News & Views: Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum

Abstract Hypothyroidism is a pathologic condition generated by the thyroid hormone deficiency. The American Thyroid Association advises for the screening of hypothyroidism beginning at 35 years and thereafter every 5 years in people at high risk for this condition: females older than 60 years, pregnant women, patients with other autoimmune disease or patients with a history of neck irradiation. In pregnant women, hypothyroidism can been associated with adverse effect for both mother and child. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ recommends the treatment of maternal overt hypothyroidism: females with a thyrotropin (TSH) level higher than the trimester-specific reference interval and decreased free thyroxine (FT4), and females for which TSH level is higher than 10.0 mIU/L, irrespective of the FT4 value, with administration of oral levothyroxine. The goal of treatment of maternal overt hypothyroidism is to bring back the serum TSH values to the reference range specific for the pregnancy trimester. The Guidelines of the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ recommends treatment of pregnancy associated subclinical hypothyroidism with the following levothyroxine doses: „1.20 μg/kg/day for TSH≤4.2 mU/l, 1.42 μg/kg/day for TSH >4.2-10 and 2.33 μg/kg/day for overt hypothyroidism“. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ and the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ do not recommend the treatment of isolated hypothyroxinemia in pregnancy.

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Guidelines of the American Thyroid Association for the Diagnosisand Management of Thyroid Disease During Pregnancy and Postpartum

Clinical and experimental thyroidology ◽

10.14341/ket2012817-18 ◽

2012 ◽

Vol 8 (1) ◽

pp. 7 ◽

Cited By ~ 4

Author(s):

V V Fadeyev

Keyword(s):

Thyroid Disease ◽

American Thyroid Association ◽

Pregnancy And Postpartum

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Does Sex Bias Play a Role for Dissatisfied Patients With Hypothyroidism?

Journal of the Endocrine Society ◽

10.1210/js.2018-00169 ◽

2018 ◽

Vol 2 (8) ◽

pp. 970-973 ◽

Cited By ~ 1

Author(s):

Elizabeth A McAninch ◽

Jennifer S Glueck ◽

Antonio C Bianco

Keyword(s):

Patient Outcomes ◽

Thyroid Disease ◽

Thyroid Diseases ◽

Sex Bias ◽

Diagnosis And Management ◽

Men 2 ◽

Current State ◽

Pregnancy And Postpartum ◽

Improve Patient

Abstract The current state of the diagnosis and management of thyroid disease cannot be separated from the larger context of women’s health for the following reasons: (1) the disproportionate incidence and prevalence of functional and structural thyroid diseases among women vs men; (2) the role of thyroid health on fertility, pregnancy, and postpartum; and (3) the challenge posed in managing the nonspecific symptoms of functional thyroid disease in the context of menopause. Here, we explore the hypothesis that sex bias has played a role in the management of thyroid diseases historically and has extended into the modern medical era. Once knowledge gaps that may have resulted from sex bias are recognized, we can strive to overcome this bias and develop better treatments to improve patient outcomes universally.

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Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum

Clinical and experimental thyroidology ◽

10.14341/ket9794 ◽

2018 ◽

Vol 14 (3) ◽

pp. 128-139

Author(s):

Valentin V. Fadeyev

Keyword(s):

Thyroid Disease ◽

Critical Appraisal ◽

Clinical Decision Making ◽

Task Force ◽

Synthesis Methods ◽

American Thyroid Association ◽

Thyroid Function Tests ◽

Diagnosis And Management ◽

Published Evidence ◽

In Pregnancy

Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.

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Evidence-Based Tightrope Walking: The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Thyroid ◽

10.1089/thy.2017.29040.tko ◽

2017 ◽

Vol 27 (3) ◽

pp. 309-311 ◽

Cited By ~ 5

Author(s):

Tim I.M. Korevaar

Keyword(s):

Thyroid Disease ◽

Evidence Based ◽

American Thyroid Association ◽

Diagnosis And Management ◽

Tightrope Walking

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Linking medical needs and performance goals: clinical and laboratory perspectives on thyroid disease

Clinical Chemistry ◽

10.1093/clinchem/39.7.1519 ◽

1993 ◽

Vol 39 (7) ◽

pp. 1519-1524 ◽

Cited By ~ 13

Author(s):

I D Hay ◽

G G Klee

Keyword(s):

Thyroid Disease ◽

Suppressive Therapy ◽

Fourth Generation ◽

American Thyroid Association ◽

Case Examples ◽

Diagnosis And Management ◽

Medical Needs ◽

Line Test ◽

And Performance ◽

Performance Guidelines

Abstract Diagnosis and management of thyroid disease benefit substantially from close interactions between clinicians and laboratorians. Clinicians desire reliable tests for diagnosis and management of both hypothyroidism and thyrotoxicosis. Traditionally, multitiered testing has been used, beginning with an index of free thyroxine concentration, which, if abnormal, has been followed by basal thyrotropin (TSH) measurements (for hypothyroidism) or thyrotropin-releasing hormone-stimulated TSH measurements (for thyrotoxicosis). Improvements in analytical methods for TSH have made it practical to use basal TSH measurements in serum as the first-line test for thyroid disease. However, performance guidelines are needed, because not all TSH assays work well in this role. The performance guidelines developed by the American Thyroid Association are reviewed to illustrate how they help to assure consistent analytical testing. Further improvements in TSH assays (third- and fourth-generation assays), which support measurements down to 0.01 mlU/L and 0.001 mIU/L, may provide additional advantages for classifying thyrotoxic patients and monitoring thyroxine-suppressive therapy in patients with thyroid cancer. The potential advantages of these newer assays are illustrated with case examples. Additional analytical performance monitors are proposed to help ensure that these next-generation TSH assays meet the expanded clinical needs.

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