Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review.

Area of Science:

• Endocrinology
• Reproductive Health
• Public Health Screening

Background:

• Thyroid dysfunction is common in fertile women, with potential adverse maternal, fetal, and neonatal outcomes.
• Screening for thyroid dysfunction in preconception and early pregnancy remains controversial.
• Current American Thyroid Association (ATA) guidelines recommend selective screening.

Purpose of the Study:

• To evaluate recommendations for universal versus selective screening methods for thyroid dysfunction.
• To assess the adequacy of screening strategies in preconception and early pregnancy.

Main Methods:

• An evidence-based review of publications since 2017, adhering to PRISMA criteria.
• Analysis focused on Population, Intervention, Comparison, Outcomes, and Study (PICOS) for women undergoing thyroid dysfunction screening.

Main Results:

• The 2017 ATA guidelines suggest selective screening; however, recent reviews advocate for universal preconception screening.
• For pregnancy, most studies favored universal screening, citing ease, low cost, and prevention of adverse outcomes.
• Arguments against universal screening include potential harms and knowledge gaps; cost-effectiveness data is limited.

Conclusions:

• Universal screening for thyroid dysfunction is recommended in early pregnancy, contrasting with 2017 ATA guidelines (weak recommendation, low-quality evidence).
• Insufficient evidence precludes a formal recommendation for preconception screening.
• Individualized national analysis is strongly advised for screening strategies.