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Department of Endocrinology (B.V., B.S.), Peninsula Medical School, Royal Devon & Exeter Hospital, Exeter EX2 5DW, United Kingdom; and Departments of Endocrinology (S.A., M.B., R.B.), Clinical Biochemistry (J.D.), and Obstetrics (S.H.), James Cook University Hospital, Middlesbrough TS4 3BW, United Kingdom
Address all correspondence and requests for reprints to: Dr. Bijay Vaidya, Department of Endocrinology, Royal Devon, Exeter Hospital, Exeter EX2 5DW, United Kingdom. E-mail: bijay.vaidya{at}pms.ac.uk.
Context: 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.
Objective: 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.
Design/Setting: 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.
Results: 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.
Conclusion: 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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