Endocrine Abstracts

Screening is defined as ‘the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not’. Ideally all the following criteria should be met: The Condition should be an important health problem; well known epidemiology and natural history of the condition. The test should be a simple, safe, precise and validated with agreed reference range. The treatment should be effective, there should be agreed evidence based policies covering which subjects need treatment and the appropriate treatment to be offered. The Screening Programme is effective in reducing mortality or morbidity (evidence from high quality Randomised Controlled Trials); is clinically, socially and ethically acceptable to health professionals and the public. The benefit from the screening programme should outweigh the physical and psychological harm (caused by the test, diagnostic procedures and treatment). The opportunity cost of the screening programme should be economically balanced in relation to expenditure on medical care as a whole (cost benefit and/or cost effectiveness analyses). In the case for thyroid screening in pregnancy, most of the above mentioned points are satisfied. In particular, everyone agrees that overt thyroid dysfunctions need to be treated, and a cost-effective analysis demonstrated that universal screening is cost-effective even assuming that only overt hypothyroidism has adverse obstetrical outcomes. The problem is still represented by the halo of uncertainty that surrounds clinical entities such as subclinical hypothyroidism and isolated hypothyroxinemia. The lack of high quality Randomized Controlled Trials in these two conditions, does not allow, by now, to universally endorse a screening for thyroid disease in pregnancy.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.