cost-effective. Early detection of thyroid dysfunction in pregnancy can minimize the adverse maternal and fetal outcomes and is demonstrated to be cost-effective. Meta-analysis confirmed that case-based screening may miss up to 49% of pregnant women with thyroid dysfunction. This provides further support for the argument in favor of universal screening of thyroid disorders in pregnancy. In order to shed more light on the advantages of universal screening for thyroid disorders in pregnancy, more comprehensive randomized controlled trials with larger cohorts are required.

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Section: Resultsmentioning

confidence: 99%

“…One study on universal screening showed that less than half of the women with positive pregnancy tests could be classified as high risk [23].…”

Section: Resultsmentioning

confidence: 99%

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Universal screening versus selective case-based screening for thyroid disorders in pregnancy

et al. 2014

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“…In the American Endocrine Society guidelines some members recommended screening while others did not [9]. All current recommendations support a targeted screening strategy, but such a strategy may miss at least from 33 to 81% of women with hypothyroidism [97,98,99,100]. …”

Section: Screening For Thyroid Hypofunction In Pregnancymentioning

confidence: 99%

“…However, the only prospective randomized trial undertaken to assess the value of screening in relation to childhood cognitive functional outcome failed to show any benefit of screening in pregnancy [88]. Nevertheless, there is support for screening to prevent pregnancy-associated problems [29,99,101] in addition to recognition of post-partum thyroiditis [102]. Despite finding no significant decrease in obstetric complications with universal screening and case finding, Negro et al [69] showed fewer obstetric complications in the low risk group identified by universal screening and benefiting from hypo/hyperthyroidism treatment.…”

Section: Screening For Thyroid Hypofunction In Pregnancymentioning

confidence: 99%

2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children

Lazarus¹,

Brown²,

Daumerie³

et al. 2014

Eur Thyroid J

601

457

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This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking.

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Universal screening for thyroid disease during pregnancy should be performed

Stagnaro-Green

Dong

Stephenson

2020

Best Practice & Research Clinical Endocrinology & Metab

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

Abstract: 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.

Cited by 11 publications

References 23 publications

Universal screening versus selective case-based screening for thyroid disorders in pregnancy

Universal screening versus selective case-based screening for thyroid disorders in pregnancy

2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children

Universal screening for thyroid disease during pregnancy should be performed

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