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The targeted high-risk case-finding approach versus universal screening for thyroid dysfunction during pregnancy: thyroid-stimulating hormone (TSH) and/or thyroid peroxidase antibody (TPOAb) test?

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Authors wish to acknowledge the Shahid Beheshti University of Medical Sciences for approval of this project and its supporting as a research grant.

Funding

This project was approved by the Shahid Beheshti University of Medical Sciences.

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Author notes

  1. S. Nazarpour: Co-first Author.

Authors and Affiliations

  1. Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No 24, Parvane Street, Yaman Street, Velenjak, Tehran, Iran

    M. Amiri, S. Nazarpour, F. Ramezani Tehrani & A. Sheidaei

  2. Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran

    S. Nazarpour

  3. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    A. Sheidaei

  4. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    F. Azizi

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Contributions

MA was involved in study design, literature search, analyzing and interpreting data, manuscript drafting, critical discussion, and revising the manuscript. SN was involved in primary design of the study  and data gathering. AS was contributed in statistical analysis, interpreting data, manuscript drafting, and critical discussion. FRT was involved in study design, and critical discussion and revising the manuscript. FA was involved in the study design and critical discussion. 

Corresponding author

Correspondence to F. Ramezani Tehrani.

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The authors have no conflict of interest to declare.

Ethics approval

The study was approved by the Ethical Committee of the Research Institute for Endocrine Sciences (RIES), and a written informed consent form was obtained from all participants (IR.SBMU.ENDOCRINE.REC.1400.003).

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Amiri, M., Nazarpour, S., Ramezani Tehrani, F. et al. The targeted high-risk case-finding approach versus universal screening for thyroid dysfunction during pregnancy: thyroid-stimulating hormone (TSH) and/or thyroid peroxidase antibody (TPOAb) test?. J Endocrinol Invest 45, 1641–1651 (2022). https://doi.org/10.1007/s40618-021-01738-7

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  • DOI: https://doi.org/10.1007/s40618-021-01738-7

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