Investigate The Appropriate Screening Method For Thyroid Diseases During Early Pregnancy

Objective: To investigate the appropriate screening method for thyroid diseases during early pregnancy.Methods : We collected information of 14535 pregnant women who attended to the The International Peace Maternity & Child Health Hospital from January 1,2014 to September 30,2014 for antenatal care and underwent one step screening for thyroid diseases in first trimester,which meant blood test for thyroid stimulating hormone(TSH),free thyroxine(FT4)and thyroid peroxidase antibody(TPOAb)at the same time.Simulation analysis was performed on these 14535 women with two-step screening(TSH first and then FT4 and TPOAb if TSH was abnormal).The incidence,missed diagnosis rate,costs of screening,and outcomes of the missed diagnosed cases of women with thyroid diseases were compared between one-step and two-step screening based on the cutoff value determined by American Thyroid Association(ATA)or our hospital(0.06-2.80 m U/L).Results: 1.When the cutoff value of TSH was set at ≥ 0.1-< 2.5 m U/L(ATA recommendation),2.90%(421/14535)of the women required medical treatment.It was significantly higher than 2.32%(337/14535),which was obtained when the normal reference value of TSH was set based on data from our hospital.2.If two-step screening protocol and ATA recommendations were applied,0.55% of women who needed treatment would be missed.However,1166284 yuan(RMB)would be saved compared with one-step screening(80.24 yuan per person).3.If two-step screening protocol and the hospitalized reference value was applied,0.63% of women would not be treated and 1213204 yuan would be saved(83.47 yuan per person)compared to one-step screening.4.For those missed diagnosed cases,no more adverse pregnant outcomes(all p>0.05),no matter ATA recommendation or unique reference in our hospital was adopted.Conclusions: We recommend the two-step method and the normal reference value of our hospital during pregnancy for thyroid function screening during early pregnancy,For the purpose of cost-saving,reduction of missed diagnosis rate and avoidance of overtreatment.