Comparison of universal screening with targeted high-risk case finding for diagnosis of thyroid disorders. Issue 1 (January 2016)

• Record Type: Journal Article
• Authors: Nazarpour, Sima; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Tohidi, Maryam; AlaviMajd, Hamid; Azizi, Fereidoun
• Is Part Of: European journal of endocrinology. Volume 174:Issue 1(2016)
• Page Start: 77
• Page End: 83
• Publication Date: 2016-01
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EJE-15-0750
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract : Objective: Debate 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 design: This 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. Results: There 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). Conclusions: The 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.