Should all women be screened for thyroid dysfunction in pregnancy?

Women's Health

Volumn 11, Issue 3, 2015, Pages 295-307

  Taylor, Peter N ^a   Okosieme, Onyebuchi E ^a   Premawardhana, Lakdasa ^a   Lazarus, John H ^a  

^a CARDIFF UNIVERSITY   (United Kingdom)

Author keywords

child neurodevelopment; hyperthyroidism; hypothyroidism; isolated hypothyroxinemia; levothyroxine; pregnancy; screening; subclinical hypothyroidism

Indexed keywords

LEVOTHYROXINE; LIOTHYRONINE; THYROID ANTIBODY; THYROID HORMONE; THYROTROPIN; THYROXINE; THYROID STIMULATING IMMUNOGLOBULIN;

AUTOIMMUNITY; COST EFFECTIVENESS ANALYSIS; FEMALE; GESTATIONAL THYROID DISORDER; HIGH RISK PREGNANCY; HUMAN; HYPERTHYROIDISM; HYPERTHYROXINEMIA; HYPOTHYROIDISM; HYPOTHYROXINEMIA; IODINE DEFICIENCY; MATERNAL HYPERTENSION; POSTPARTUM HEMORRHAGE; PREGNANCY; PREMATURITY; PREVALENCE; QUALITY OF LIFE; REVIEW; SCREENING TEST; SOLUTIO PLACENTAE; SPONTANEOUS ABORTION; SUBCLINICAL HYPERTHYROIDISM; SUBCLINICAL HYPOTHYROIDISM; THYROID DISEASE; THYROID FUNCTION; THYROID FUNCTION TEST; BLOOD; PREGNANCY COMPLICATIONS; PRENATAL CARE; PROCEDURES; THYROID DISEASES;

FEMALE; HUMANS; HYPERTHYROIDISM; HYPOTHYROIDISM; IMMUNOGLOBULINS, THYROID-STIMULATING; PREGNANCY; PREGNANCY COMPLICATIONS; PRENATAL CARE; THYROID DISEASES; THYROID FUNCTION TESTS; THYROID HORMONES;

EID: 84932094980     PISSN: 17455057     EISSN: 17455065     Source Type: Journal    
DOI: 10.2217/whe.15.7     Document Type: Review

References (116)

1. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr. Rev. 31(5), 702-755 (2010).
2. Lazarus JH. Thyroid function in pregnancy. Br. Med. Bull. 97, 137-148 (2011).
3. Vanderpump MP. The epidemiology of thyroid disease. Br. Med. Bull. 99, 39-51 (2011).
4. Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J. Clin. Endocrinol. Metab. 94(6), 1853-1878 (2009).
5. Franklyn JA, Boelaert K. Thyrotoxicosis. Lancet 379(9821), 1155-1166 (2012).
6. Roberts CG, Ladenson PW. Hypothyroidism. Lancet 363(9411), 793-803 (2004).
7. Taylor PN, Razvi S, Pearce SH, Dayan CM. A review of the clinical consequences of variation in thyroid function within the reference range. J. Clin. Endocrinol. Metab. 98(9), 3562-3571 (2013).
8. Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr. Rev. 29(1), 76-131 (2008).
9. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21(10), 1081-1125 (2011).
10. De Groot L, Abalovich M, Alexander EK et al. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 97(8), 2543-2565 (2012).
11. Gronowski AM, Haddow J, Kilpatrick S, Lazarus JH, Negro R. Thyroid function during pregnancy: who and how should we screen Clin. Chem. 58(10), 1397-1401 (2012).
12. Lazarus JH. Screening for thyroid dysfunction in pregnancy: is it worthwhile J. Thyroid. Res. 2011, 397012 (2011).
13. Wilson JMG, Jungner G. WHO. Principles and Practice of Screening for Disease. World Health Organization, Geneva, Switzerland (1968).
14. Vila L, Velasco I, Gonzalez S et al. Controversies in endocrinology: On the need for universal thyroid screening in pregnant women. Eur. J. Endocrinol. 170(1), r17-r30 (2014).
15. Galofre Ferrater JC, Corrales Hernandez JJ, Perez Corral B et al. Clinical guideline for the diagnosis and treatment of subclinical thyroid dysfunction in pregnancy. Working Group on Subclinical Thyroid Dysfunction of the Spanish Endocrinology Society. Endocrinologia Nutricion 56(2), 85-91 (2009).
16. Galofre JC, Davies TF. Autoimmune thyroid disease in pregnancy: a review. J. Womens Health (Larchmt) 18(11), 1847-1856 (2009).
17. Stagnaro-Green A. Optimal care of the pregnant woman with thyroid disease. J. Clin. Endocrinol. Metab. 97(8), 2619-2622 (2012).
18. Chang DL, Pearce EN. Screening for maternal thyroid dysfunction in pregnancy: a review of the clinical evidence and current guidelines. J. Thyroid Res. 2013, 851326 (2013).
19. Vaidya B, Hubalewska-Dydejczyk A, Laurberg P, Negro R, Vermiglio F, Poppe K. Treatment and screening of hypothyroidism in pregnancy: results of a European survey. Eur. J. Endocrinol. 166(1), 49-54 (2012).
20. Surks MI, Ortiz E, Daniels GH et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 291(2), 228-238 (2004).
21. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European Thyroid Association Guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur. Thyroid J. 3(2), 76-94 (2014).
22. Korevaar TI, Schalekamp-Timmermans S, De Rijke YB et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J. Clin. Endocrinol. Metab. 98(11), 4382-4390 (2013).
23. Zimmermann MB. Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. Am. J. Clin. Nutr. 89(2), s668-s672 (2009).
24. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch. Intern. Med. 160(4), 526-534 (2000).
25. Vanderpump MP, Tunbridge WM, French JM et al. The incidence of thyroid disorders in the community: a twentyyear follow-up of the Whickham Survey. Clin. Endocrinol. 43(1), 55-68 (1995).
26. Altomare M, La Vignera S, Asero P et al. High prevalence of thyroid dysfunction in pregnant women. J. Endocrinol. Invest. 36(6), 407-411 (2013).
27. Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study. J. Clin. Endocrinol. Metab. 98(9), 3694-3701 (2013).
28. Stagnaro-Green A. Overt hyperthyroidism and hypothyroidism during pregnancy. Clin. Obstet. Gynecol. 54(3), 478-487 (2011).
29. Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch. Gynecol. Obstet. 281(2), 215-220 (2010).
30. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 12(1), 63-68 (2002).
31. Schneuer FJ, Nassar N, Tasevski V, Morris JM, Roberts CL. Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancy outcomes. J. Clin. Endocrinol. Metab. 97(9), 3115-3122 (2012).
32. Okosieme OE, Marx H, Lazarus JH. Medical management of thyroid dysfunction in pregnancy and the postpartum. Expert Opin. Pharmacother. 9(13), 2281-2293 (2008).
33. Casey BM, Dashe JS, Wells CE et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet. Gynecol. 105(2), 239-245 (2005).
34. Glinoer D, Soto MF, Bourdoux P et al. Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J. Clin. Endocrinol. Metab. 73(2), 421-427 (1991).
35. Williams GR. Neurodevelopmental and neurophysiological actions of thyroid hormone. J. Neuroendocrinol. 20(6), 784-794 (2008).
36. Li Y, Shan Z, Teng W et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin. Endocrinol. 72(6), 825-829 (2010).
37. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J. Clin. Endocrinol. Metab. 95(4), 1699-1707 (2010).
38. Allan WC, Haddow JE, Palomaki GE et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J. Med. Screen. 7(3), 127-130 (2000).
39. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, Bonsel GJ. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur. J. Endocrinol. 160(6), 985-991 (2009).
40. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J. Clin. Endocrinol. Metab. 95(9), e44-e48 (2010).
41. Haddow JE, Palomaki GE, Allan WC et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N. Engl. J. Med. 341(8), 549-555 (1999).
42. Pop VJ, Brouwers EP, Vader HL, Vulsma T, Van Baar AL, De Vijlder JJ. Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3 year follow-up study. Clin. Endocrinol. 59(3), 282-288 (2003).
43. Henrichs J, Bongers-Schokking JJ, Schenk JJ et al. Maternal thyroid function during early pregnancy and cognitive functioning in early childhood: the generation R study. J. Clin. Endocrinol. Metab. 95(9), 4227-4234 (2010).
44. Lazarus JH, Bestwick JP, Channon S et al. Antenatal thyroid screening and childhood cognitive function. N. Engl. J. Med. 366(6), 493-501 (2012).
45. Negro R, Stagnaro-Green A. Clinical aspects of hyperthyroidism, hypothyroidism, and thyroid screening in pregnancy. Endocr. Pract. 20(6), 597-607 (2014).
46. Casey BM, Dashe JS, Wells CE, Mcintire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet. Gynecol. 107(2 Pt 1), 337-341 (2006).
47. Lazarus JH, Kaklamanou M. Significance of low thyroidstimulating hormone in pregnancy. Curr. Opin. Endocrinol. Diabetes Obes. 14(5), 389-392 (2007).
48. Bianco AC, Kim BW. Deiodinases: implications of the local control of thyroid hormone action. J. Clin. Invest. 116(10), 2571-2579 (2006).
49. Pop VJ, De Vries E, Van Baar AL et al. Maternal thyroid peroxidase antibodies during pregnancy: a marker of impaired child development J. Clin. Endocrinol. Metab. 80(12), 3561-3566 (1995).
50. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. J. Clin. Endocrinol. Metab. 96(6), E920-E924 (2011).
51. Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 264(11), 1422-1425 (1990).
52. Toulis KA, Goulis DG, Venetis CA et al. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur. J. Endocrinol. 162(4), 643-652 (2010).
53. Negro R. Thyroid autoimmunity and pre-term delivery: brief review and meta-analysis. J. Endocrinol. Invest. 34(2), 155-158 (2011).
54. Prummel MF, Wiersinga WM. Thyroid autoimmunity and miscarriage. Eur. J. Endocrinol. 150(6), 751-755 (2004).
55. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J. Clin. Endocrinol. Metab. 91(7), 2587-2591 (2006).
56. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 342, d2616 (2011).
57. Moleti M, Trimarchi F, Vermiglio F. Doubts and concerns about isolated maternal hypothyroxinemia. J. Thyroid. Res. 2011, 463029 (2011).
58. Dominguez I, Reviriego S, Rojo-Martinez G et al. Iodine deficiency and thyroid function in healthy pregnant women. Med. Clin. (Barca) 122(12), 449-453 (2004).
59. Henrichs J, Ghassabian A, Peeters RP, Tiemeier H. Maternal hypothyroxinemia and effects on cognitive functioning in childhood: how and why Clin. Endocrinol. 79(2), 152-162 (2013).
60. Casey BM, Dashe JS, Spong CY, Mcintire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet. Gynecol. 109(5), 1129-1135 (2007).
61. Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet. Gynecol. 81(3), 349-353 (1993).
62. Li Y, Shan Z, Teng W et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin. Endocrinol. 72(6), 825-829 (2010).
63. Vermiglio F, Lo Presti VP, Moleti M et al. Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J. Clin. Endocrinol. Metab. 89(12), 6054-6060 (2004).
64. Zimmermann MB. Iodine deficiency. Endocr. Rev. 30(4), 376-408 (2009).
65. Zimmermann MB. The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid 17(9), 829-835 (2007).
66. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21(10), 1081-1125 (2011).
67. Zimmermann M, Delange F. Iodine supplementation of pregnant women in Europe: a review and recommendations. Eur. J. Clin. Nutr. 58(7), 979-984 (2004).
68. Nawoor Z, Burns R, Smith DF, Sheehan S, O'herlihy C, Smyth PP. Iodine intake in pregnancy in Ireland- A cause for concern Ir. J. Med Sci. 175(2), 21-24 (2006).
69. Mian C, Vitaliano P, Pozza D et al. Iodine status in pregnancy: role of dietary habits and geographical origin. Clin. Endocrinol. 70(5), 776-780 (2009).
70. Derbyshire E, Davies GJ, Costarelli V, Dettmar PW. Habitual micronutrient intake during and after pregnancy in Caucasian Londoners. Matern. Child. Nutr. 5(1), 1-9 (2009).
71. Vanderpump MP, Lazarus JH, Smyth PP et al. Iodine status of UK schoolgirls: a cross-sectional survey. Lancet 377(9782), 2007-2012 (2011).
72. Bath S, Walter A, Taylor A, Rayman M. Iodine status of UK women of childbearing age. J. Hum. Nutr. Diet. 21(4), 379-380 (2008).
73. Pearce EN, Lazarus JH, Smyth PP et al. Perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant women. J. Clin. Endocrinol. Metab. 95(7), 3207-3215 (2010).
74. Lazarus JH, Smyth PP. Iodine deficiency in the UK and Ireland. Lancet 372(9642), 888 (2008).
75. Delange F. Iodine deficiency in Europe anno 2002. Thyroid Int. 5, 3-18 (2002).
76. Mazzarella C, Terracciano D, Di Carlo A et al. Iodine status assessment in Campania (Italy) as determined by urinary iodine excretion. Nutrition 25(9), 926-929 (2009).
77. Vitti P, Delange F, Pinchera A, Zimmermann M, Dunn JT. Europe is iodine deficient. Lancet 361(9364), 1226 (2003).
78. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: where do we stand in 2013 Thyroid 23(5), 523-528 (2013).
79. Seal JA, Doyle Z, Burgess JR, Taylor R, Cameron AR. Iodine status of Tasmanians following voluntary fortification of bread with iodine. Med. J. Aust. 186(2), 69-71 (2007).
80. Clifton VL, Hodyl NA, Fogarty PA et al. The impact of iodine supplementation and bread fortification on urinary iodine concentrations in a mildly iodine deficient population of pregnant women in South Australia. Nutr. J. 12, 32 (2013).
81. Skeaff SA, Lonsdale-Cooper E. Mandatory fortification of bread with iodised salt modestly improves iodine status in schoolchildren. Br. J. Nutr.109(6), 1109-1113 (2013).
82. Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet 382(9889), 331-337 (2013).
83. Taylor PN, Okosieme OE, Dayan CM, Lazarus JH. Therapy of endocrine disease: Impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur. J. Endocrinol. 170(1), r1-r15 (2014).
84. Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Arch. Intern. Med. 167(14), 1533-1538 (2007).
85. Hadlow NC, Rothacker KM, Wardrop R, Brown SJ, Lim EM, Walsh JP. The relationship between TSH and free T4 in a large population is complex and nonlinear and differs by age and sex. J. Clin. Endocrinol. Metab. 98(7), 2936-2943 (2013).
86. Soldin OP. Thyroid function testing in pregnancy and thyroid disease: trimester-specific reference intervals. Ther. Drug Monit. 28(1), 8-11 (2006).
87. Stricker R, Echenard M, Eberhart R et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur. J. Endocrinol. 157(4), 509-514 (2007).
88. Haddow JE, Knight GJ, Palomaki GE, Mcclain MR, Pulkkinen AJ. The reference range and within-person variability of thyroid-stimulating hormone during the first and second trimesters of pregnancy. J. Med. Screen.11(4), 170-174 (2004).
89. Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann. Clin. Biochem. 38(Pt 4), 329-332 (2001).
90. Li C, Shan Z, Mao J et al. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women J. Clin. Endocrinol. Metab. 99(1), 73-79 (2014).
91. Korevaar TI, Medici M, De Rijke YB et al. Ethnic differences in maternal thyroid parameters during pregnancy: the Generation R study. J. Clin. Endocrinol. Metab. 98(9), 3678-3686 (2013).
92. Midgley JE, Hoermann R. Measurement of total rather than free thyroxine in pregnancy: the diagnostic implications. Thyroid 23(3), 259-261 (2013).
93. Kahric-Janicic N, Soldin SJ, Soldin OP, West T, Gu J, Jonklaas J. Tandem mass spectrometry improves the accuracy of free thyroxine measurements during pregnancy. Thyroid 17(4), 303-311 (2007).
94. Okosieme OE. Thyroid hormone replacement: current status and challenges. Expert. Opin. Pharmacother. 12(15), 2315-2328 (2011).
95. Okosieme OE, Belludi G, Spittle K, Kadiyala R, Richards J. Adequacy of thyroid hormone replacement in a general population. QJM 104(5), 395-401 (2011).
96. Taylor PN, Iqbal A, Minassian C et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: evidence from a large community-based study. JAMA Intern. Med. 174(1), 32-39 (2014).
97. Taylor PN, Minassian C, Rehman A et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. J. Clin. Endocrinol. Metab. 99(10), 3895-3902 (2014).
98. Vaidya B, Anthony S, Bilous M et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding J. Clin. Endocrinol. Metab. 92(1), 203-207 (2007).
99. Khan I, Witczak JK, Hadjieconomou S, Okosieme OE. Preconception thyroid-stimulating hormone and pregnancy outcomes in women with hypothyroidism. Endocr. Pract. 19(4), 656-662 (2013).
100. Taylor PN, Minassian C, Iqbal A et al. Thyroid function monitoring and TSH levels in pregnant individuals on levothyroxine for primary hypothyroidism in the UK. Eur. Thyroid J. 2(Suppl. 1), O35 (2013).
101. Sisson JC, Freitas J, Mcdougall IR et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid 21(4), 335-346 (2011).
102. Kuy S, Roman SA, Desai R, Sosa JA. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch. Surg. 144(5), 399-406 (2009).
103. Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur. J. Endocrinol. 160(1), 1-8 (2009).
104. Taylor PN, Vaidya B. Side effects of anti-thyroid drugs and their impact on the choice of treatment for thyrotoxicosis in pregnancy. Eur. Thyroid J. 1(3), 176-185 (2012).
105. Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Am. J. Obstet. Gynecol. 160(1), 63-70 (1989).
106. ACOG Committee Opinion No. 381 Subclinical hypothyroidism in pregnancy. Obstet. Gynecol. 110(4), 959-960 (2007).
107. Garber JR, Cobin RH, Gharib H et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the american association of clinical endocrinologists and the american thyroid association. Endocr. Pract. 18(6), S988-S984 (2012).
108. Reid SM, Middleton P, Cossich MC, Crowther CA. Interventions for clinical and subclinical hypothyroidism in pregnancy. Cochrane Database Syst. Rev. (7), CD007752 (2010).
109. Lepoutre T, Debieve F, Gruson D, Daumerie C. Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases. Gynecol. Obstet. Invest. 74(4), 265-273 (2012).
110. Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum. Reprod. Update 9(2), 149-161 (2003).
111. Chang DL, Leung AM, Braverman LE, Pearce EN. Thyroid testing during pregnancy at an academic Boston Area Medical Center. J. Clin. Endocrinol. Metab. 96(9), e1452-e1456 (2011).
112. Dosiou C, Barnes J, Schwartz A, Negro R, Crapo L, Stagnaro-Green A. Cost-effectiveness of universal and riskbased screening for autoimmune thyroid disease in pregnant women. J. Clin. Endocrinol. Metab. 97(5), 1536-1546 (2012).
113. Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. Am. J. Obstet. Gynecol. 200(3), 267e1-e7 (2009).
114. Hiéronimus S, Bec-Roche M, Ferrari P, Chevalier N, Fénichel P, Brucker-Davis F. Iodine status and thyroid function of 330 pregnant women from Nice area assessed during the second part of pregnancy. Ann. Endocrinol. (Paris) 70(4), 218-224 (2009).
115. ClinicalTrials Database: NCT00388297. https://clinicaltrials.gov/ct2/show/NCT00388297
116. Unit BCT. Randomised Controlled Trial of the Efficacy and Mechanism of Levothyroxine Treatment on Pregnancy and Neonatal Outcomes in Women with Thyroid Antibodies (TABLET). www.birmingham.ac.uk