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THYROID SCREENING IN PREGNANCY – IS IT WARRANTED?, Dr. Jyoti Bhaskar
- 1. THYROID SCREENING IN PREGNANCY – IS IT WARRANTED? DR. JYOTI BHASKAR DR. SHARDA JAIN DR. JYOTI AGARWAL
- 3. Gaining Knowledge is the first step to Wisdom Sharing Knowledge is the first step to Humanity
- 4. 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
- 5. 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
- 6. 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.
- 7. 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
- 8. 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
- 9. 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
- 10. 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”
- 11. 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.
- 12. 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 )
- 13. 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,
- 14. 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
- 15. Life Care Centre has a over 200 ppt on shildeshare.net For benefit of Medical fraternity. use it yourself & share among your friends
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Editor's Notes
- #5: In India too, there is a significant burden of thyroid diseases. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases.
- #7: Maternal hypothyroidism is one of the common hormonal disorders encountered during pregnancy.1(/p215/col2/para2) The prevalence of overt hypothyroidism in pregnancy is 1.3 per 1000 females and that of subclinical hypothyroidism is 23 per 1000.1(/p215/col2/para2) The most common cause of maternal hypothyroidism is endemic iodine deficiency.2(/p8/para2) Hypothyroidism in women may result in increased incidence of infertility, miscarriage rates, and risk for obstetric and fetal complications.1(/p215/col2/para2) The obstetric complications include anemia, preeclampsia, cardiac dysfunction, placental abruption, and postpartum hemorrhage.1(/p215/col2/para2) The fetal complications include premature birth, low-birth weight, fetal distress in labor, fetal death, perinatal death, and congenital hypothyroidism.1(/p215/col2/para2) Studies have shown that even mild, untreated maternal hypothyroidism may impair the cognitive function of the offspring. This can be prevented by administering thyroid hormone replacement therapy during pregnancy.3(/p464/col1/para4) References Sahu MT, et al. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynaecol Obstet. 2010;218:215-220. Lazaras JH. Thyroid function in pregnancy. Br Med Bull. 2010;1-12. AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. American College of Endocrinology.8, 6. 1-13.Available at: http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf. Accessed March 1, 2011.