College Student University of Guam Mangilao, Guam, United States
Background: In 2017, the American Thyroid Association (ATA) updated clinical criteria to determine if women who are pregnant or seeking pregnancy should be screened for thyroid disease. Women who meet at least one of the criteria are considered high risk for maternal or fetal complications related to thyroid disease and thyroid stimulating hormone (TSH) testing is recommended. The diagnostic accuracy of the screening tool has yet to be evaluated. Furthermore, we aimed to determine the level of healthcare access of the “at risk” population in the United States to investigate a potential barrier to thyroid disease screening for women of childbearing age.
Methods: A cross-sectional analysis was completed using data from the 2011-2012 and 2017-March 2020 Pre-Pandemic National Health and Nutrition Examination Survey (NHANES) datasets. Women below 18 and currently receiving levothyroxine (LT4), methimazole, or propylthiouracil treatments were excluded. Sociodemographic and healthcare access characteristics between women who did and did not meet screening criteria were compared using the Chi-square test with the Rao-Scott second-order correction and the adjusted Wald test, as appropriate, for weighted data. A secondary analysis was completed with women under 30 years as all women 30+ years meet screening criteria. We used thyroid function test results and the ATA screening algorithm to determine LT4 treatment recommendations (i.e., “gold standard” test). The sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated with meeting one or two ATA criteria as the “diagnostic test under investigation.”
Results: An estimated 76.6% of women of child-bearing age and 37.7% of women under 30 years old met at least one of the screening criteria. An estimated 22.1% of the “high risk” population lacked coverage and another 27.2% were insured through Medicaid. Meeting at least one criterion, the screening tool had 77.6% sensitivity, 31.0% specificity, and a diagnostic accuracy of 33.9%. Meeting two criteria decreased sensitivity to 66.5%, but increased specificity to 55.5% and diagnostic accuracy to 56.2%. Negative predictive value slightly increased based on meeting two criteria (95.4% to 96.2%).
Conclusions: The ATA’s screening criteria has a low to moderate diagnostic accuracy but is highly accurate in excluding women who are not recommended for treatment. Given the significant proportion of childbearing aged women on publicly funded insurance or without insurance, it is important to consider the potential costs of high-volume screening with the potential benefits of early capture of undiagnosed thyroid disease.
*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*
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