3.2 Universal testing versus no testing Thyroid dysfunction Study ref Design LoE N Aim, setting, population, Results Limitations/ measurements/observations Comments () SLR I 26,408 In the other (n=21,846), before 15 + 6 Compared with the no testing group, more Cochrane (2 RCTs) weeks' gestation, women in the universal women in the universal testing group tested review testing group had their sera tested; women 'positive' for hypothyroidism (RR 998.18, 95% CI who tested 'positive' (TSH > 97.5th percentile, 62.36 to 15,978.48; 21,839 women; GRADE: fT4 < 2.5th percentile, or both) received high). More women in the universal testing levothyroxine. group received pharmacological treatment for thyroid dysfunction (RR 1102.90, 95% CI 69.07 to 17,610.46; n=1,050); 10% had their dose lowered because of low TSH, high fT4 or minor side effects. () RCT II 1,671 Aim: To evaluate the effect of subclinical 2.5<TSH≤10 was found in 252/996 from the High risk of hypothyroidism (SCH) testing and intervention control group and 167/675 from the testing bias; see on pregnancy outcomes. group. Section 3.3 Setting: Peking Union Medical College In the testing group, 105 SCH and 4 Hospital (testing group; n=675) and Haidian hypothyroid women received thyroid Maternal & Child Health Hospital (control hormone replacement therapy. group whose serum was stored and measured shortly after delivery; n=996). Population: Exclusion criteria included age <18 years, ectopic pregnancy, twin pregnancy and known thyroid disease. Observations: Thyrotropin levels 2.5–10 mIU/L and free T4 levels in normal were considered SCH. Some of the testing group were treated with levothyroxine. The others had regular follow-up visits.
3.2 Universal testing versus no testing Thyroid dysfunction Study ref Design LoE N Aim, setting, population, measurements/observations Results Limitations/ Comments () SLR I 26,408 (2 RCTs) In the other (n=21,846), before 15 + 6 weeks' gestation, women in the universal testing group had their sera tested; women who tested 'positive' (TSH > 97.5th percentile, fT4 < 2.5th percentile, or both) received levothyroxine. Compared with the no testing group, more women in the universal testing group tested 'positive' for hypothyroidism (RR 998.18, 95% CI 62.36 to 15,978.48; 21,839 women; GRADE: high). More women in the universal testing group received pharmacological treatment for thyroid dysfunction (RR 1102.90, 95% CI 69.07 to 17,610.46; n=1,050); 10% had their dose lowered because of low TSH, high fT4 or minor side effects. Cochrane review () RCT II 1,671 Aim: To evaluate the effect of subclinical hypothyroidism (SCH) testing and intervention on pregnancy outcomes. Setting: Peking Union Medical College Hospital (testing group; n=675) and Haidian Maternal & Child Health Hospital (control group whose serum was stored and measured shortly after delivery; n=996). Population: Exclusion criteria included age <18 years, ectopic pregnancy, twin pregnancy and known thyroid disease. Observations: Thyrotropin levels 2.5–10 mIU/L and free T4 levels in normal were considered SCH. Some of the testing group were treated with levothyroxine. The others had regular follow-up visits. 2.5<TSH≤10 was found in 252/996 from the control group and 167/675 from the testing group. In the testing group, 105 SCH and 4 hypothyroid women received thyroid hormone replacement therapy. High risk of bias; see Section 3.3
Thyroid%20dysfunction%20evidence%20evaluation%2016May17.docx