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Related Experiment Video

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Routine serum thyroid-stimulating hormone testing-optimizing pre-conception health or generating toxic knowledge?

Abha Maheshwari1, Priya Bhide2, Jyotsna Pundir3

  • 1Aberdeen Fertility Centre, NHS Grampian Foresterhill, Aberdeen, AB25 2ZL, UK.

Human Reproduction (Oxford, England)
|September 1, 2017
PubMed
Summary
This summary is machine-generated.

Optimizing thyroid-stimulating hormone (TSH) levels before conception is crucial for maternal and child health. However, routine pre-conception screening for subclinical hypothyroidism (SCH) in all women remains controversial due to uncertain benefits and potential harms.

Keywords:
TSHfertilitypre-conceptionpregnancysubclinical hypothyroidism

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Area of Science:

  • Endocrinology
  • Reproductive Health
  • Maternal-Fetal Medicine

Background:

  • Subclinical hypothyroidism (SCH) in pregnant women is linked to adverse obstetric and neonatal outcomes.
  • Thyroxine treatment during pregnancy has not shown clear health benefits.
  • Professional societies recommend optimizing serum TSH levels pre-conception.

Purpose of the Study:

  • To evaluate the benefits and risks of routine pre-conception screening for SCH in asymptomatic women.
  • To address the uncertainty surrounding the optimal TSH threshold (<2.5 mIU/l) for pre-conception screening.
  • To assess the clinical and economic impact of implementing widespread SCH screening.

Main Methods:

  • Systematic review of existing literature and ongoing randomized trials.
  • Analysis of the diagnostic criteria for SCH and the implications of recalibrating TSH ranges.
  • Consideration of screening strategies for both planned and unplanned pregnancies.

Main Results:

  • Initiating thyroxine during pregnancy has not demonstrated significant health advantages.
  • The recommended pre-conception TSH threshold of <2.5 mIU/l creates diagnostic uncertainty and potential for increased diagnoses.
  • Widespread screening may lead to increased treatment, anxiety, and costs without proven benefits for all women.

Conclusions:

  • Routine pre-conception screening for SCH in asymptomatic women requires further investigation through large, well-designed studies.
  • The potential benefits of optimizing thyroid status pre-conception for offspring health need to be weighed against the risks of over-diagnosis and over-treatment.
  • Current evidence is insufficient to support routine screening, necessitating more research to clarify the true value of this approach.