Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, Iran.
Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran.
J Endocrinol Invest. 2022 Sep;45(9):1641-1651. doi: 10.1007/s40618-021-01738-7. Epub 2022 Apr 2.
To compare the effects of different thyroid screening scenarios, using the universal and targeted high-risk case-finding approaches with different diagnostic tests on the prevalence of subclinical hypothyroidism (SCH), thyroid autoimmunity, and pregnancy outcomes after adjustments for the intervention.
During a secondary analysis of data collected in Tehran Thyroid and Pregnancy Study, a total of 2277 women from the total population, including 1303 high-risk individuals for thyroid dysfunction. The Cochran-Mantel-Haenszel method, adjusted for the intervention, was also used to evaluate the relationships between different screening scenarios [i.e., universal approach using thyroid-stimulating hormone (TSH) and/or thyroid peroxidase antibody (TPOAb) tests and targeted high-risk case-finding approach using TSH and/or TPOAb tests] and pregnancy outcomes (i.e., preterm delivery and NICU admission). The universal approach using both TSH and TPOAb measurements was considered as the reference scenario. We analyzed outcomes of different screening methods in individuals treated with LT4, compared to those individuals who were not treated.
Compared to the universal screening approach with both TSH and TPOAb measurements, the targeted high-risk case-finding approach overlooked approximately 42%, 62%, and 74% of women with elevated TSH (> 4 µlU/mL) when using both TSH and TPOAb tests, TSH alone, and TPO alone, respectively. After adjusting for the missed cases, 2.86% of women with preterm delivery and 2.76% of women with NICU admission were missed when they were screened using the targeted high-risk case-finding approach by measuring both TSH and TPOAb. The percentage of missed cases increased when applying the targeted approach with the TSH test alone, without measuring TPOAb. Overall, 4.16% and 4.02% of women with preterm delivery and NICU admission were overlooked in this scenario, respectively. After adjustments for the intervention, the probability of NICU admission in neonates of mothers, who were screened using the targeted high-risk case-finding approach with TPOAb measurement, was 2.31 folds higher than those screened by the reference scenario.
This study suggests that although the targeted high-risk case-finding approach including both TSH and TPOAb tests, may overlook some women with SCH, it is a reasonable option since it is not associated with a higher risk of adverse pregnancy outcomes.
通过使用不同诊断检测的通用和靶向高危病例发现方法比较不同甲状腺筛查方案对亚临床甲状腺功能减退症（SCH）、甲状腺自身免疫和妊娠结局的影响，这些方案均基于干预措施进行调整。
在德黑兰甲状腺与妊娠研究中收集的数据的二次分析期间，共纳入 2277 名来自总人群的女性，其中包括 1303 名甲状腺功能障碍高危个体。采用 Cochran-Mantel-Haenszel 方法，对不同筛查方案（即使用促甲状腺激素（TSH）和/或甲状腺过氧化物酶抗体（TPOAb）检测的通用方法和使用 TSH 和/或 TPOAb 检测的靶向高危病例发现方法）与妊娠结局（即早产和新生儿重症监护病房（NICU）入院）之间的关系进行调整。使用 TSH 和 TPOAb 测量的通用方法被认为是参考方案。我们分析了在接受 LT4 治疗的个体与未接受治疗的个体中，不同筛查方法的结果。
与使用 TSH 和 TPOAb 测量的通用筛查方法相比，使用 TSH 和 TPOAb 检测的靶向高危病例发现方法分别漏诊了约 42%、62%和 74%的 TSH 升高（>4μIU/mL）的女性；当单独使用 TSH 或 TPO 检测时，漏诊率分别为 28.6%和 27.6%。在通过测量 TSH 和 TPOAb 进行靶向高危病例发现筛查时，有 2.86%的早产和 2.76%的 NICU 入院的女性被漏诊。当单独使用 TSH 进行靶向方法筛查，不测量 TPOAb 时，漏诊的病例比例会增加。总的来说，在这种情况下，有 4.16%和 4.02%的早产和 NICU 入院的女性被忽略。在调整干预措施后，在使用 TPOAb 检测的靶向高危病例发现方法进行筛查的母亲的新生儿中，NICU 入院的概率是参考方案的 2.31 倍。
本研究表明，虽然包括 TSH 和 TPOAb 检测的靶向高危病例发现方法可能会漏诊一些 SCH 女性，但由于它与不良妊娠结局的风险增加无关，因此是一种合理的选择。
