thyroid screening in pregnancy – is it warranted?, dr. jyoti bhaskar
TRANSCRIPT
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THYROID SCREENING IN PREGNANCY – IS IT WARRANTED?
DR. JYOTI BHASKARDR. SHARDA JAINDR. JYOTI AGARWAL
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Gaining Knowledge is the first step to WisdomSharing Knowledge is the first step to Humanity
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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
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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
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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.
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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
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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
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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
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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”
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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.
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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 )
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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,
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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
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