title: Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases.
abstract: OBJECTIVE
  Universal screening for thyroid diseases during pregnancy is controversial. Targeted screening does not identify all women with thyroid dysfunction. Furthermore, antithyroid peroxidase antibodies (TPOAb) are suspected to be associated with an increased risk of fetal loss, premature delivery and hypothyroidism. The aim of our study was to assess the rationale behind universal screening and propose thyroxine treatment in particular cases.
  
  
  METHODS
  Between January 2008 and May 2009, 537 consecutive iodine-supplemented women with a singleton pregnancy [441 TPOAb- controls and 96 TPOAb+ women (47 nontreated and 49 treated)] were evaluated using thyroid and obstetric parameters. According to our algorithm for thyroid screening in pregnancy, if thyroid-stimulating hormone (TSH) exceeded 1 mU/l in TPOAb+ women, 50 µg of levothyroxine (L-T4) was prescribed.
  
  
  RESULTS
  The miscarriage rate was significantly higher in the nontreated TPOAb+ group compared with the treated group (16 vs. 0%; p = 0.02). Compared to the control group, TSH in TPOAb+ patients was higher at the first prenatal visit prior to L-T4 treatment (p < 0.01), while free thyroxine was higher than in the control group after the 20th week (p < 0.05).
  
  
  CONCLUSIONS
  Our study supports the potential benefit of universal screening and L-T4 treatment for autoimmune thyroid disease during pregnancy. Efforts are still needed to further decrease miscarriage rates.
authors.affiliation: Department of Endocrinology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Thibault
authors.initials: T
authors.lastname: Lepoutre
authors.forename: Frederic
authors.initials: F
authors.lastname: Debiève
authors.forename: Damien
authors.initials: D
authors.lastname: Gruson
authors.forename: Chantal
authors.initials: C
authors.lastname: Daumerie
mesh_terms: D000022:Abortion, Spontaneous / Q000517:prevention & control*; D001323:Autoantibodies / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D050031:Hashimoto Disease / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007453:Iodide Peroxidase / Q000276:immunology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D013967:Thyroiditis, Autoimmune; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use*
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine