Endocrine Abstracts

Objectives: Thyroid screening in pregnancy has in Slovakia started in 2009 on the basis of a ministerial guidance for diagnosis and therapy of autoimmune diseases of thyroid gland in pregnant women. (source: Vestník MZ SR 39., 2009, pp. 33–39). Its effectiveness was analysed in 2016 and compared with a similar analysis from 2011. The analysis was aimed to verify the implementation rate of the Guidance in practice.

Methods: Records from pregnant women registered in the Health Insurance Company Dôvera (28% share in Slovakia) were evaluated. Included were women with documented first visit at gynecologist who confirmed pregnancy in 2016. Examination of blood sample for TSH and APTO followed by examination by endocrinologist with negative anamnesis of appointments with endocrinologists in 2015 were including criteria for the analysis. All women were monitored till the end of 2017.

Results: 16 891 women were included. Out of them 5 901 (34.9%) underwent a „mandatory ‘examination for TSH and ATPO. Out of these 526 (i.e. 8.9% of 5 901) were subsequently examined and followed up by endocrinologist also in 2017 for thyroid pathology of TSH and/or ATPO. 210 women (39.9% of 526) in the latter group needed medicament treatment: 6 women (2.9%) for hyperfunction and 204 women (97.1%) for hypofunction of thyroid gland with average daily dose 74.5 mg thyroxin. Thyroid disease screening in pregnant women implemented by gynecologists in 2016 was low reaching 34.9%, however, surprisingly it was even lower than in 2011 when it reached 37.1%. Newly diagnosed thyreopathy reached only 3.1% in the whole group of 16 891 women, and thyreopathy with needed treatment only 1.2%. The overall screening costs amounted to 135 922 €, i.e. 23€ per one woman. Average costs of one identified thyreopathy were 258.4 € and of one treated thyreopathy 647.3 €.

Conclusions: The high proportion of laboratory thyreopathies in 2016 requiring long-term follow up by endocrinologist (8.9% in the group with examined TSH and ATPO) and necessity of a long-term therapy in this group (39.9%) allow to conclude that this screening is clinically as well as cost effective and should be performed on the whole population of pregnant women. The Low implementation of the screening by out-patient gynecologists despite the ministerial guidance has been in force for seven years is a critical weakness.