title: Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding.
abstract: OBJECTIVE
  Screening of thyroid disorders in pregnancy has been controversial. Recent recommendations favour targeted high-risk case finding, though this approach may miss a significant number of those affected. We aimed to assess the prevalence of accepted high-risk criteria in women with autoimmune thyroiditis and/or hypothyroidism detected from universal screening in an iodine-sufficient population.
  
  
  METHODS
  In 400 non-selected women in the 9-11th gestational week, thyroid-related tests were performed, and those with abnormalities were offered consultation.
  
  
  METHODS
  TSH was determined by IRMA, and the upper cut-off value for screening was set at 3.5 mIU/l. For free thyroxine (FT(4)) and thyroperoxidase antibodies (TPO-Ab), RIAs were used, with cut-offs of <10 pmol/l and >50 IU/ml respectively. Endocrinological consultation included Doppler ultrasonography and was aimed to confirm autoimmune thyroiditis and/or hypothyroidism. The prevalence of consensus high-risk criteria was assessed.
  
  
  RESULTS
  Among the 400 women, 65 (16.3%) had ≥1 abnormality: higher TSH was found in 10.3%, lower FT(4) in 2% and positive TPO-Ab in 8.3%. Fifty-one women were examined and followed up. Levo-T(4) treatment was initiated in 49 women for autoimmune thyroiditis (in 42), hypothyroidism (in 34) or both (in 27). Only 22 (45%) of 49 treated women fulfilled ≥1 high-risk criterion: most commonly family history (31%), history of miscarriage or preterm delivery (14%) and personal history (8%).
  
  
  CONCLUSIONS
  Over half (55%) of pregnant women with abnormalities suggestive of autoimmune thyroiditis and/or hypothyroidism would be missed if only those with high-risk criteria were examined. A more extensive screening of thyroid autoimmunity and dysfunction seems warranted.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, Czech Republic. horacek@fnhk.cz
authors.forename: Jiri
authors.initials: J
authors.lastname: Horacek
authors.forename: Sylvie
authors.initials: S
authors.lastname: Spitalnikova
authors.forename: Blanka
authors.initials: B
authors.lastname: Dlabalova
authors.forename: Eva
authors.initials: E
authors.lastname: Malirova
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Vizda
authors.forename: Ioannis
authors.initials: I
authors.lastname: Svilias
authors.forename: Jitka
authors.initials: J
authors.lastname: Cepkova
authors.forename: Catherine
authors.initials: C
authors.lastname: Mc Grath
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Maly
mesh_terms: D001323:Autoantibodies / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011863:Radioimmunoassay; D013959:Thyroid Diseases / Q000097:blood* / Q000175:diagnosis*; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000175:diagnosis; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin; D013974:Thyroxine