Thyroid nodules and thyroid cancer in women with positive thyroid screening in pregnancy: a double-centric, retrospective, cohort study.

OBJECTIVE: Thyroid nodules are a common finding in the general population. The primary aim of the study was to determine the prevalence of thyroid nodules and cancer found by ultrasound (US) in women who underwent screening for thyroid dysfunction during pregnancy. DESIGN: A double-centric, retrospective, cohort study. PATIENTS AND METHODS: We searched through medical records, including thyroid ultrasonography, of pregnant women who were positively screened for thyroid disorders (using thyroid-stimulating hormone and thyroid antibodies) from an unselected population ('universal screening group', n = 690) and of women who underwent the testing based on the presence of clinical risk factors defined by American Thyroid Association ('case-finding group', n = 249). RESULTS: Prevalence of benign and malignant thyroid nodules was lower in the 'universal screening group' than in the 'case-finding group' (9.9% vs 17.7%, P= 0.002, and 0.9% vs 7.2%, P< 0.001, respectively). Consistently, the thyroid cancer rate was lower among the nodules in the 'universal screening group' than in the 'case-finding group' (8.1% vs 29.0%, P= 0.003). Ultrasound EU-TIRADS (European Thyroid Imaging and Reporting Data System) category ≥4 had a 95.8% sensitivity for thyroid cancer. In palpable nodules, the prevalence of cancer was significantly higher than in the non-palpable ones (44.0% vs 2.2%, P < 0.001). In a multivariate regression analysis, thyroid nodules were associated with a history of infertility and parity. CONCLUSIONS: Compared to the data from cancer registries, universal screening allowed detecting thyroid cancer in pregnancy three to five times more frequently, but the cancer rate among nodules (8.1%) did not differ from the common population. US had very good sensitivity for thyroid cancer in pregnancy.

Intellectual performance of children of mothers with an untreated thyroid disorder in the first trimester of pregnancy.

INTRODUCTION: The focus of the present study was the importance of the mother's thyroid function for foetal development in the first trimester, when the baby is totally dependent on the mother for thyroid hormones. MATERIAL AND METHODS: The study consisted in testing the intellectual performance of children with both euthyroid and thyroid-dysfunction mothers. The experimental group comprised 60 children of mothers with an untreated thyroid disorder in the first trimester of their pregnancy (TSH≥3.5 and/or TPO-Ab≥20). The control group contained 132 children whose mothers showed no symptoms of a thyroid disorder either before or during pregnancy/postpartum. Both groups of children were administered the WISC-III, whereby the intellectual performance of the experimental-group children was compared with that of the control-group children. The comparison included the percentage of children with IQ≤ 85 and SLD and/or ADD risks. Our research is a follow-up to a blanket thyroid screening of 1 649 pregnant women conducted during 2004-2006 in the region around Havlíckuv Brod. RESULTS: The research found no significant difference between the two groups of children with respect to their intellectual abilities, either regarding their overall IQ (p=0.67), verbal IQ (p=0.81), performance IQ (p=0.41), or the individual scores (ISP: p=0.85; IPU: p=0.54, IKO: p=0.57; IRZ: p=0.13), nor did the experimental group show a significantly higher occurrence of children with IQ≤85 than the control group (p=0.66). However, the experimental group did exhibit a statistically significant increase in the percentage of children with a suspected SLD or clinically significant attention issues (p =0.05). CONCLUSION: Untreated thyroid disorders in the first trimester of pregnancy can increase the risk of the child developing attention or learning issues. < p > < /p >.

Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding.

OBJECTIVE: Screening of thyroid disorders in pregnancy has been controversial. Recent recommendations favour targeted high-risk case finding, though this approach may miss a significant number of those affected. We aimed to assess the prevalence of accepted high-risk criteria in women with autoimmune thyroiditis and/or hypothyroidism detected from universal screening in an iodine-sufficient population. DESIGN: In 400 non-selected women in the 9-11th gestational week, thyroid-related tests were performed, and those with abnormalities were offered consultation. METHODS: TSH was determined by IRMA, and the upper cut-off value for screening was set at 3.5 mIU/l. For free thyroxine (FT(4)) and thyroperoxidase antibodies (TPO-Ab), RIAs were used, with cut-offs of <10 pmol/l and >50 IU/ml respectively. Endocrinological consultation included Doppler ultrasonography and was aimed to confirm autoimmune thyroiditis and/or hypothyroidism. The prevalence of consensus high-risk criteria was assessed. RESULTS: Among the 400 women, 65 (16.3%) had ≥1 abnormality: higher TSH was found in 10.3%, lower FT(4) in 2% and positive TPO-Ab in 8.3%. Fifty-one women were examined and followed up. Levo-T(4) treatment was initiated in 49 women for autoimmune thyroiditis (in 42), hypothyroidism (in 34) or both (in 27). Only 22 (45%) of 49 treated women fulfilled ≥1 high-risk criterion: most commonly family history (31%), history of miscarriage or preterm delivery (14%) and personal history (8%). CONCLUSIONS: Over half (55%) of pregnant women with abnormalities suggestive of autoimmune thyroiditis and/or hypothyroidism would be missed if only those with high-risk criteria were examined. A more extensive screening of thyroid autoimmunity and dysfunction seems warranted.