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Journal of Thyroid Research
Volume 2011, Article ID 397012, 4 pages
http://dx.doi.org/10.4061/2011/397012
Review Article

Screening for Thyroid Dysfunction in Pregnancy: Is It Worthwhile?

Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Wales, Cardiff CF14 4XN, UK

Received 17 March 2011; Accepted 13 April 2011

Academic Editor: Bijay Vaidya

Copyright © 2011 John H. Lazarus. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage) and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress) which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future.