Gestational thyroid function abnormalities in conditions of mild iodine deficiency: early screening versus continuous monitoring of maternal thyroid status.
OBJECTIVE
To longitudinally evaluate the timing of maternal thyroid underfunction occurrence in mildly iodine-deficient (ID) pregnant women, and ultimately assess the benefit of thyroid function testing at early gestation only in identifying maternal thyroid underfunction.


METHODS
Serum free-thyroxine and TSH were measured in 220 consecutive women once in early pregnancy (by week 12) and twice per trimester subsequently. Anti-thyroperoxidase and anti-thyroglobulin were also determined at initial and final observation.


RESULTS
Thyroid autoantibodies were detectable in 8.2% women. Overall, the prevalence of hypothyroidism over the course of gestation was 11.8% (26/220), with a relative risk of hypothyroidism in antibody-positive women of 5.0 (chi(2) 20.02, P<0.0005). Nonetheless, almost 70% hypothyroid women tested negative for thyroid autoantibodies. Fifteen/26 (57.7%) hypothyroid women were identified at presentation, and the remaining 11 at either early (6/11) or late (5/11) phases of the 2nd trimester. Isolated hypothyroxinemia was observed in 56/220 (25.4%) women, mostly from the 2nd trimester onwards.


CONCLUSIONS
In mildly ID areas thyroid function testing early in gestation seems to be only partly effective in identifying thyroid underfunction in pregnant women. Indeed, in our series more than 40% hypothyroid women would not have been diagnosed had we limited our observation to early thyroid function tests alone. Although thyroid autoimmunity carried a 5-fold increased risk of hypothyroidism, iodine deficiency seems to be a major determinant in the occurrence of thyroid underfunction. Adequate iodine supplementation should be strongly recommended to meet the increased hormone demand over gestation.
Moleti
Mariacarla
M
Dipartimento Clinico-Sperimentale di Medicina e Farmacologia, Sezione di Endocrinologia, University of Messina, 98125 Messina, Italy.
Lo Presti
Vincenzo Pio
VP
Mattina
Filiberto
F
Mancuso
Alfredo
A
De Vivo
Antonio
A
Giorgianni
Grazia
G
Di Bella
Beatrice
B
Trimarchi
Francesco
F
Vermiglio
Francesco
F
D000328:Adult; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis; D007231:Infant, Newborn; D007453:Iodide Peroxidase / Q000097:blood; D007455:Iodine / Q000172:deficiency*; D007558:Italy; D008137:Longitudinal Studies; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011256:Pregnancy Outcome; D012306:Risk; D013959:Thyroid Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D055815:Young Adult
D013972:Thyrotropin; D007455:Iodine; D007453:Iodide Peroxidase; D013974:Thyroxine