Schildkliertest voor moeders (leestip)

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De Volkskrant besteedde aandacht in een artikel over een schildkliertest voor moeders.
Screenen zou veel leed voorkomen.

Aanleiding voor dit artikel is dit onderzoek: http://www.ncbi.nlm.nih.gov/pubmed/25000138

The attitude towards hypothyroidism during early gestation: time for a change of mind?
Pop VJ, Broeren M, Wiersinga WM.

Abstract
Background
The attitude not to screen thyroid function of all pregnant women is mainly based on conflicting evidence whether treatment of women with mild hypothyroidism is beneficial. However, there is consensus that all women with overt hypothyroidism (OH) and those with thyrotrophin (TSH) > 10 mIU/L should immediately been treated, but figures of these conditions are scarce. We assessed the prevalence of OH and TSH > 10 mIU/L during the first trimester of pregnancy.

Methods
In 4199 Dutch Caucasian healthy pregnant women of three studies in 2002, 2005 and 2013 from the same iodine sufficient area in the South-East of The Netherlands, thyroid function was assessed at 10-12 weeks gestation. We defined the first trimester specific cut-offs (2.5th - 97.5th percentile) for thyrotrophin (TSH) and thyroxin (FT4) in thyroid peroxidase antibody (TPO-Ab) negative women in each study to determine the prevalence of women with OH and those with an TSH > 10 mIU/L. We extrapolated these figures to the pregnant population of 2012 in The Netherlands, the UK and the US.

Results
The prevalence of OH or a TSH > 10 mIU/L in these 4199 women was 26 (0.62%) of whom 96% had (highly) elevated TPO-Ab titres. Based on the birth figures of 2012, if all pregnant women from The Netherlands, the UK or the US, would be screened, the conservative annual number of cases would be: 1.000, 4.500 and 25.000, respectively. However, the UK and also parts of the US have recently been demonstrated to be an iodine deficient area, which will result in even higher figures.

Conclusion
Our findings show that the discussion concerning thyroid screening during pregnancy should be based on the figures of severe hypothyroidism in healthy pregnant women. Screening of thyroid function is not expensive because all pregnant women have a standardized blood sample test at 8 - 12 weeks gestation. Positive cases largely benefit from a cheap, safe and effective treatment. Word count: 2028. Key words: overt hypothyroidism, screening, pregnancy, iodine status.

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Als je meer wilt lezen over schildklier en screenen bij zwangere vrouwen?

Ga naar:
- Aandacht voor screening schildklier bij zwangere vrouwen
- Aanbevelingen NIV-Richtlijn Schildklierfunctiestoornissen en zwangerschap in vraag en antwoord
- Van alles over schildklier en zwangerschap

Daar ligt een belangrijke taak - ook voor SON - om artsen, verloskundigen en vrouwen (met een kinderwens) veel meer opmerkzaam te maken op de mogelijkheid van hypothyreoïdie.
De schildklier zou verplichte kost moeten worden bij vervolgopleidingen voor zorgverleners.
Goede voorlichting en zorg van vrouwen met een schildklieraandoening is nodig om complicaties in de zwangerschap te voorkomen!

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Clinical aspects of hyperthyroidism, hypothyroidism, and thyroid screening in pregnancy
Roberto Negro, MD, FACE, Alex Stagnaro-Green, MD, MHPE
Endocr Pract. 2014;20(6):597-607.

Abstract

Objective
To evaluate the peer-reviewed literature on hypothyroidism, hyperthyroidism, and thyroid autoimmunity in pregnancy.

Methods
We review published studies on thyroid autoimmunity and dysfunction in pregnancy, the impact of thyroid disease on pregnancy, and discuss implications for screening.

Results
Overt hyperthyroidism and hypothyroidism are responsible for adverse obstetric and neonatal events. Several studies of association suggest that either subclinical hypothyroidism or thyroid autoimmunity increase the risk of complications. One randomized controlled trial showed that pregnant women with subclinical hypothyroidism benefit from treatment in terms of obstetric and neonatal complications, whereas another study demonstrated no benefit in the intelligence quotient of babies born to women with subclinical hypothyroidism. Thyroid autoimmunity has been associated with increased rate of pregnancy loss, recurrent miscarriage, and preterm delivery.

Conclusion
Current guidelines agree that overt hyperthyroidism and hypothyroidism need to be promptly treated and that as potential benefits outweigh potential harm, subclinical hypothyroidism also requires substitutive treatment. The chance that women with thyroid autoimmunity may benefit from levothyroxine treatment to improve obstetric outcome is intriguing, but adequately powered randomized controlled trials are needed. The issue of universal thyroid screening at the beginning of pregnancy is still a matter of debate, and aggressive case-finding is supported.

Meer informatie
Het volledige artikel kun je lezen op http://www.medscape.com.
Je kunt je gratis registreren op die site.
Het artikel sluit aan bij de Amerikaanse richtlijnen.
Die richtlijnen wijken af van de Nederlandse richtlijn: http://schildkliertje.blogspot.nl/2013/ ... ag-en.html