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Targeted Thyroid Testing During Pregnancy in Clinical Practice

Granfors, Michaela MD; Åkerud, Helena MD; Skogö, Johan MD; Stridsberg, Mats MD; Wikström, Anna-Karin MD; Sundström-Poromaa, Inger MD

doi: 10.1097/AOG.0000000000000344
Contents: Original Research

OBJECTIVE: To evaluate the efficacy of a targeted thyroid testing approach during pregnancy in clinical practice.

METHODS: This is a retrospective cohort study performed within Uppsala County, Sweden. Data were derived from the population-based Uppsala Biobank of Pregnant Women, in which blood samples are collected in conjunction with the routine ultrasound screening in gestational week 17–19. For this study, 5,254 pregnant women with an estimated date of delivery between January 1, 2009, and December 31, 2011, were included. On review of their medical records, women who were tested for thyroid dysfunction during pregnancy in clinical practice were identified (n=891). From the remaining untested women, 1,006 women were randomly selected for analyses of thyrotropin (TSH), free thyroxine levels, and thyroid peroxidase antibodies. Thyroid-stimulating hormone levels in both groups were analyzed with regard to trimester-specific upper reference levels as recommended by the International Endocrine Society Guidelines.

RESULTS: The proportion of trimester-specific TSH elevation was 12.6% in the targeted thyroid testing group and 12.1% in the untested group (P=.8; odds ratio [OR] 1.04, 95% confidence interval [CI] 0.79–1.37). The proportion of overt hypothyroidism was 1.1% and 0.7% in the groups, respectively (P=.4; OR 1.57, 95% CI 0.55–4.45).

CONCLUSIONS: The prevalence of trimester-specific elevated TSH and overt hypothyroidism was equal in targeted thyroid tested and untested women. When implemented in clinical practice, targeted thyroid testing is unsatisfactory. If ongoing studies provide support for treatment of pregnant women with elevated TSH, universal thyroid testing appears the most reasonable approach.


Targeted thyroid testing during pregnancy is unsatisfactory in clinical practice because the prevalence of hypothyroidism is equal in targeted tested and untested women.

Departments of Women's and Children's Health and Medical Sciences, Uppsala University, Uppsala, Sweden.

Corresponding author: Michaela Granfors, MD, Department of Women's and Children's Health, University Hospital, SE 751 85 Uppsala, Sweden; e-mail:

Supported by grants from Gillbergska stiftelsen, Uppsala, Sweden, and grants from the Department of Women's and Children's Health, University Hospital, Uppsala, Sweden.

The authors thank Lena Moby for skillful technical assistance.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.