GUIDELINES FOR THYROID SCREENING IN WOMEN
According to Chang and Pierce (2013), thyroid dysfunction isassociated with inauspicious in women, specifically in pregnant womenthat may lead to miscarriage, preterm delivery, placental abruption,and eclampsia. This paper, therefore, reviews the current clinicalevidence related to thyroid screening guidelines, its strength andlimitation and how they influence clinical practice in decisionmaking.
Explanationof the guidelines on screening procedures for Thyroid Disease inWomen
Universal screening during pregnancy is the first presented guidelinetowards thyroid disease. This screening involves Serum Thyrotropinfor primary thyroid dysfunction. A healthy pregnant woman willexperience significance changes in maternal thyroid physiology.Therefore, serum thyroid-stimulating hormone (TSH) concentrationshould be the first and the most authentic test for evaluatingthyroid occasion in pregnancy (Stagnaro-Green et al., 2011).
Another guideline emphasizes on evidence-based approach and testingonly those women with personal history of the medical thyroidcondition. The guideline is to identify individual with high risk ofhyperthyroidism. It involves testing of serum TSH concentrationlevel.
Strengthsand limitations of the guidelines
In serum thyrotropin screening can be replaced a well dosed LT4therapy in pregnancy women and chemoprevention because it does notconfer any jeopardy to the fetus and the mother. However, theweakness of this screening guideline involve a high cost of treatmentand monitoring, misinterpretation of TFTs resulting into incompatibletreatment, and lack of exact dosage of LT4 that might lead intoovertreatment or under treatment.
Evidence based approach is not applicable in all clinical scenariosand one of its main shortcomings is based on weak scientific data orsubjectivity of the epidemiologic versus experimental in order toarrive into decision. Guidelines from American College ofObstetricians and Gynecology supports the thyroid testing only inhigh-risk pregnant women who have historical backgrounds of thyroiddisorders. However, American Thyroid Association support against theuniversal screening of healthy women, but they advocate for theevidence-based approach (Tharpe et al., 2013).
Explainhow the guidelines might support your clinical decision making
The above two guidelines should engage healthcare providers with theaim of interpreting the TFTs and avoid inappropriate treatment. Inaddition, a clinical decision should be made that increases the lifeof the patient through screening TSH during pregnancy and treat allwomen with Subclinical Hypothyroidism. These guidelines should alsohelp healthcare providers with in medical decision making for aparticular clinical condition and therefore, professional judgementshould be applied.
Chang, L. D. & Pearce, E. N. (2013). Screening for MaternalThyroid Dysfunction in Pregnancy: A review of Clinical Evidence andCurrent Guidelines. Journal of Thyroid Research, Vol. 2013.doi:10.4061/2011/397012.
Schuiling, K. D., & Likis, F. E. (2013). Women’s GynecologicHealth. Second Edition. Burlington, MA: Jones and BartlettPublishers.
Stagnaro-Green et al. (2011). Guidelines of the AmericanThyroid Association for the Diagnosis and Management of the ThyroidDisease During Pregnancy and Postpartum. Thyroid, Vol. 21(10) DOI: 10.1089/thy.2011.0087.
Tharpe, N., Farley, C. L., & Jordan, R. G. (2013). Clinicalpractice guidelines for midwifery and women`s health. Burlington,Mass: Jones & Bartlett Learning.