Screening Pregnant Women for Autoimmune Thyroid Disease Is Cost-Effective

Reduced thyroid function during pregnancy can have adverse effects on both the mother and fetus, including increased risk of miscarriage and preterm labor. Thyroid autoimmunity also puts the mother at increased risk of developing postpartum thyroiditis and hypothyroidism in the future. While screening of high-risk women for thyroid dysfunction is recommended, universal screening of pregnant women remains controversial.

Chrysoula Dosiou, MD, of Stanford University School of Medicine, and colleagues from the University of Illinois at Chicago, V. Fazzi Hospital in Lecce, Italy, Stanford University School of Medicine in Stanford, California, and George Washington University School of Medicine and Health Sciences Washington, D.C., developed a computer model to compare the cost-effectiveness of three screening strategies: universal screening with thyroid-stimulating hormone and anti-thyroid peroxidase antibodies during the first trimester, risk-based screening, and no screening. In this model, a positive screening test led to follow-up testing and treatment with thyroid hormone when indicated. The model takes into account the development of adverse obstetrical outcomes during pregnancy, postpartum thyroiditis, and overt hypothyroidism during a woman’s lifetime.

According to data presented today at the 81st Annual Meeting of the American Thyroid Association (ATA), universal screening for autoimmune thyroid disease in the first trimester of pregnancy is cost-effective compared with screening of only high-risk women. Both the risk-based and universal screening options are cost-effective when relative to no screening.

About the ATA Annual Meeting

The 81st Annual Meeting of the American Thyroid Association will be held October 26-30, 2011 at the Renaissance Esmeralda Resort & Spa in Indian Wells (near Palm Springs), California. This four day creative and innovative scientific program, chaired by Drs. Anthony Hollenberg and Martha Zeiger, has carefully balanced clinical and basic science sessions on the latest advances in thyroidology. The ATA meeting is designed to offer continuing education for endocrinologists, internists, surgeons, basic scientists, nuclear medicine scientists, pathologists, endocrine fellows and nurses, physician assistants and other health care professionals.

Autoimmune Thyroid Disease and Pregnancy

Thyroid disorders are the second most common endocrinologic disorders found in pregnancy. Overt hypothyroidism is estimated to occur in 0.3-0.5% of pregnancies. Subclinical hypothyroidism appears to occur in 2-3%, and hyperthyroidism is present in 0.1-0.4%.

Autoimmune thyroid dysfunctions remain a common cause of both hyperthyroidism and hypothyroidism in pregnant women. Graves disease accounts for more than 85% of all cases of hyperthyroid, whereas Hashimoto thyroiditis is the most common cause of hypothyroidism.