title: Screening for autoimmune thyroid disorders after spontaneous abortion is cost-saving and it improves the subsequent pregnancy rate.
abstract: BACKGROUND
  Hypothyroidism and/or autoimmune thyroid disorders (AITD) may contribute to spontaneous abortions (SpA). Cost-effectiveness analyses of thyroid screening in women after SpA are lacking. Our aim was to evaluate the cost-effectiveness of screening for AITD and/or hypothyroidism and their treatment in women after SpA with regard to their reproductive health.
  
  
  METHODS
  We performed a cross-sectional non-randomized study with follow-up in 2008-2011 in the settings of Departments of Endocrinology and Obstetrics/Gynecology of a university hospital. We enrolled 258 women after SpA before the 12th gestational week and followed them for a median of 3 years. At enrollment, serum concentrations of thyroid stimulatory hormone (TSH), antibodies to thyroid peroxidase (TPOAb) and free thyroxine (FT4) were measured and thyroid ultrasound performed. Women with overt hypothyroidism were treated with levothyroxine (n = 45; 61.6%) and women with subclinical hypothyroidism or euthyroid AITD were treated (n = 28; 38.4%) or left untreated (n = 38; 14.7%). Euthyroid women without signs of AITD served as controls (n = 147; 57.0%).
  
  
  RESULTS
  Of the 38 untreated women with AITD and/or subclinical hypothyroidism, 8 (21.1%) reported secondary infertility as compared to 16/147 (10.9%) controls and 3/73 (4.1%) treated women (p = 0.021). Treatment was associated with an increased rate of successfully completed subsequent pregnancies (increment of 6 newborns/100 women) and a savings of €19,539/100 women. Total costs per successfully completed pregnancy were €1,189 in controls, €1,564 in the treated, and €2,488 in the untreated women.
  
  
  CONCLUSIONS
  Screening for thyroid disorders in women after SpA and treatment with levothyroxine is cost-saving and it improves the subsequent pregnancy rate.
authors.affiliation: Third Department of Medicine, General University Hospital and First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. bartakovaj@gmail.com.
authors.forename: Jana
authors.initials: J
authors.lastname: Bartáková
authors.forename: Eliška
authors.initials: E
authors.lastname: Potluková
authors.forename: Vladimír
authors.initials: V
authors.lastname: Rogalewicz
authors.forename: Tomáš
authors.initials: T
authors.lastname: Fait
authors.forename: Dita
authors.initials: D
authors.lastname: Schöndorfová
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Telička
authors.forename: Jan
authors.initials: J
authors.lastname: Krátký
authors.forename: Jan
authors.initials: J
authors.lastname: Jiskra
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology*; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007247:Infertility, Female / Q000209:etiology; D007453:Iodide Peroxidase / Q000276:immunology; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D018873:Pregnancy Rate; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000191:economics / Q000627:therapeutic use*
chemical_list: D001323:Autoantibodies; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine