Authors

Sima Nazarpour 1, Fahimeh Ramezani Tehrani 2*, Masoumeh Simbar 3, Maryam Tohidi 4, Hamid Alavi Majd 5,  Fereidoun Azizi 6

Affiliations

  1. 1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  2. 2Tehran University of Medical Sciences, Tehran, Iran.
  3. 3Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  4. 4Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  5. 5Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. fzhadaegh@endocrine.ac.ir.

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Abstract

Objective: Debate about the need for universal screening of thyroid dysfunction in pregnancy is ongoing. The present study aimed to compare universal screening with targeted high-risk case findings for early diagnosis of thyroid disorders in Iranian pregnant women.
Study design: This cross-sectional prospective study was carried out on 1600 pregnant women in their first trimester. A checklist, including all related risk factors recommended by The American Thyroid Association, was completed for all participants. Serum concentrations of thyroxine (T4), T-uptake, TSH and thyroid peroxidase antibody (TPOAb) were measured and thyroid status was documented, based on hormonal measurements and clinical examinations.
Results: There were 656 women (44.3%) that had at least one risk factor for thyroid diseases and were eligible for the targeted high-risk case finding (high-risk group) approach, while 55.7% had no risk factors (low-risk group). Using the universal screening approach, there were 974 women (65.8%) with normal thyroid status and 506 participants (34.2%) with thyroid disturbances, including overt hyperthyroidism (0.7%), overt hypothyroidism (1.1%), subclinical hypothyroidism (30.1%; positive TPOAb (5.5%) and negative TPOAb (24.6%); and euthyroid and positive TPOAb (2.3%). Of women with thyroid dysfunction, 64.4% were in the high-risk group and 35.6% were in the low-risk group (P<0.0001). Conclusions: The targeted high-risk case finding approach overlooks about one-third of pregnant women with thyroid dysfunction. If ongoing prospective trials provide evidence on the efficacy of treating subclinical hypothyroidism in pregnancy, in populations with a low prevalence of presumed risk factors, the targeted high-risk case finding approach will be proven inefficient.