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Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review
Objective: To evaluate the recommendations on the most adequate screening method (universal or selective) for thyroid dysfunction. Although thyroid dysfunction is a common disorder in fertile women and untreated cases may have negative maternal, fetal and neonatal outcomes, its screening in preconce...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Tehran University of Medical Sciences
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144488/ https://www.ncbi.nlm.nih.gov/pubmed/34054992 http://dx.doi.org/10.18502/jfrh.v14i4.5204 |
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author | Ferreira, Joana Lima Gomes, Mafalda Príncipe, Rosa Maria |
author_facet | Ferreira, Joana Lima Gomes, Mafalda Príncipe, Rosa Maria |
author_sort | Ferreira, Joana Lima |
collection | PubMed |
description | Objective: To evaluate the recommendations on the most adequate screening method (universal or selective) for thyroid dysfunction. Although thyroid dysfunction is a common disorder in fertile women and untreated cases may have negative maternal, fetal and neonatal outcomes, its screening in preconception and early pregnancy is controversial. Materials and methods: An evidence-based review was conducted to identify publications since 2017 of American Thyroid Association (ATA) guidelines, according to the following Population, Intervention, Comparison, Outcomes and Study (PICOS): women in preconception or pregnancy without thyroid disease who underwent universal or selective screening for thyroid dysfunction. Study selection obeyed the PRISMA criteria. Results: We included 15 of 325 publications. The 2017 ATA guidelines recommend selective screening in both preconception and pregnancy. The only two reviews on preconception recommended universal screening. For pregnancy, nine articles suggested universal screening, while a prospective study advocated selective screening. The main benefits advocated for universal screening were easy and low-cost tests; absence of missed diagnosis; safe and inexpensive treatment and its potential in preventing negative outcomes. Iodine deficiency is a decisive indication, but it was not evaluated in all clinical studies. Screening harms and knowledge gaps were the main arguments against universal screening. There are very few cost-effectiveness studies. Conclusion: We recommend universal screening for thyroid dysfunction in early pregnancy, which is a distinct point of view from 2017 ATA guidelines (weak recommendation, low-quality evidence). It is not possible to make a formal recommendation for preconception (insufficient evidence). We strongly suggest an individualized analysis by each country. |
format | Online Article Text |
id | pubmed-8144488 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Tehran University of Medical Sciences |
record_format | MEDLINE/PubMed |
spelling | pubmed-81444882021-05-28 Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review Ferreira, Joana Lima Gomes, Mafalda Príncipe, Rosa Maria J Family Reprod Health Review Article Objective: To evaluate the recommendations on the most adequate screening method (universal or selective) for thyroid dysfunction. Although thyroid dysfunction is a common disorder in fertile women and untreated cases may have negative maternal, fetal and neonatal outcomes, its screening in preconception and early pregnancy is controversial. Materials and methods: An evidence-based review was conducted to identify publications since 2017 of American Thyroid Association (ATA) guidelines, according to the following Population, Intervention, Comparison, Outcomes and Study (PICOS): women in preconception or pregnancy without thyroid disease who underwent universal or selective screening for thyroid dysfunction. Study selection obeyed the PRISMA criteria. Results: We included 15 of 325 publications. The 2017 ATA guidelines recommend selective screening in both preconception and pregnancy. The only two reviews on preconception recommended universal screening. For pregnancy, nine articles suggested universal screening, while a prospective study advocated selective screening. The main benefits advocated for universal screening were easy and low-cost tests; absence of missed diagnosis; safe and inexpensive treatment and its potential in preventing negative outcomes. Iodine deficiency is a decisive indication, but it was not evaluated in all clinical studies. Screening harms and knowledge gaps were the main arguments against universal screening. There are very few cost-effectiveness studies. Conclusion: We recommend universal screening for thyroid dysfunction in early pregnancy, which is a distinct point of view from 2017 ATA guidelines (weak recommendation, low-quality evidence). It is not possible to make a formal recommendation for preconception (insufficient evidence). We strongly suggest an individualized analysis by each country. Tehran University of Medical Sciences 2020-12 /pmc/articles/PMC8144488/ /pubmed/34054992 http://dx.doi.org/10.18502/jfrh.v14i4.5204 Text en Copyright © 2020 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. |
spellingShingle | Review Article Ferreira, Joana Lima Gomes, Mafalda Príncipe, Rosa Maria Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review |
title | Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review |
title_full | Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review |
title_fullStr | Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review |
title_full_unstemmed | Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review |
title_short | Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review |
title_sort | controversial screening for thyroid dysfunction in preconception and pregnancy: an evidence-based review |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144488/ https://www.ncbi.nlm.nih.gov/pubmed/34054992 http://dx.doi.org/10.18502/jfrh.v14i4.5204 |
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