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

The Journal of Clinical Endocrinology and Metabolism
Roberto NegroAlex Stagnaro-Green

Abstract

Thyroid disease during pregnancy has been associated with multiple adverse outcomes. Whether all women should be screened for thyroid disease during pregnancy is controversial. 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. 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. The study was conducted at two ambulatory clinics of community hospitals in southern Italy. A total of 4562 women were randomly assigned to the universal screening or case-finding group. 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(...Continue Reading

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Thyroid : Official Journal of the American Thyroid Association
Alex Stagnaro-GreenAmerican Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum
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