THYROID SCREENING IN PREGNANCY – IS IT WARRANTED?

DR. JYOTI BHASKARDR. SHARDA JAINDR. JYOTI AGARWAL

Gaining Knowledge is the first step to WisdomSharing Knowledge is the first step to Humanity

Epidemiology of thyroid disease in India

Estimated 42 million people suffer from thyroid

diseases (60% are women).

One in every 10 persons in India is suffering from

hypothyroidism

Prevalence of hypothyroidism (3.9%) &

Sub Clinical Hypothyroidism (9.4%).

More common in women (11.4%)>men (6.2%).

About 53% of subjects with SCH were positive for anti-

TPO antibodies.

Over 11% people from Delhi reported hypothyroidism

HYPOTHYROIDISM

Most common endocrine disorder in pregnancy

Overt hypothyroidism : 0.3% to 0.5%

Subclinical hypothyroidism : 2% to 7%

Anti TPO antibodies are present in 58% of SCH

Sahu MT, et al. Arch.Gynaecol. Obstet. 2010;218:215-220

Maternal Hypothyroidism Most common cause: endemic iodine deficiency2

Women with hypothyroidism carry an increased risk of infertility, miscarriage, and obstetric complications1

Foetal complications: premature birth, low-birth weight (LBW), fetal distress in labor, fetal death, perinatal death, and congenital hypothyroidism1

Even an untreated subclinical hypothyroidism during pregnancy can lead to cognitive impairment in the offspring.3

1. Sahu MT, et al. Arch.Gynaecol. Obstet. 2010;218:215-220.2. Lazaras JH. British Medical Bulletin. 2010;1-12.3. AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism, 2006:1-13

http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf.

Morbidity Associated with Hypothyroidism During Pregnancy

Spontaneous miscarriages Gestational hypertension and

preeclampsia Premature delivery Increased frequency of neonatal ICU

admissions Increased fetal mortality Impaired neuropsychological

development

Joint Statement of AACE, ATA and Endocrine Society:Potential benefits of early detection and treatment of thyroid dysfunction outweigh the potential side effects that could result from early detection and therapy…. Therefore, we favor screening for subclinical thyroid dysfunction in adults, including pregnant women and those contemplating pregnancy.

Thyroid, January, 2005

Consensus Statements:

ITS: Maternal hypothyroidism should be checked by early diagnosis at the first prenatal visit or at the time of diagnosis of pregnancy ( Indian Thyroid Society 2013)

ATA: Women and men >35 years of age should be screened every 5 years

American College of Ob-Gyn: Thyroid testing in pregnancy should be performed on symptomatic women and those with a personal Hx of thyroid disease or other medical conditions associated with thyroid disease (eg, diabetes mellitus).

US Preventive Services Task Force: Recommends screening only in newborns

American College of Physicians: Screening of women >50 “may be indicated”

Is a serum TSH the best screening test?

Yes!! With the exception of the rare patient with secondary hypothyroidism, a serum TSH is the best screening test for both hyperthyroidism and hypothyroidism.

Should women routinely be screened for thyroid disease?

YES !• ALL WOMEN WHO ARE INFERTILE• PLANNING PREGNANCY• AT FIRST ANTENATAL VISIT OR AT TIME OF DIAGNOSIS OF PREGNANCY ( ITS )

Hypothyroidism and Pregnancy

Maternal hypothyroidism - early diagnosis is

must in the first prenatal visit or at

diagnosis of pregnancy. Reference : 1 Banerjee S. Thyroid disorders in pregnancy. Indian thyroid guidelines 2011,

Should Pregnant women be screened in every trimester? There is NO EVIDENCE to strongly recommend TSH

monitoring in every trimester for all antenatal women ITS recommends Monitoring only the thyroid antibody

positive euthyroid women in each trimester A targeted screening at 26-32 weeks gestation may be

considered:. Patients with symptoms and signs of hypothyroidism, including goitre, A past bad obstetric history, A history of thyroid disorder or neck surgery, or irradiation, History of other autoimmune illness, a family history of thyroid illness, Residence in an iodine-deplete area

Life Care Centre has a over 200 ppt on shildeshare.net

For benefit of Medical fraternity. use it yourself & share among your friends

ADDRESS 11 Gagan Vihar, Near Karkari

Morh Flyover, Delhi - 51

CONTACT US 9650588339

011-22414049

WEBSITE : www.lifecareivf.in

www.lifearecentre.inwww.globalstemgenn.com

ISO 14001:2004 (EMS) …..Caring hearts, healing

hands

ISO 9001:2008 Helpline : 9599044257Web.www.lifecareivf.in

Helpline : 9910081484

Helpline 9599044357