Thyroid Dysfunction during pregnancy

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J Clin Endocrinol

Metab. 2010 Feb 3. [Epub ahead of print]

Universal

Screening Versus Case Finding for Detection and Treatment of Thyroid Hormonal

Dysfunction During Pregnancy.

Negro

R, Schwartz

A, Gismondi

R, Tinelli

A, Mangieri

T, Stagnaro-Green

A.

Divisions of

Endocrinology (R.N.), Obstetrics and Gynecology (A.T.), and Neonatology and

Intensive Care Unit (T.M.), V. Fazzi Hospital, 73100 Lecce, Italy; Department

of Medical Education (A.S.), University of Illinois, Chicago, Illinois 60612;

Division of Obstetrics and Gynecology (R.G.), Casa di Cura Salus, 72100

Brindisi, Italy; and Department of Medicine, Department of Obstetrics and

Gynecology, Touro University College of Medicine (A.S.-G.), Hackensack, New

Jersey 07601.

Context: Thyroid disease during pregnancy has

been associated with multiple adverse outcomes. Whether all women should be

screened for thyroid disease during pregnancy is controversial. Objective: The

objective of the study was to determine whether treatment of thyroid disease

during pregnancy decreases the incidence of adverse outcomes and compare the

ability of universal screening vs. case finding in detecting thyroid

dysfunction. Design: Women in the first trimester were randomly assigned to the

universal screening group or case-finding group. Women in both groups were

stratified as high risk or low risk based on risk factors for thyroid disease.

All women in the universal screening group, and high-risk women in the

case-finding group, were immediately tested for free T4, TSH, and thyroid

peroxidase antibody. Low-risk women in the case-finding group had their sera

tested postpartum. Setting: The study was conducted at two ambulatory clinics

of community hospitals in southern Italy. Patients: A total of 4562 women were

randomly assigned to the universal screening or case-finding group.

Intervention: Intervention included levothyroxine in women with a TSH above 2.5

mIU/liter in TPO antibody-positive women and antithyroid medication in women

with a undetectable TSH and elevated free T4. Main Outcome Measure: Total number

of adverse obstetrical and neonatal outcomes was measured. Results: No

significant differences were seen in adverse outcomes between the case-finding

and universal screening groups. Adverse outcomes were less likely to occur

among low-risk women in the screening group than those in the case-finding

group. Conclusions: Universal screening compared with case finding did not

result in a decrease in adverse outcomes. Treatment of hypothyroidism or

hyperthyroidism identified by screening a low-risk group was associated with a

lower rate of adverse outcomes.