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Submitted on August 11, 2006
Accepted on October 4, 2006
Department of Endocrinology, Peninsula Medical School, Royal Devon & Exeter Hospital, Exeter; Department of Endocrinology, James Cook University Hospital, Middlesbrough; Department of Clinical Biochemistry, James Cook University Hospital, Middlesbrough; Department of Obstetrics, James Cook University Hospital, Middlesbrough, UK
* To whom correspondence should be addressed. 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: To assess efficacy of the targeted high-risk case-finding approach in identifying women with thyroid dysfunction during early pregnancy.
Design/Setting: Single-center cohort study.
Patients/Outcome measures: We prospectively analyzed TSH, FT4 and FT3 in 1560 consecutive pregnant women during their first antenatal visit (median gestation 9 weeks). We tested thyroperoxidase antibodies (TPOAb) in 1327 (85%). We classified 413 (26.5%) women, 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 (2.6%) women had raised TSH (>4.2mu/l). The prevalence of raised TSH was higher in the high-risk group (6.8% vs. 1% in the low-risk group, RR 6.5, 95%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), TPOAb (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, 12/40 (30%) women with raised TSH were in the low-risk group.
Conclusion: Targeted thyroid function testing of only high-risk group would miss about one-third of pregnant women with overt/subclinical hypothyroidism.
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