DETECTION OF THYROID DYSFUNCTION IN PREGNANCY HIGH RISK VERSUS UNIVERSAL SCREENING: OUR EXPERIENCE.

Abstract

Background: Thyroid dysfunction is common in women of childbearing age. It can result in substantial adverse maternal, fetal and neonatal complications if left undiagnosed and untreated. Objective: As J and K falls in the Himalayan goiter belt, one of the world’s biggest goiter belt, the objective of this study was to determine the prevalence of thyroid disorders during pregnancy and to compare the efficacy of high risk versus universal screening for thyroid disorders during early pregnancy. Methodology: This prospective observational study was conducted on 290 pregnant women in first trimester attending outpatient department of a tertiary care center .Women were divided into low risk and high risk group. Both groups were subjected to thyroid function tests (TSH,T3,T4) and subjects with altered tests were further tested for thyroid antibodies. Results from both groups were compared. Results: Baseline characteristics of pregnant women in both groups were comparable. Overall percentage of women with thyroid dysfunction was 6.2%.Percentage of women with thyroid dysfunction in low risk women was 3% and that in high risk group was12.5%. This difference is statistically significant (12.5% versus 3%; relative risk (RR) 2.6; 95% confidence interval (CI)5.50-18.50;p value=0.004). Conclusion: Based on our study we conclude that there is need of universal screening for thyroid dysfunction in pregnancy. Testing only high risk women would miss about one-third of pregnant women with thyroid disorders and when possible adverse fetomaternal outcomes are so significant and tools to diagnose and intervene are easily available, leaving maternal disease undiagnosed even in one-third pregnant women is no longer tolerable.