Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
J Clin Endocrinol Metab. 2019 Jun 1;104(6):2346-2354. doi: 10.1210/jc.2018-02303.
Targeted screening is proposed for the detection of thyroid dysfunction in pregnant women rather than universal screening (US). We aimed to determine the detection rate of subclinical hypothyroidism (SCH) and overt hypothyroidism (OH) based on American Thyroid Association guidelines (ATA-GL) and whether it could be improved.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 1832 pregnant women in a single center. Thyroid function (TSH and free T4) and iron status were determined. The high-risk group (HRG) included women with one or more ATA-GL risk factors and the low-risk group (LRG) included women without. Participants with other risk factors [body mass index (BMI) 30 to 39.9 kg/m2, Caucasian background] were classified as HRG+ and those with iron deficiency as HRG++.
The HRG included 64% of women and the LRG included 36% (P < 0.001). Of all participants, 4.5% had SCH and 0.5% OH. The detection rate of SCH and OH was comparable between the LRG and HRG (46% vs 54% and 25% vs 75%; P = 0.560 and 0.157, respectively). In the HRG, the detection rate of SCH was lower than that of US (54% vs 100%; P < 0.001), but that of OH was comparable (75%; P = 0.596). The detection rate of SCH in the HRG+ and HRG++ was comparable to that in the US group (81% and 88% vs 100%; P = 0.220 and 0.439, respectively).
Targeted high-risk case finding screening was not effective for the detection of SCH but performed better for OH. When obesity in the range BMI 30 to 39.9 kg/m2 and a Caucasian background were included as risk factors, the detection rate of SCH became comparable with that of US.
与普遍筛查（US）相比，建议针对甲状腺功能障碍对孕妇进行靶向筛查。我们旨在根据美国甲状腺协会指南（ATA-GL）确定亚临床甲状腺功能减退症（SCH）和显性甲状腺功能减退症（OH）的检出率，以及是否可以提高该检出率。
设计、地点和参与者：对单中心的 1832 名孕妇进行横断面研究。测定甲状腺功能（TSH 和游离 T4）和铁状态。高危组（HRG）包括具有一个或多个 ATA-GL 危险因素的妇女，低危组（LRG）包括没有危险因素的妇女。具有其他危险因素（BMI 为 30 至 39.9kg/m2，白种人背景）的参与者被归类为 HRG+，而铁缺乏的参与者被归类为 HRG++。
HRG 包括 64%的女性，LRG 包括 36%（P < 0.001）。所有参与者中，4.5%患有 SCH，0.5%患有 OH。LRG 和 HRG 之间 SCH 和 OH 的检出率相似（46%比 54%和 25%比 75%；P = 0.560 和 0.157）。在 HRG 中，SCH 的检出率低于 US（54%比 100%；P < 0.001），但 OH 的检出率相似（75%；P = 0.596）。HRG+和 HRG++的 SCH 检出率与 US 组相似（81%和 88%比 100%；P = 0.220 和 0.439）。
针对高危病例的筛查对 SCH 的检出率无效，但对 OH 的检出率更好。当将 BMI 范围为 30 至 39.9kg/m2 的肥胖和白种人背景纳入危险因素时，SCH 的检出率与 US 相当。
