Importance of Universal screening for thyroid disorders in first trimester of pregnancy

[helvella]

We have read many very sad stories here. I wholeheartedly endorse testing of all mothers during pregnancy and, ideally, being readily available before becoming pregnant.

Indian J Endocrinol Metab. 2014 Sep;18(5):735-8. doi: 10.4103/2230-8210.139221.

Importance of Universal screening for thyroid disorders in first trimester of pregnancy.

Dave A, Maru L, Tripathi M.

Author information

Department of Obstetrics and Gynaecology, Maharaja Yashwantrao Hospital and Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India.

Abstract

OBJECTIVE:

To determine the importance of screening for Thyriod disorders in the first trimester of pregnancy.

MATERIALS AND METHODS:

The Study was conducted on 305 patients which were were randomly selected and screened on OPD basis by TSH levels (cut off level 0.10-2.50 mIU/ml).

RESULTS:

In the 305 women screened mean age was 24.46 years, mean gestational age was 9.09 weeks, 89.83% were euthyroid, 9.8%were hypothyroid, 0.32% were hyperthyroid. Incidence of hypothyroidism in high risk population was 20.58% and in normal population was 6.7%. There was significant association of thyroid disorders with high risk factors (P < 0.001). In hypothyroid women 46% had adverse perinatal outcomes and 53.33% had normal outcomes. This shows statistically significant association abnormal TSH values with adverse pregnancy outcomes (P < 0.001). In abnormal perinatal outcomes 6.2% women had Caesarean section out of them 73.68% were euthyroid, 26.31% were hypothyroid 1.9% had preterm labour, out of them 50% were euthyroid, 50% were hypothyroid. Out of 2.2% spontaneous abortions 28.5% were in euthyroid group while 71.4% were in hypothyroid group. There was 1 term stillbirth in hypothyroid group. This study showed significant association between abnormal thyroid stimulating hormone (TSH) values and adverse perinatal outcomes (P < 0.001).

CONCLUSION:

There is significant correlation between risk factors and hypothyroidism. So high risk screening is mandatory in early pregnancy. But if we screen only high risk population we would miss 4.6% cases which could have been diagnosed and treated earlier. Therefore it is important to screen all pregnant women in the first trimester, it should be made mandatory.

KEYWORDS:

Hypothyroidism in pregnancy; Universal screening; screening in first trimester

PMID: 25285296

ncbi.nlm.nih.gov/pubmed/252...

[Clutter]

I totally agree, Rod. I'd love to see thyroid screened in all women planning conception and newly pregnant (I was shocked to find out screening isn't automatic). Given that some women don't know they're pregnant for several weeks they're well into the first trimester by the time they get tested (if they do).

Thyroid and pregnancy were discussed in Inside Health bbc.co.uk/programmes/b04kbl8w Hypothyroid women planning conception were advised to consult their GP to have replacement hormone increased, if necessary, while euthyroid women were advised to increase their dietary iodine intake but avoid kelp supplements which may contain too much iodine.

[helvella Administrator Thyroid UK in reply to Clutter]

It is good that known hypothyroid women are being so advised - but it leaves a huge number who have no idea that they have an issue.

The universality seems to be key - and it looks as if more doctors in India would go for it than in the UK.

Rod