Sergio Donnay1, Carmen Fajardo2, José Carlos Fernández-García3, Teresa Torres4, Orosia Bandrés5, José Ramón Domínguez6, Edelmiro Menéndez7, Joaquín Serrano8, Sara Torrejón9, Irela López9, José Javier Pineda10, José Muñoz11, Anna Lucas12, Frederic Tortosa13, Gracia Moll14, Francisca Vich14. 1. Hospital Universitario Fundación Alcorcón, Madrid, Spain. Electronic address: SDonnay@fhalcorcon.es. 2. Hospital Universitario de La Ribera, Alzira, Valencia, Spain. 3. Hospital Universitario Virgen de la Victoria, Málaga, Spain. 4. Centro de Atención Primaria Antoni Creus i Querol, Terrasa, Barcelona, Spain. 5. Centro de Especialidades Grande Covián, Zaragoza, Spain. 6. Hospital Universitario San Juan de Alicante, Alicante, Spain. 7. Hospital Universitario Central de Asturias, Oviedo, Spain. 8. Hospital General Universitario de Alicante, Alicante, Spain. 9. Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain. 10. Hospital García Orcoyen, Estella, Navarra, Spain. 11. Centroe de Especialidades de Seo de Urgell, Spain. 12. Hospital Universitari "Germans Trias i Pujol", Badalona, Barcelona, Spain. 13. Hospital Universitari de la Vall d'Hebron, Barcelona, Spain. 14. Hospital Comarcal de Inca, Inca, Mallorca, Spain.
Abstract
INTRODUCTION: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. STUDY DESIGN: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. RESULTS: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p=0.007) and had more frequently high TSH levels (>2.5μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p<0.001). CONCLUSIONS: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain.
INTRODUCTION: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. STUDY DESIGN: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. RESULTS: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GHwomen showed that intra-GHwomen made their first visit later (59.7% vs. 75.4% respectively before week 12, p=0.007) and had more frequently high TSH levels (>2.5μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p<0.001). CONCLUSIONS: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain.