() Cohort III-2 1,600 To compare universal testing with Using the universal testing approach, there Aim: targeted high-risk case findings for early were 974 women (65.8%) with normal thyroid diagnosis of thyroid disorders in Iranian status and 506 participants (34.2%) with pregnant women. thyroid disturbances, including overt hyperthyroidism (0.7%), overt hypothyroidism Setting: Iran (1.1%), subclinical hypothyroidism (30.1%; Population: Pregnant women in their first positive TPOAb (5.5%) and negative TPOAb trimester, of whom 656 (44.3%) had at least (24.6%); and euthyroid and positive TPOAb one risk factor for thyroid diseases and were (2.3%). Of women with thyroid dysfunction, eligible for the targeted high-risk case finding 64.4% were in the high-risk group and 35.6% (high-risk group) approach, while 55.7% had were in the low-risk group (P<0.0001). no risk factors (low-risk group; n=944). The targeted high-risk case finding approach Observations: A checklist, including all related overlooks one-third of pregnant women risk factors recommended by the American with thyroid dysfunction. If ongoing Thyroid Association, was completed for all prospective trials provide evidence on the participants. Serum concentrations of efficacy of treating subclinical hypothyroidism thyroxine (T4), T-uptake, TSH and thyroid in pregnancy, in populations with a low peroxidase antibody (TPOAb) were measured prevalence of presumed risk factors, the and thyroid status was documented, based targeted high-risk case finding approach will on hormonal measurements and clinical be proven inefficient. examinations.
() Cohort III-2 1,600 Aim: To compare universal testing with targeted high-risk case findings for early diagnosis of thyroid disorders in Iranian pregnant women. Setting: Iran Population: Pregnant women in their first trimester, of whom 656 (44.3%) 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; n=944). Observations: 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. Using the universal testing 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). The targeted high-risk case finding approach overlooks 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.
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