**2.3 General or only high-risk pregnant women testing?**

Presently available information that supports the hypothesis that an inappropriate first trimester surge in maternal FT4, whatever the circulating TSH, would interfere with the

Thyroid in Pregnancy 47

Glinoer (Glinoer et all., 1995) also documented somewhat higher TSH levels among the subpopulation of women with elevated antibody levels and these findings are confirmed in the

Serum concentrations of FT4 were lower in TPO Ab positive as compared to TPO Ab

Fig. 9. Serum concentrations of FT4 in TPO Ab positive and TPO Ab negative women

An answer to the question of screening cost-effectiveness of thyroid function in pregnancy was already presented by Dosiou (Dosiou et all., 2008). In this study is not defined costefficiency, but it is unquestioned fact that early diagnosis of thyroid disorder is cost-effective

The importance of maternal thyroxine for the development of the fetus brain early in pregnancy has received increasing acceptance. It has more recently become evident that maternal hypothyroxinemia results in the birth of children with decreased mental and

This project proved the usefulness of universal screening of thyroid disease in pregnancy. The occurrence of pathological results in laboratory tests was 679/3577. Determination of the specific reference intervals for TSH, FT4, and TPO Ab in pregnancy is one of the basic requirements when implementing the general examination. Cooperation with gynaecologists differed, the main stumbling block was the willingness of gynaecologists to

**2.5 Cost effectiveness of the thyroid failure screening** 

and beneficial for both mother and child.

inform pregnant women about the project.

**3. Conclusion** 

psychomotor development.

present study.

negative women as is showed on Fig. 9.

development of the cerebral cortex, even if maternal euthyroidism is maintained by normal circulating T3. There is at present increasing consensus (Morreale et all., 2004) that maternal hypothyroidism, both clinical and subclinical, requires early detection and prompt treatment, because of its important negative effects for the woman, the pregnancy and the child. There also exists a positive association between the presence of thyroid antibodies and pregnancy loss with postpartum thyroiditis.

The most practical approach is to screen all pregnant women for hypothyroidism as early in pregnancy as possible (or before conception). In the case of the mother, screening would reset in early diagnosis and treatment of subclinical hypothyroidism. Unfortunately, pregnant women with subclinical hypothyroidism seem to escape early clinical detection. In Mitchel study (Mitchel & Klein, 2004), 58% of the hypothyroid women were unaware of their disorder, and it took a median of 5 years from the time of the pregnancy for the clinical diagnosis to be made.

Vaidya study shows that targeted thyroid function testing of only high-risk pregnant women would miss nearly one-third of women with overt/subclinical hypothyroidism during early pregnancy (Vaidya et all., 2007). In Czech Republic, case finding screening is able to disclose less than 20% of asymptomatic mild or deep hypothyroidism or women with positive TPO Ab in pregnancy (Springer et all., 2009).

#### **2.4 Relationship between TPO Ab and TSH, resp. FT4**

The relationship between TPO Ab and TSH is not definite, despite it being known that women with high level of TSH more frequently have positive TPO Ab. In study group, divided by serum TSH concentration, were 44.1% TPO Ab positive (in part), with TSH >3.67 mU/l and 10.1% or 9.15% in the group with TSH < 0.06 mU/l or TSH in the reference interval, as is showed on Fig. 8.

Fig. 8. TPO Ab in groups with different TSH level

development of the cerebral cortex, even if maternal euthyroidism is maintained by normal circulating T3. There is at present increasing consensus (Morreale et all., 2004) that maternal hypothyroidism, both clinical and subclinical, requires early detection and prompt treatment, because of its important negative effects for the woman, the pregnancy and the child. There also exists a positive association between the presence of thyroid antibodies and

The most practical approach is to screen all pregnant women for hypothyroidism as early in pregnancy as possible (or before conception). In the case of the mother, screening would reset in early diagnosis and treatment of subclinical hypothyroidism. Unfortunately, pregnant women with subclinical hypothyroidism seem to escape early clinical detection. In Mitchel study (Mitchel & Klein, 2004), 58% of the hypothyroid women were unaware of their disorder, and it took a median of 5 years from the time of the pregnancy for the clinical

Vaidya study shows that targeted thyroid function testing of only high-risk pregnant women would miss nearly one-third of women with overt/subclinical hypothyroidism during early pregnancy (Vaidya et all., 2007). In Czech Republic, case finding screening is able to disclose less than 20% of asymptomatic mild or deep hypothyroidism or women

The relationship between TPO Ab and TSH is not definite, despite it being known that women with high level of TSH more frequently have positive TPO Ab. In study group, divided by serum TSH concentration, were 44.1% TPO Ab positive (in part), with TSH >3.67 mU/l and 10.1% or 9.15% in the group with TSH < 0.06 mU/l or TSH in the reference

pregnancy loss with postpartum thyroiditis.

with positive TPO Ab in pregnancy (Springer et all., 2009).

**2.4 Relationship between TPO Ab and TSH, resp. FT4** 

Fig. 8. TPO Ab in groups with different TSH level

diagnosis to be made.

interval, as is showed on Fig. 8.

Glinoer (Glinoer et all., 1995) also documented somewhat higher TSH levels among the subpopulation of women with elevated antibody levels and these findings are confirmed in the present study.

Serum concentrations of FT4 were lower in TPO Ab positive as compared to TPO Ab negative women as is showed on Fig. 9.

Fig. 9. Serum concentrations of FT4 in TPO Ab positive and TPO Ab negative women
