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Revisiting the Thyroid Disorder Screening Policy in Pregnancy in Iran: Options, Uncertainties, and a Pathway for Evaluating Universal Thyroid Stimulating Hormone Screening
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S Nazarpour    , F Mahboobi Fard , K Nakhoda , Sh Amirshekari , F Azizi , F Ramezani Tehrani |
| Reproductive Endocrinology Research Center, Research Institute for Endocrine Molecular Biology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran, , fah.tehrani@gmail.com |
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Abstract: (20 Views) |
Thyroid disorders in pregnancy are associated with serious maternal and fetal consequences. This policy brief aims to compare screening policy options for thyroid disorders during pregnancy in Iran. This document draws on a targeted review of international and national evidence, including the 2026 American Thyroid Association Clinical Guidelines update and published cost-effectiveness studies. We compared four policy options based on diagnostic sensitivity, cost-effectiveness, equity of access, and feasibility within the Iranian health system. Given the 18.1% prevalence of thyroid disorders in Iranian pregnant women, the current risk factor-based screening policy lacks sufficient sensitivity, leaving many affected women undiagnosed. The 2026 American Thyroid Association Clinical Guidelines update emphasizes repeat testing in mild cases and iodine supplementation, but finds current evidence insufficient for recommending routine universal screening. Using a fixed Thyroid Stimulating Hormone (TSH) threshold of 4.0 mU/L instead of pregnancy-specific reference ranges misses approximately 54% of overt hypothyroidism cases. Although Iran has had a specific local reference range since 2013, the main challenge remains ensuring its continued clinical use. Four options were compared: maintaining the status quo, universal TSH screening with and without anti-TPO testing, and targeted screening in high-risk regions. Universal TSH screening, along with continued use of the existing specific reference range, repeat testing in mild cases, and insurance coverage, is a promising option—conditional on a pilot study and internal cost-effectiveness evaluation—rather than a definitive recommendation. Iodine supplementation during preconception, pregnancy, and lactation is essential for policy success.
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| Keywords: Universal Screening, TSH, Thyroid Dysfunction in Pregnancy, Health Policy, Iodine, Iran |
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Full-Text [PDF 1029 kb]
(13 Downloads)
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Type of Study: Review |
Subject:
Endocrinology
Received: 2026/06/22 | Accepted: 2026/09/7 | Published: 2026/04/30
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