Population Reference Values and Prevalence Rates following Universal Screening for Subclinical Hypothyroidism during Pregnancy of an Afro-Caribbean Cohort

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Abstract

Background: Subclinical hypothyroidism (SCH) has been reported to be associated with adverse pregnancy outcomes, however universal screening and treatment is controversial. Objectives: Our objectives were to determine population-specific pregnancy reference values (R1) for serum thyroid-stimulating hormone (TSH) and free thyroxine (FT<sub>4</sub>) at 14 weeks' gestation, along with the prevalence of SCH and thyroid peroxidase antibody (TPOAb). Methods: This was a prospective hospital-based cohort study. 1,402 subjects were recruited. Blood samples were obtained from 769 singleton pregnancies due to default between recruitment and scheduled blood draw. The prevalence of SCH was determined using R1, the laboratory non-pregnant reference values (R2) and previously recommended pregnancy reference values (R3). Results: R1 for TSH and FT<sub>4</sub> was 0.03-3.17 mU/l (mean ± SD, 1.1 ± 0.76) and 8.85-17.02 pmol/l (mean ± SD, 11.96 ± 2.06), respectively. The prevalence of SCH using reference values R1, R2 and R3 was 1.4% (11/769), 0.5% (4/769) and 1.9% (15/769). Prevalence was significantly greater using R3 when compared to R2 (p = 0.011). TPOAb prevalence was 2.6%. A significantly greater prevalence of TPOAb was found in subclinical hypothyroid subjects using all three reference values than in euthyroid subjects (∼25 vs. 2%, p < 0.05). Conclusions: These reference values are the first to be reported for an Afro-Caribbean population. Our findings support the use of pregnancy-specific reference values in our population.

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Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

Martin Surks, Eduardo L. Ortiz, Gilbert Daniels … (2004)

Patients with serum thyroid-stimulating hormone (TSH) levels outside the reference range and levels of free thyroxine (FT4) and triiodothyronine (T3) within the reference range are common in clinical practice. The necessity for further evaluation, possible treatment, and the urgency of treatment have not been clearly established. To define subclinical thyroid disease, review its epidemiology, recommend an appropriate evaluation, explore the risks and benefits of treatment and consequences of nontreatment, and determine whether population-based screening is warranted. MEDLINE, EMBASE, Biosis, the Agency for Healthcare Research and Quality, National Guideline Clearing House, the Cochrane Database of Systematic Reviews and Controlled Trials Register, and several National Health Services (UK) databases were searched for articles on subclinical thyroid disease published between 1995 and 2002. Articles published before 1995 were recommended by expert consultants. A total of 195 English-language or translated papers were reviewed. Editorials, individual case studies, studies enrolling fewer than 10 patients, and nonsystematic reviews were excluded. Information related to authorship, year of publication, number of subjects, study design, and results were extracted and formed the basis for an evidence report, consisting of tables and summaries of each subject area. The strength of the evidence that untreated subclinical thyroid disease is associated with clinical symptoms and adverse clinical outcomes was assessed and recommendations for clinical practice developed. Data relating the progression of subclinical to overt hypothyroidism were rated as good, but data relating treatment to prevention of progression were inadequate to determine a treatment benefit. Data relating a serum TSH level higher than 10 mIU/L to elevations in serum cholesterol were rated as fair but data relating to benefits of treatment were rated as insufficient. All other associations of symptoms and benefit of treatment were rated as insufficient or absent. Data relating a serum TSH concentration lower than 0.1 mIU/L to the presence of atrial fibrillation and progression to overt hyperthyroidism were rated as good, but no data supported treatment to prevent these outcomes. Data relating restoration of the TSH level to within the reference range with improvements in bone mineral density were rated as fair. Data addressing all other associations of subclinical hyperthyroid disease and adverse clinical outcomes or treatment benefits were rated as insufficient or absent. Subclinical hypothyroid disease in pregnancy is a special case and aggressive case finding and treatment in pregnant women can be justified. Data supporting associations of subclinical thyroid disease with symptoms or adverse clinical outcomes or benefits of treatment are few. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mIU/L or 4.5-10.0 mIU/L) are minimal and we recommend against routine treatment of patients with TSH levels in these ranges. There is insufficient evidence to support population-based screening. Aggressive case finding is appropriate in pregnant women, women older than 60 years, and others at high risk for thyroid dysfunction.

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Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline.

Leslie De Groot, Marcos Abalovich, Erik Alexander … (2012)

The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes. Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.

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Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease.

Zubair Baloch, Pierre Carayon, Bernard Conte-Devolx … (2003)

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Journal

Journal ID (publisher-id): ETJ

Journal ID (pmc): ETJ

Journal ID (doi): 10.1159/issn.2235-0640

Title: European Thyroid Journal

Publisher: S. Karger AG

ISSN (Print): 2235-0640

ISSN (Electronic): 2235-0802

Publication date Subscription-year: 2014

Publication date (Print): December 2014

Publication date (Electronic): 10 October 2014

Volume: 3

Issue: 4

Pages: 234-239

Affiliations

Departments of ^aObstetrics and Gynaecology, ^bChemical Pathology, ^cMicrobiology and ^dMedicine, and ^eTropical Metabolism Research Institute, University of the West Indies, Kingston, Jamaica

Author notes

*Dr. Nadine Johnson, Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston 7 (Jamaica), E-Mail nadinej@cwjamaica.com

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Nadine Johnson https://orcid.org/0000-0002-2337-1520

Article

Publisher ID: 367654 Pmcid ID: PMC4311298 Other ID: Eur Thyroid J 2014;3:234-239

DOI: 10.1159/000367654

PMC ID: PMC4311298

PubMed ID: 25759799

SO-VID: 0b9ec0c8-bc05-4fd0-8f0d-69ed723e1a4f

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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Date received : 30 June 2014

Date accepted : 15 August 2014

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Figures: 2, Tables: 1, Pages: 6

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Population Reference Values and Prevalence Rates following Universal Screening for Subclinical Hypothyroidism during Pregnancy of an Afro-Caribbean Cohort

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Karger: Endocrinology

Most cited references 28

Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline.

Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease.

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