Screening tiroideo universal: beneficio potencial o costo innecesario
DOI:
https://doi.org/10.18041/2390-0512/bioc..1.2439Palabras clave:
Embarazo, tamizaje, hipotiroidismo, diagnósticoResumen
La enfermedad tiroidea representa un riesgo de morbilidad obstétrica durante la gestación; afecta el desarrollo fetal y los resultados en la vida postnatal. Sin embargo las distintas guías de manejo no recomiendan el tamizaje tiroideo. En este artículo se presenta una revisión de la literatura disponible en los últimos 5 años con respecto a la patología tiroidea y su asociación con los resultados perinatales y obstétricos adversos. Los hallazgos muestran que el hipertiroidismo no representa actualmente un objeto de discusión en cuanto al diagnóstico y al manejo. Por otra parte, el hipotiroidismo afecta aproximadamente el 3-5% de los embarazos y el tipo subclínico corresponde al 80% de ellos, siendo hoy el elemento principal de la controversia, debido a la posibilidad de que existan un grupo de pacientes subclínicas que se comportarían como hipotiroideas clínicas y para las cuales se hace necesario ajustar los parámetros diagnósticos y de manejo.
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Referencias
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8. Gabbe S, Niebyl J, Simpson J, et al. Obstetrics: Normal and problem pregnancies. 7 edicion. Elsevier. Capitulo 42.
9. Mundial. WHO/PAHO Regional Expert Group for Cardiovascular Disease.Improving Public Health in the Americas by Optimizing Sodium and Iodine Intakes Prevention through Population‐wide Dietary Salt Reduction Report from the Washington DC Meeting. 2011.
10. Pearce E. Thyroid disorders during pregnancy and postpartum. BPOBGYN. 2015. 29. 700-706.
11. Pelin R, Fox W, Abman S, et al. Fetal and neonatal physiology. 4 edición. Saunders. 2011. Capitulo 182.
12. Stricker R, Echenard M, Eberhart R, et al. Evaluation of maternal thy¬roid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2016;157:509.
13. Yan J, Sripada S, Saravelos S, et al. Thyroid peroxidase antibody in women with unexplained recurrent miscarriage: prevalence, prognostic value, and response to empirical thyroxine therapy. FertilSteril. 2012. 98; 378-382.
14. Lee Y, Ng H, Lau K, et al. Increased fetal abortion rate in autoinmune thyroid disease is related to circulating TPO autoantibodies in an autoinmune thyroiditis animal model. FertilSteril. 2009, 91- 2104-2109.
15. Johnson M., Althouse A.,Wakim N. et al. Hypothyroidism In Recipients Decreases Live Birth Rate In Donor-Recipient (Dr) In-Vitro Fertilization (Ivf) Cycles. FertilSteril. 2014. 102, e270.
16. Bernardi L, Cohen R, Stephenson M, et al. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. FertilSteril. 2013. 1326-1331.
17. Teng W, Shan Z, Patil-Sisodia K, et al. Hypothyroidism in pregnancy. TheLancet. 2013. 1. 228-237.
18. Cleary-Goldman J, Fergal D, Lambert-Massrlian L, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2015;112:85-92.
19. Plowden T, Schisterman E, Sjaarda L, et al. Sublcinical
Hypothyroidism and thyrooid autoimmunity are not associated with fecundity, pregnancy los or live birth. JCEM. 2016. 101. 2358-2365.
20. Agrawal S. Perinatal outcomes in pregnancy with subclinical hypothyroidism. Fertil steril. 2015. 104. E116-e116.
21. Ghassabian A, Henrichs J, Tiemmeier H. Impact of mild hormone
deficiency in pregnancy on cognitive function in children: Lessons fron the Generation R Study. BPRCEM. 2014. 28. 221-232.
22. Korevaar T, Muetzel R, Medici M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population based cohort study. The lancet. 2016. 4. 35-43.
23. Gyllemberg D, Sorander A, Surcel H, et al. Hypothyroxinemia during gestation and offspring schizophrenia in a national birth cohort. Biological Psychiatry. 2016. 79. 962-970.
24. Cruz I, Alvarez M, Cano R, et al. Treatment with fixed thyroxine doses in pregant women with subclinical hypothyroidism. Endocrinol Nutr. 2012. 59. 284-287.
25. Kim Ch, Ahn J, Kang S, et al. effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome with subclinical hypothyroidism undergoing in vitro fertilization/intracitoplasmatic sperm injection. Fertil Steril. 95. 1650-1654.
26. Candil S, Balsa J, Alvarez J, et al. Análisis coste-efectividad del cribado universal e la enfermedad tiroidea een mujeres embarazadas en España. Endocrinol Nutr. 2014. 62. 322-330.
27. Chang D., Leung A., Braverman L, et al. Thyroid Testing during Pregnancy at an Academic Boston Area Medical Center.JCEM. 2011. 96.E1452–E1456.
28. Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012; 2(1): 17–
19.
29. Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, Zhou J. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur. J. Endocrinol. 2011. Volúmen 164, Número 2; Páginas 263-8. European Society of Endocrinology.
30. Vila Ll., Velasco I, Gonzalez S, et al. On the need for universal thyroid screening in pregnant women.EJE. 2014. R17-R30.
31. McClain, M, Lambert-Messerlian, G., Haddow, J, et al. first- and second-trimester TSH, free thyroxine, and thyroid antibody measurements in women with known hypothyroidism: a FASTER trial study. AJOG, 2012, Volúmen 199, Número 2, Pages 129.e1-129.e6, Mosby, Inc.
32. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2010. 105:239–245.
33. Casey BM1, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. The Colorado Thyroid Disease Prevalence Study.Obstet Gynecol. 2011; 105 (2); 239-45.
34. Shields BM, Knight BA, Hill AV, HattersleyAT,Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J. Clin. Endocrinol. Metab. Publicado December 1, 2013.Volúmen 98, Número 12; Páginas E1941-5
35. Fitzpatrick, D., Russell, M. Diagnosis and Management of Thyroid Disease in Pregnancy. ObstetGynecolClin N Am 37 (2010) 173–193. Elsevier Inc.
36. Abalovich M, Gutierrez S, Alcaraz G, et al. Overt and sub¬clinical hypothyroidism complicating pregnancy. Thyroid. 2012;12:63.
37. Bath SC, Steer CD, Golding J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their chil¬dren: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013;382:331-337.
38. Yassa L, Fawcett R, Marqusee E, Alexander EK. Thyroid Hormone Early Adjustment in Pregnancy (the THERAPY) trial. J ClinEndocrinolMetab. 2010. 32-34.
39. Subclinical hypothyroidism in the infertile female population: a guideline. Practice Committee of the American Society for Reproductive Medicine. Fertility and sterility. 2015; 104, 545-553.
40. Männistö T, Surcel HM, Ruokonen A, et al. Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population. Thyroid. 2011. 21. 291-298.
41. Mascarenhas J.V, Anoop H.S, Patil M, et al. Improvement in Fertility outcome follows initiation of thyroxine for women with subclinical Hypothyroidism. THETRP. 2011. 8. 3-6.
42. Johnson M., Althouse A.,Wakim N. et al. Hypothyroidism In Recipients Decreases Live Birth Rate In Donor-Recipient (Dr) In-Vitro Fertilization (Ivf) Cycles. FertilSteril. 2014. 102. e270.
43. Bernardi L, Cohen R, Stephenson M. et al. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. FertilSteril. 2013. 1326-1331.
44. Gyamfi C. Basic Science and Clinical Evidence Regarding Treatment of Subclinical Hypothyroidism During Pregnancy. ClinicalObGyn. 2011. 54. 488-492.
45. Unuane D, Tournaye H, Velkeniers B, et al. Endocrine disorders & female infertility. BPRCEM. 2011. 25. 861-873.
46. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid
screening and childhood cognitive function. N Eng J Med. 2012. 366-493.
47. Pankkila F, Mannisto T, Surcel HM, et al. Maternal thyroid dys¬function during pregnancy and thyroid function of her child in adolescence. J ClinEndocrinolMetab. 2013. 98. 965-972.
48. Cooper D. y Biondi B. Subclinical thyroid disease. TheLancet. 2012. 379. 1142-1154.
49. Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period.Int J EndocrinolMetab. 2014.2. 1.
50. Korevaar TI, Medici M, de Rijke YB, et al. Ethnic differences in maternal thyroid parameters during pregnancy: The Generation R Study. J ClinEndocrinolMetab. 2013. 9. 3678-3686.
2. Kliegman R, Stanton B, St Geme J y Schor N. Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. 2016. Chapter 565.
3. Estados unidos de América. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. 2011: Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum.
4. Estados unidos de América. Thyroid Disease in Pregnancy Number 148.The American College of Obstetricians and Gynecologists. 2015.
5. De Groot L, Abalovich M, Alexander E. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. 2012. J ClinEndocrinolMetab. 2012, 97(8):2543–2565.
6. Creasy R., Resnik R., Iams J., Lockwood C., Moore T. y Greene M., Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, Seventh Edition. Saunders, an imprint of Elsevier Inc. 2014. 24. 1022-1037.
7. Melmed S, Polonsky K, Crane R, et al. Williams Textbook of endocrinology. 13 edicion. Elsevier. 2016. Capitulo 11.
8. Gabbe S, Niebyl J, Simpson J, et al. Obstetrics: Normal and problem pregnancies. 7 edicion. Elsevier. Capitulo 42.
9. Mundial. WHO/PAHO Regional Expert Group for Cardiovascular Disease.Improving Public Health in the Americas by Optimizing Sodium and Iodine Intakes Prevention through Population‐wide Dietary Salt Reduction Report from the Washington DC Meeting. 2011.
10. Pearce E. Thyroid disorders during pregnancy and postpartum. BPOBGYN. 2015. 29. 700-706.
11. Pelin R, Fox W, Abman S, et al. Fetal and neonatal physiology. 4 edición. Saunders. 2011. Capitulo 182.
12. Stricker R, Echenard M, Eberhart R, et al. Evaluation of maternal thy¬roid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol. 2016;157:509.
13. Yan J, Sripada S, Saravelos S, et al. Thyroid peroxidase antibody in women with unexplained recurrent miscarriage: prevalence, prognostic value, and response to empirical thyroxine therapy. FertilSteril. 2012. 98; 378-382.
14. Lee Y, Ng H, Lau K, et al. Increased fetal abortion rate in autoinmune thyroid disease is related to circulating TPO autoantibodies in an autoinmune thyroiditis animal model. FertilSteril. 2009, 91- 2104-2109.
15. Johnson M., Althouse A.,Wakim N. et al. Hypothyroidism In Recipients Decreases Live Birth Rate In Donor-Recipient (Dr) In-Vitro Fertilization (Ivf) Cycles. FertilSteril. 2014. 102, e270.
16. Bernardi L, Cohen R, Stephenson M, et al. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. FertilSteril. 2013. 1326-1331.
17. Teng W, Shan Z, Patil-Sisodia K, et al. Hypothyroidism in pregnancy. TheLancet. 2013. 1. 228-237.
18. Cleary-Goldman J, Fergal D, Lambert-Massrlian L, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2015;112:85-92.
19. Plowden T, Schisterman E, Sjaarda L, et al. Sublcinical
Hypothyroidism and thyrooid autoimmunity are not associated with fecundity, pregnancy los or live birth. JCEM. 2016. 101. 2358-2365.
20. Agrawal S. Perinatal outcomes in pregnancy with subclinical hypothyroidism. Fertil steril. 2015. 104. E116-e116.
21. Ghassabian A, Henrichs J, Tiemmeier H. Impact of mild hormone
deficiency in pregnancy on cognitive function in children: Lessons fron the Generation R Study. BPRCEM. 2014. 28. 221-232.
22. Korevaar T, Muetzel R, Medici M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population based cohort study. The lancet. 2016. 4. 35-43.
23. Gyllemberg D, Sorander A, Surcel H, et al. Hypothyroxinemia during gestation and offspring schizophrenia in a national birth cohort. Biological Psychiatry. 2016. 79. 962-970.
24. Cruz I, Alvarez M, Cano R, et al. Treatment with fixed thyroxine doses in pregant women with subclinical hypothyroidism. Endocrinol Nutr. 2012. 59. 284-287.
25. Kim Ch, Ahn J, Kang S, et al. effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome with subclinical hypothyroidism undergoing in vitro fertilization/intracitoplasmatic sperm injection. Fertil Steril. 95. 1650-1654.
26. Candil S, Balsa J, Alvarez J, et al. Análisis coste-efectividad del cribado universal e la enfermedad tiroidea een mujeres embarazadas en España. Endocrinol Nutr. 2014. 62. 322-330.
27. Chang D., Leung A., Braverman L, et al. Thyroid Testing during Pregnancy at an Academic Boston Area Medical Center.JCEM. 2011. 96.E1452–E1456.
28. Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012; 2(1): 17–
19.
29. Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, Zhou J. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur. J. Endocrinol. 2011. Volúmen 164, Número 2; Páginas 263-8. European Society of Endocrinology.
30. Vila Ll., Velasco I, Gonzalez S, et al. On the need for universal thyroid screening in pregnant women.EJE. 2014. R17-R30.
31. McClain, M, Lambert-Messerlian, G., Haddow, J, et al. first- and second-trimester TSH, free thyroxine, and thyroid antibody measurements in women with known hypothyroidism: a FASTER trial study. AJOG, 2012, Volúmen 199, Número 2, Pages 129.e1-129.e6, Mosby, Inc.
32. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2010. 105:239–245.
33. Casey BM1, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. The Colorado Thyroid Disease Prevalence Study.Obstet Gynecol. 2011; 105 (2); 239-45.
34. Shields BM, Knight BA, Hill AV, HattersleyAT,Vaidya B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J. Clin. Endocrinol. Metab. Publicado December 1, 2013.Volúmen 98, Número 12; Páginas E1941-5
35. Fitzpatrick, D., Russell, M. Diagnosis and Management of Thyroid Disease in Pregnancy. ObstetGynecolClin N Am 37 (2010) 173–193. Elsevier Inc.
36. Abalovich M, Gutierrez S, Alcaraz G, et al. Overt and sub¬clinical hypothyroidism complicating pregnancy. Thyroid. 2012;12:63.
37. Bath SC, Steer CD, Golding J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their chil¬dren: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013;382:331-337.
38. Yassa L, Fawcett R, Marqusee E, Alexander EK. Thyroid Hormone Early Adjustment in Pregnancy (the THERAPY) trial. J ClinEndocrinolMetab. 2010. 32-34.
39. Subclinical hypothyroidism in the infertile female population: a guideline. Practice Committee of the American Society for Reproductive Medicine. Fertility and sterility. 2015; 104, 545-553.
40. Männistö T, Surcel HM, Ruokonen A, et al. Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population. Thyroid. 2011. 21. 291-298.
41. Mascarenhas J.V, Anoop H.S, Patil M, et al. Improvement in Fertility outcome follows initiation of thyroxine for women with subclinical Hypothyroidism. THETRP. 2011. 8. 3-6.
42. Johnson M., Althouse A.,Wakim N. et al. Hypothyroidism In Recipients Decreases Live Birth Rate In Donor-Recipient (Dr) In-Vitro Fertilization (Ivf) Cycles. FertilSteril. 2014. 102. e270.
43. Bernardi L, Cohen R, Stephenson M. et al. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. FertilSteril. 2013. 1326-1331.
44. Gyamfi C. Basic Science and Clinical Evidence Regarding Treatment of Subclinical Hypothyroidism During Pregnancy. ClinicalObGyn. 2011. 54. 488-492.
45. Unuane D, Tournaye H, Velkeniers B, et al. Endocrine disorders & female infertility. BPRCEM. 2011. 25. 861-873.
46. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid
screening and childhood cognitive function. N Eng J Med. 2012. 366-493.
47. Pankkila F, Mannisto T, Surcel HM, et al. Maternal thyroid dys¬function during pregnancy and thyroid function of her child in adolescence. J ClinEndocrinolMetab. 2013. 98. 965-972.
48. Cooper D. y Biondi B. Subclinical thyroid disease. TheLancet. 2012. 379. 1142-1154.
49. Delange F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period.Int J EndocrinolMetab. 2014.2. 1.
50. Korevaar TI, Medici M, de Rijke YB, et al. Ethnic differences in maternal thyroid parameters during pregnancy: The Generation R Study. J ClinEndocrinolMetab. 2013. 9. 3678-3686.
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2017-01-05
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Cómo citar
Screening tiroideo universal: beneficio potencial o costo innecesario. (2017). Biociencias, 12(1), 55-63. https://doi.org/10.18041/2390-0512/bioc..1.2439
