Screening For Thyroid Disease Research Articles

Is Thyroid Replacement Therapy Necessary in Fertility Patients with “Normal” TSH?

AbstractThyroid diseases are very common disorders in women, and thyroid hormones are crucial players in many aspects of fetal growth and neurodevelopment, both of which are dependent on an adequate supply of maternal thyroid hormones from early gestation onwards. It is therefore very important to keep women euthyroid during gestation. Globally, hypothyroidism is still frequently caused by iodine deficiency. In iodine sufficient areas, the most common cause of hypothyroidism is thyroid autoimmunity with positive anti-thyroperoxidase antibodies (anti-TPO) measurable in serum. It is well known that overt maternal and fetal hypothyroidism must be avoided during gestation as well as before assisted fertility. It is, however, less clear if milder forms or subclinical hypothyroidism requires thyroxine replacement therapy. Screening for thyroid disease is not recommended by guidelines, but case finding based on specific criteria form general practice among endocrinologists and fertility specialists. There are many different factors to be aware of including, how measurements and interpretations of the laboratory tests for thyroid related hormones are complicated by a combination of changes due to the physiology of pregnancy, and the difficulty of laboratory measurements to correct for these changes. A pragmatic algorithm for the management has been suggested, but there are still many inconsistencies and controversies in the field. Very importantly, all clinicians managing thyroid diseases should be aware of this and discuss it with the female patients of fertile age as soon as the diagnosis of hypothyroidism is made in order to avoid negligence from the patient if she becomes pregnant.

Endocrinological Evaluations of a Neurofibromatosis Type 1 Cohort: Is it Necessary to Evaluate Autoimmune Thyroiditis in Neurofibromatosis Type 1?

Background:Neurofibromatosis type 1 is an autosomal dominant neurocutaneous disorder in which the coexistence of autoimmune thyroiditis and thyroid gland tumours has been reported previously.Aims:To determine the thyroid function and autoimmune thyroid diseases in neurofibromatosis type 1 patients in order to identify the possible association between neurofibromatosis type 1 and thyroid diseases.Study Design:Case-control study.Methods:The study includes 78 consecutive patients diagnosed with neurofibromatosis type 1 between June 2010 and June 2014 and 50 healthy controls. Baseline demographic data were generated from patient examination record forms, including age, sex, height, and weight, as well as levels of free triiodothyronine, free thyroxine, thyroid-stimulating hormone, anti-thyroid peroxidase and anti-thyroglobulin levels.Results:Mean age, sex, and body mass index were similar in both groups (p>0.05). The mean levels of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were not statistically different between the neurofibromatosis type 1 and control groups. Similarly, no statistically significant difference was observed between the neurofibromatosis type 1 and control groups for anti-thyroid peroxidase and anti-thyroglobulin positivity (2.5% vs 0%, p>0.05).Conclusion:Screening for autoimmune thyroid disease and thyroid function seems to be unnecessary in patients with neurofibromatosis type 1.

The Association of Thyroid Disease and Oral Lichen Planus: A Literature Review and Meta-analysis.

The objective of this study was to systemically evaluate the association between oral lichen planus (OLP) and thyroid disease. Eleven electronic databases were searched for any clinical study published up until August 2016 that explored an association between OLP and thyroid disease, complemented with manual searching. The titles and abstracts of all studies identified from the electronic searches were then assessed independently to determine inclusion of the study. The population of interest was patients with OLP, and the exposure was the presence of thyroid disease in OLP patients. Statistical analyses were conducted using Review Manager 5.2. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated to evaluate the association between OLP and thyroid disease. Eight studies were included for review, and of these, four case-control studies were included in the final meta-analysis. The mean Newcastle-Ottawa Scale score evaluating the methodological quality of the four studies was 6.5. The OR was 2.10 (95% CI: 1.47-3.01), indicating a statistically significant difference in the prevalence of thyroid disease between the OLP and control groups. Heterogeneity was satisfactory (I2 = 0%, <25%). An approximately symmetrical funnel plot suggested no obvious publication bias. Two articles showed a higher correlation between OLP and hypothyroidism (OR 1.83, 95% CI: 1.16-2.89), with satisfactory heterogeneity (I2 = 0%, <25%). This meta-analysis indicated a significantly high prevalence of thyroid disease among OLP patients compared with controls, suggesting that routine screening for thyroid disease could be beneficial to OLP patients. However, due to the small number of studies included, further studies are needed to confirm the results.

Autoimmune hypothyroidism is three times more frequent in female prolactinoma patients compared to healthy women: data from a cross-sectional case-control study.

The potent immunomodulatory action of prolactin has been demonstrated in many experimental in vitro studies. In accordance with these data, our retrospective analyses revealed higher prevalence of autoimmune thyroid diseases in prolactinoma patients compared to general population. A cross-sectional case-control study was carried out in a single tertiary referral centre. The main aim was to assess the frequency of newly diagnosed autoimmune thyroid diseases in female patients with prolactinomas. The study population consisted of 260 females (154 patients and 106 sex-matched, ethnicity-matched, and age-matched healthy controls) enroled in a prospective manner. Physical exam, thyroid ultrasound, and laboratory testing (measurement of antibodies to thyroglobulin, thyroid peroxidase, TSH-receptor, serum TSH and FT4 levels) were performed in all study participants. Autoimmune thyroid diseases were diagnosed in 29.9% of the patients and 10.4% of the healthy subjects (p = 0.0002). Subclinical hypothyroidism was found in 9.7% of the patients versus 2.8% of the controls (p = 0.044). Autoimmune hyperthyroidism was observed in 1.3% of all patients. The prevalence of newly diagnosed autoimmune thyroid diseases, and especially the subclinical hypothyroidism, was significantly higher in our female prolactinoma patients in comparison to age-matched healthy women. Based on our results, we suggest routine screening for autoimmune thyroid diseases (thyroid function, immunology and ultrasound examination) in all female patients with prolactinoma at the time of diagnosis. We also recommend a close follow-up of thyroid function in these women in case of pregnancy and after delivery.

Routine First Trimester Screening for Maternal Thyroid Disease

AbstractThe aim was to assess the proportion of women requiring a referral to an endocrinologist when carrying out routine screening for maternal thyroid disease simultaneously with screening for Down syndrome. Between November 2009 and September 2015, women having a first trimester combined test were screened; those symptomatic or being investigated for thyroid problems were excluded. In the first half of the period the blood sample was tested for anti-thyroid peroxidase (TPO) antibodies, serum thyroid stimulating hormone (TSH), and free thyroxine (fT4); thereafter fT4 was not used. Women with at least one analyte outside the range (TPO more than 5.6 kU/L, TSH 0.35–4.94 mU/L, fT4 9.0–19.1 pmL/L) were referred to an endocrinologist for counseling. Of 10,052 women screened, 1190 (11.8%) had TSH, fT4, or antibody levels outside the range; 13.0% when fT4 was used and 10.4% thereafter. Most of these positive results were due to a single abnormal marker. There was a much higher positive rate in multiple pregnancies (27.3% compared with 11.5% in singletons; P &lt; 0.0001). There was an association between positivity and maternal age (P &lt; 0.0001), a higher rate in the small ethnic group of Asians (P &lt; 0.0005) and a lower rate among smokers (P &lt; 0.02) and following assisted reproduction (P &lt; 0.05). Routine antibody and hormone testing at the same time as the combined test generated a large number of referrals but this did not overload the services.

Thyroid Dysfunction among Greek Patients with Type 1 and Type 2 Diabetes Mellitus as a Disregarded Comorbidity.

Introduction The aim of this study was to determine the prevalence of thyroid dysfunction in Greek patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus as well as its possible relations to glycaemic control and to diabetic complications. Methods A total of 1015 patients, consecutively followed in the Outpatient Diabetes Center, were studied. Anthropometric and biochemical measurements, occurrence of diabetes complications, and classical comorbidities were assessed. Average HbA1c of the previous year was calculated. Wellbeing was determined, using a 10-point optimal scale. All the above parameters were compared between subjects with or without thyroid disease. Results All patients were euthyroid at the time of the study, either on thyroid medications or not. Hypothyroidism occurrence did not differ between T2DM and T1DM patients (37.1% versus 43.5%, p > 0.05). Nodular goiter was observed more frequently in T2DM patients (34.1% versus 18.8%, p < 0.05). T2DM patients with hypothyroidism compared to those without hypothyroidism had higher HbA1c (7.27% versus 6.98%, p < 0.01), TChol (184.97 mg/dl versus 168.17 mg/dl, p < 0.001), and higher HDL-Chol (51.28 mg/dl versus 46.77 mg/dl, p < 0.01). T2DM patients without hypothyroidism had a better wellness feeling (7.5 versus 5.3 points, p < 0.01). Conclusions Screening for thyroid disease among T2DM patients should be routinely considered, as it is found to be an additional commorbidity. If it remains undiagnosed, it could aggravate the clinical course of the disease.

Laboratory Screening of Thyroid Diseases Among People of Different Districts of the Transcarpathian Region

The objective: is to compare the diagnosis rate of hyper- and hypothyroidism, including the latent one, among the residents of mountainous and low-lying areas of the iodine endemic Transcarpathian region.&#x0D; Patients and methods. The level of thyroid stimulating hormone was determined by using an automated system Roche Hitachi Сobas e411 (immuno-chemiluminescence analyzes) in medical laboratory «ASTRA-DIA» (Uzhhorod). 7943 people from 12 administrative districts were examined during 2011-2015.&#x0D; Results. Thyroid gland diseases were diagnosed in 21,44% of the patients who lived in the mountainous areas of the Transcarpathian region, including subclinical hypothyroidism in 7,29% of cases. These rates were 24,28% and 9,35% respectively among the patients from low-lying districts. Status of euthyroidism was found only in 67,5% of patients who lived in the Transcarpathian region for at least 10 years, while the rate among the total number of the examined is 80,47%.&#x0D; Conclusions. TSH level can be used for screening for thyroid disorders. People living more than 10 years in the iodine endemic areas can be considered at risk of hyper- and hypothyroidism, including subclinical, where appropriate screening of these diseases is needed at least once in 2 years.

Current status of screening and management of thyroid diseases during pregnancy

Objective To investigate the current status of screening and management of thyroid diseases during pregnancy, and to provide evidence for further improvement of clinical management. Methods Clinical data of 5 981 pregnant women who delivered at Peking University First Hospital between September 1, 2013 and September 30, 2014 were analyzed retrospectively. Their average age was (30±4) years (18-47 years) and average gestational week was (39.2±1.6) weeks (25.5-42.0 weeks). The reference range of thyroid stimulating hormone (TSH) was 0.1-2.5 mU/L recommended by the American Thyroid Association (ATA). The reference range of free thyroxine (FT4) was 11.48-22.70 pmol/L and the cut-off value of thyroid peroxidase antibody (TPOAb) was 34 U/ml both recommended by the kit. The specific reference range of TSH was obtained from normal pregnant women in this study (0.23-4.08 mU/L in the first trimester). Pregnant women with hypothyroidism were divided into two groups according to their TSH level at the first trimester: TSH≥2.5-<4.08 mU/L group and TSH≥4.08 mU/L group. T test, Chi-square or Fisher's exact test were applied for statistical analysis. Results (1) Screening status: Of the 5 981 pregnant women, there were 13 cases (0.2%) of hyperthyroidism and 146 cases (2.4%) of hypothyroidism diagnosed before conception (133 cases of Hashimoto thyroiditis, eight cases after operation for thyroid cancer, and five cases after 131I therapy because of hyperthyroidism). Among the 5 822 cases requiring screening, 4 044 cases (69.5%) received screening tests of TSH, FT4 and TPOAb during early pregnancy according to Chinese Guidelines, and 1 778 cases received neither standard screening nor screening test. (2) Treatment of hypothyroidism: Hypothyroidism treatment rate was only 61.5% (107/174) according to the reference range recommended by the ATA, lower than that of 88.1% (52/59) according to the reference range of this study (χ2=14.430, P<0.05). There were 60 cases receiving no treatment in TSH≥2.5-<4.08 mU/L group. Forty-three of these cases were reexamined, and one of them was abnormal, with a rate of 2.3% (1/43). There were seven cases without treatment in TSH≥4.08 mU/L group; six of them were reexamined among which one was abnormal, with a rate of 1/6. (3) Thyrotoxicosis: Among the 4 044 pregnant women, 99 cases had TSH <0.1 mU/L, including 11 cases with FT4 ≥22.70 pmol/L (22.82-60.96 pmol/L). Only three cases were positive for thyrotrophin receptor antibody, and then diagnosed as hyperthyroidism and treated with propylthiouracil. (4) Thyroid cancer: Among the 5 981 pregnant women, six cases were diagnosed as thyroid cancer during pregnancy and lactation, with an incidence of 100.3/100 000. Of the six cases, five were diagnosed during pregnancy, and one at one month postpartum. All of the six cases underwent operation and were confirmed to be papillocarcinoma by pathology. Conclusions The screening rate of thyroid diseases during pregnancy is high, but the clinical management is not fully standardized. We suggested that each center should established its own normal reference range for thyroid function test. The incidence of thyroid cancer during pregnancy is increasing, thus attention should be paid to its diagnosis. Key words: Thyroid diseases; Pregnancy complications; Thyrotropin; Thyroxine; Iodide peroxidase; Reference values

The effect of aging on the anatomic position of the thyroid gland.

Thyroid disease is common among elderly patients, frequently necessitating thyroid gland examination, imaging, and surgery. However, no prior studies have determined the effect of age on the anatomic position of the thyroid gland in the anterior neck. We hypothesized that the thyroid gland resides at a more caudal position in the neck in elderly patients as compared to younger patients. Head and neck CT scans were collected from 122 atraumatic patients without thyroid disease aged 18-39 years, 40-59 years, 60-79 years, and 80+ years. Measurements of thyroid gland position and other aspects of head and neck anatomy were conducted in the mid-sagittal plane. The distance between the thyroid gland and the sternal notch decreased from 45 ± 10.4 mm in the 18-39 age group to 30.8 ± 9 mm in the 80+ age group (P < 0.001). The position of the gland did not change significantly relative to anatomic landmarks in the head or neck, although the trachea was angled more closely to the horizontal plane in elderly patients (P < 0.001). Cervical spine height was also lower among patients ≥60 years of age compared to those <60 years of age (P < 0.001). Multivariate linear modeling suggested that thyroid gland position was dependent on changes in cervical spine height, hyoid bone to hard palate distance, and tracheal angle (P = 1.7 × 10-11 ; r2 = 0.37). Clinicians should be aware of the more caudad positioning of the gland when planning surgery or screening for thyroid disease in the elderly. Clin. Anat. 30:205-212, 2017. © 2016 Wiley Periodicals, Inc.

Thyroid and Islet Autoantibodies Predict Autoimmune Thyroid Disease at Type 1 Diabetes Diagnosis.

Screening of autoimmune thyroid disease in children with type 1 diabetes is important but varies between clinics. To determine the predictive value of thyroid autoantibodies, thyroid function, islet autoantibodies, and HLA-DQ at diagnosis of type 1 diabetes for autoimmune thyroid disease during follow-up. Forty-three Swedish pediatric endocrinology units. At diagnosis of type 1 diabetes, autoantibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb), glutamic acid decarboxylase (GADA), insulin, insulinoma-associated protein-2, and 3 variants of zinc transporter 8 (ZnT8W/R/QA) HLA-DQA1-B1 genotypes and thyroid function were analyzed in 2433 children. After 5.1 to 9.5 years, information on thyroxine treatment was gathered from the Swedish National Board of Health and Welfare's Prescribed Drug Register. Thyroxine was prescribed to 6% of patients. In patients <5 years of age, female sex [hazard ratio (HR) = 4.60; P = 0.008] and GADA (HR = 5.80; P = 0.02) were predictors. In patients 5 to 10 years old, TPOAb (HR = 20.56; P < 0.0001), TGAb (HR = 3.40; P = 0.006), and thyroid-stimulating hormone (TSH) (HR = 3.64; P < 0.001) were predictors, whereas in 10 to 15 year olds, TPOAb (HR = 17.00; P < 0.001) and TSH (HR = 4.11; P < 0.001) predicted thyroxine prescription. In addition to TPOAb and TSH, GADA at diagnosis of type 1 diabetes is important for the prediction of autoimmune thyroid disease in children <5 years of age.

Coeliac disease screening in children with type 1 diabetes mellitus: is it time for a new approach?

NICE guidelines recommend annual screening for autoimmune thyroid disease (ATD) in children with type 1 diabetes mellitus (T1DM), but only one initial screen for coeliac disease (CD) at T1DM diagnosis and thereafter if symptomatic. Our study aimed to assess the relationship between the diagnosis of CD and T1DM within our local population, and review the current screening guidelines. We performed a cross-sectional review of patients attending the Oxfordshire Paediatric Diabetes Service to identify those with CD and ATD. Further analysis established how the diagnosis of CD had been made, and the timing of the diagnosis. Of the 342 children within the Oxfordshire Paediatric Diabetes Service, we identified 28 patients with CD (8.2%) and 20 with ATD (5.8%). Only 28% of CD diagnoses were made from initial new diabetic screening bloods, whereas 56% were diagnosed from annual review bloods. One patient (4%) presented with symptoms outside annual review. Forty-four percent of the cohort were diagnosed with CD within the first year of T1DM diagnosis but 12% were diagnosed after five years with T1DM. Our results show a higher prevalence of CD than previous literature has suggested. The majority of cases were asymptomatic and identified by annual review bloods after initially negative screening tests. We recommend that national guidelines should be re-evaluated with on-going yearly screening for CD, at least for the first 10 years following diagnosis of T1DM. Copyright © 2016 John Wiley & Sons.

The Choosing Wisely Initiative of the German Society of Internal Medicine : Recommendations of the German Society for Endocrinology and the German Society for Geriatrics

A. After osteoporotic fractures in the elderly, as a rule specific antiosteoporotic therapy should be initiated. a. Osteoporosis as a disease of the elderly should be diagnosed and treated (recommendation of the German Society for Geriatrics). B. All patients with diabetes mellitus should complete a specific diabetes training program when antidiabetic drug medication is initiated. C. In Germany, all pregnant women should be advised to undertake iodine supplementation. D. Endocrine causes of hypertension should be ruled out in younger patients and in patients on multiple antihypertensive drugs. E. All unclear cases of hypercalcemia should be clarified. A. Testosterone substitution therapy should not be initiated on the basis of only one measurement of a reduced testosterone level without clinical signs and clarification of the underlying cause. B. Imaging procedures should only be used after the existence of hormonal disease has been confirmed. C. Sonographic screening for thyroid disease is not advised in the elderly. D. Long-term therapy with levothyroxine for nodular goiter should be avoided. E. In relevant stress situations hydrocortisone replacement therapy should not be continued without dose adjustment in patients with adrenal or pituitary insufficiency.

Reply letter: Screening for thyroid disease in pregnancy

Reply letter: Screening for thyroid disease in pregnancy

Hypothyroidism in Women

Hypothyroidism, a disease in which the thyroid gland does not make enough thyroid hormone, is the second most common endocrine disorder among women. Symptoms of hypothyroidism include fatigue, weight gain, alteration in cognition, infertility, and menstrual abnormalities. The most common cause of hypothyroidism in the United States is Hashimoto’s thyroiditis. The American Thyroid Association recommends an initial screening for thyroid disease at age 35years and every 5years thereafter. Thyroid-stimulating hormone is highly sensitive to thyroid dysfunction and is used to evaluate thyroid disorders. Monotherapy with levothyroxine is the standard for treating hypothyroidism. Diagnosing hypothyroidism requires appropriate diagnostic tests to facilitate prompt diagnosis and treatment.

Screening for thyroid disease in pregnancy

Screening for thyroid disease in pregnancy

Thyroid disease in pregnancy

Thyroid disease is common in young women, and thus frequently managed in pregnancy, affecting 1% to 2% of pregnant women. Pregnancy may modify the course of thyroid disease, and pregnancy outcomes can depend on optimal management of thyroid disorders. Moreover, thyroid autoantibodies have been associated with increased early pregnancy wastage, and uncontrolled thyrotoxicosis and untreated hypothyroidism are both associated with adverse pregnancy outcomes. Consequently, obstetric providers must be familiar with thyroid physiology, as well as screening and management of thyroid diseases in pregnancy. Following a brief overview of physiology, this article provides a review of the diagnosis and management of the spectrum of thyroid disease occurring in pregnancy.

Effects of thyroid autoimmunity on pregnancy outcomes in euthyroid women receiving in vitro fertilization: a meta-analysis

To investigate the association of thyroid autoimmunity (TAI) with pregnancy outcomes in euthyroid women undergoing in vitro fertilization (IVF). The meta-analysis was a systematic review of cohort studies published before May 10th, 2014. Data were retrieved from Medline, Embase and Cochrane library, and the keywords were "thyroid autoimmunity" and "pregnancy outcome", with restriction to artificial reproductive technique. RevMan 5.2 software was used for data analysis. In all, 11 cohort studies met the inclusion criteria and were included in the meta-analysis. The results showed that TAI was not associated with clinical pregnancy rate (RR=0.99, 95%CI: 0.89-1.11, P=0.92), but significantly associated with miscarriage risk (RR=1.54, 95%CI: 1.24-1.92, P<0.001). Live birth/ongoing pregnancy rate decreased in the TAI group compared with the control group, but there was no statistically significant difference (RR=0.89, 95%CI: 0.79-1.00, P=0.06). As for euthyroid women who are receiving IVF, TAI contributes to increased risk of miscarriage. Therefore, we recommend universal screening for thyroid disease among women undergoing IVF.

Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners.

Background:Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy.Objectives:The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy.Materials and Methods:Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed.Results:There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists.Conclusions:There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.

Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain

Objective To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. Methodology A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. Results Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. Conclusions Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España

ObjectiveTo assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. MethodologyA decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. ResultsUniversal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. ConclusionsUniversal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.