Selective screening for thyroid dysfunction in pregnant women: How often do low-risk women cease to be treated following the new guidelines of the American Thyroid Association?

Abstract

Objective: Universal screening for thyroid dysfunction in pregnant women is not recommended by the American Thyroid Association (ATA) or the American Association of Clinical Endocrinologists (AACE). This study evaluated the frequency of pregnant women that would have an indication for levothyroxine (L-T4) according to the new ATA/AACE guidelines among low-risk women without an indication for screening with TSH. Subjects and methods: The sample consisted of 412 pregnant women ranging in age from 18 to 30 years. These women were considered to be at low risk for thyroid dysfunction according to ATA/AACE and would not be candidates for screening with TSH. Anti-thyroid peroxidase antibodies (TPOAb) and TSH were measured. Women who had TSH > 2.5 mIU/L or TPOAb in the first trimester were submitted to subsequent evaluations in the second and third trimester. Results: In the first trimester, none of the pregnant women would have L-T4 therapy "recommended" and treatment would be "considered" in only two. In the second trimester, pregnant women with positive TPOAb or TSH > 2.5 mIU/L in the first trimester (n = 30) were reevaluated. L-T4 treatment would be "recommended" in only one woman and would be "considered" in two others. The 28 women that were not treated in the second trimester were reevaluated in the third trimester, but none of them would have L-T4 "recommended". Conclusion: The findings of the study suggest that selective screening, recommended by ATA/AACE does not result in a significant loss of pregnant women with an indication for L-T4 treatment.

Selective case finding versus universal screening for detecting hypothyroidism in the first trimester of pregnancy: a comparative evaluation of a group of pregnant women from Rio de Janeiro

“…Rosario and cols. who evaluated 412 low-risk pregnant women in a metropolitan region of Belo Horizonte (Minas Gerais, Brazil) found that selective screening, recommended by ATA, does not result in a significant loss of women with an indication for LT4 treatment (19). These results differs from ours, possibly due to differences in patient selection, since it is unclear how assessment of signs and symptoms of hypothyroidism was made.…”

Antepartum Care for Pregnant People with Overt Hypothyroidism, Subclinical Hypothyroidism, and Positive Thyroid Autoantibodies

“…Given that universal screening is not recommended, professional associations recommend that pregnant people should be screened for thyroid disorders based on clinical signs, personal health history, and risk factors 6,8,41 . Indications for screening according to ACOG and ATA are listed in Table 3.…”

“…11 Given that universal screening is not recommended, professional associations recommend that pregnant people should be screened for thyroid disorders based on clinical signs, personal health history, and risk factors. 6,8,41 Indications for screening according to ACOG and ATA are listed in Table 3. It is important to note the ATA considers individuals older than 30 years and individuals with 2 or more prior pregnancies to be at increased risk for thyroid dysfunction, whereas ACOG screening guidelines do not address these specific popoulations.…”