Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy.
BACKGROUND
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.


METHODS
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 T(4), TSH, and thyroid peroxidase antibody. Low-risk women in the case-finding group had their sera tested postpartum.


METHODS
The study was conducted at two ambulatory clinics of community hospitals in southern Italy.


METHODS
A total of 4562 women were randomly assigned to the universal screening or case-finding group.


METHODS
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 T(4).


METHODS
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.
Negro
Roberto
R
Division of Endocrinology, 73100 Lecce, Italy. dr.negro@libero.it
Schwartz
Alan
A
Gismondi
Riccardo
R
Tinelli
Andrea
A
Mangieri
Tiziana
T
Stagnaro-Green
Alex
A
D000328:Adult; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000175:diagnosis; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008403:Mass Screening; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis*; D011256:Pregnancy Outcome; D018570:Risk Assessment; D013959:Thyroid Diseases / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use; D055815:Young Adult
D018828:Immunoglobulins, Thyroid-Stimulating; D013963:Thyroid Hormones; D013972:Thyrotropin; D013974:Thyroxine