Screening of thyreopathies in pregnancy

Czech version

Authors: Jan Jiskra; Zdeňka Límanová
Authors‘ workplace: III. interní klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Prakt Gyn 2013; 17(1): 61-67
Category: Gynecology and Obstetrics: Review Article

Overview

High prevalence and negative impact of untreated thyroid diseases on the pregnancy arises worldwide discussion about the most effective strategy of their screening. There is general consensus that the screening should be focused on the clinically high-risk women (“aggressive case-finding”) and should include investigation of serum TSH (thyroid stimulatory hormone). However, such restricted screening omits 30-80 % of women with positive laboratory results (at least 50 % of women according to studies performed in Czech Republic). Therefore, in recently published national guidelines Czech Endocrine Society ČSL JEP endorses universal screening which should include investigation of serum TSH and TPOAb (antibodies to thyroid peroxidase) among women in the first trimester of pregnancy.

Key words:
pregnancy – hypothyroidism – thyroid stimulatory hormone – antibodies against thyroid peroxidase – miscarriage

Sources

1. Abalovich M, Amino N, Barbour LA et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007; 92(Suppl 8): S1–S47.

2. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Thyroid 2011; 21(10): 1–45.

3. Patel J, Landers K, Li H et al. Thyroid hormones and fetal neurological development. J Endocrinol 2011; 209(1): 1–8.

4. Límanová Z, Springer D, Horáček J et al. Doporučení pro diagnostiku a léčbu onemocnění štítné žlázy v těhotenství a pro ženy s poruchou fertility. ČES ČLS JEP, DMEV 2013; 16(1): 38–61.

5. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31(5): 702–755.

6. Thangaratinam S, Tan A, Knox E et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. Br Med J 2011; 342: d2616.

7. De Groot L, Abalovich M, Alexander EK et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97(8): 2543–2565.

8. Vaidya B, Anthony S, Bilous M et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high risk case nding? J Clin Endocrinol Metab 2007; 92(1): 203–207.

9. Horacek J, Spitalnikova S, Dlabalova B et al. Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding. Eur J Endocrinol 2010; 163(4): 645–650.

10. Chang DL, Leung AM, Braverman LE, Pearce EN. Thyroid testing during pregnancy at an academic Boston Area Medical Center. J Clin Endocrinol Metab 2011; 96(9): E1452-E1456.

11. Wang W, Teng W, Shan Z et al. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur J Endocrinol 2011; 164(2): 263–268.

12. Jiskra J, Bartáková J, Holinka Š et al. Low prevalence of clinically high-risk women and pathological thyroid ultrasound among pregnant women positive in universal screening for thyroid disorders. Exp Clin Endocrinol Diabetes 2011; 119(9): 530–535.

13. Potlukova E, Potluka O, Jiskra J et al. Is Age a Risk Factor for Hypothyroidism in Pregnancy? An Analysis of 5223 Pregnant Women. J Clin Endocrinol Metab 2012; 97(6): 1945–1952.

14. Límanová Z, Springer D. Současné zkušenosti s vyšetřováním tyreopatií v graviditě – výsledky pilotního projektu. Čas Lék Čes 2011; 150(7): 386–390.

15. Gronowski AM, Haddow J, Kilpatrick S et al. Thyroid function during pregnancy: who and how should we screen? Clin Chem 2012; 58(10): 1397–1401.

16. Simmons RK, Echouffo-Tcheugui JB, Sharp SJ et al. Screening for type 2 diabetes and population mortality over 10 years (ADDITION-Cambridge): a cluster-randomised controlled trial. Lancet 2012; 380(9855): 1741–1748.

17. Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. Br Med J 2012; 345(7884): e7191.

18. Negro R, Mangieri T, Coppola L et al. Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study. Hum Reprod 2005; 20(6): 1529–1533.

19. Negro R, Formoso G, Mangieri T et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006; 91(7): 2587–2591.

20. Lazarus JH, Betswick JP, Channon S et al. Antenatal thyroid screening and childhood cognitive function. New Engl J Med 2012; 366(6): 493–501.

21. Brent GA. Diagnosing thyroid dysfunction in pregnant women: Is case finding enough? J Clin Endocrinol Metab 2007; 92(1): 39–41.

22. Osório J. Thyroid function: Thyroid screening in pregnancy – no effect on child cognition? Nat Rev Endocrinol 2012; 8(4): 193.

23. Dosiou C, Sanders GD, Araki SS, Crapo LM. Screening pregnant women for autoimmune thyroid disease: a cost-effectiveness analysis. Eur J Endocrinol 2008; 158(6): 841–851.

24. Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. Am J Obstet Gynecol 2009; 200(3): 267.e1–7.

25. Dosiou C, Barnes J, Schwartz A, Negro R, Crapo L, Stagnaro-Green A. Cost-effectiveness of universal and risk-based screening for autoimmune thyroid disease in pregnant women. J Clin Endocrinol Metab 2012; 97(5): 1536–1546.

26. Telička Z, Jiskra J, Springer D. Simple Method of Economical Analysis of Diagnosis Procedure (Used in Screening of Thyroid Gland Diseases in Pregnant Women) during the first trimester of pregnancy. European Journal for Biomedical Informatics. Prague 2010. Dostupné z WWW: <http://ejbi.cz/articles/201012/59/1.html>

27. Vaidya B, Hubalewska-Dydejczyk A, Laurberg P et al. Treatment and screening of hypothyroidism in pregnancy: results of a European survey. Eur J Endocrinol 2012, 166(1): 49–54.