Thyroid disease symptoms during early pregnancy do not identify women with thyroid hypofunction that should be treated

Thyroid disease symptoms during early pregnancy do not identify women with thyroid hypofunction that should be treated

Summary Objective To evaluate whether women during early pregnancy with “hypothyroidism” symptoms are at risk of biochemically defined hypothyroidism. The 2017 Guidelines of the American Thyroid Association (ATA) recommend case‐finding on the basis of symptoms to identify these women during pregnanc...

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Bibliographic Details
Published in:Clinical endocrinology (Oxford) Vol. 87; no. 6; pp. 838 - 843
Main Authors: Pop, VJ, Broeren, MA, Wiersinga, WM, Stagnaro‐Green, A
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01-12-2017
Subjects:
Adult
case‐finding
Female
Gestation
Humans
Hypothyroidism
Hypothyroidism - diagnosis
Hypothyroidism - pathology
Iodine
Pregnancy
Pregnancy Trimester, First
Risk Factors
symptoms
Thyroid
Thyroid diseases
Thyroid Diseases - diagnosis
Thyroid Diseases - pathology
Thyroid Function Tests
Thyroid Gland - pathology
Thyroid-stimulating hormone
Thyroxine
Womens health
symptoms
thyroid
case-finding
pregnancy
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Summary:Summary Objective To evaluate whether women during early pregnancy with “hypothyroidism” symptoms are at risk of biochemically defined hypothyroidism. The 2017 Guidelines of the American Thyroid Association (ATA) recommend case‐finding on the basis of symptoms to identify these women during pregnancy, while evidence is lacking. Design Construct validation of a thyroid hypofunction symptom checklist during the first trimester of pregnancy comparing high scores with biochemically defined hypothyroidism. Patients A total of 2198 healthy pregnant women from an iodine‐sufficient area in 2013‐2014. Measurements Completion of a draft questionnaire with “classical” symptoms of hypothyroidism at 12 weeks of gestation. The 2.5th and 97.5th percentiles of TSH and fT4 during pregnancy in TPO‐Ab‐negative (<35 kU/L) women were used to define euthyroid women and those with overt (clinical) and subclinical hypothyroidism. The prevalence of overt (subclinical) hypothyroidism was compared between women with high symptom scores and those with low symptom scores. Results According to fT4 and TSH cut‐offs (0.23‐4.0 mIU/L and 11.5‐18.0 pmol/L, respectively), there were 15 women with “to treat hypofunction” (overt hypothyroidism or TSH >10 mIU/L) and 68 women with subclinical hypothyroidism. Questionnaire construct validation revealed a 12‐item hypothyroid checklist with normally distributed scores. The cut‐off indicating high scores of OH was set at 1 SD > mean. Women with high symptom scores did not present more often with biochemically defined thyroid hypofunction. Conclusion This study does not support the ATA recommendation that pregnant women who require levothyroxine therapy can be identified by case‐based screening of women with symptoms of thyroid disease.
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ISSN:0300-0664
1365-2265
DOI:10.1111/cen.13433