scholarly journals Comparison of ATA and Updated ACOG Guidelines for Thyroid Disease in Pregnancy. Russian translation

2021 ◽  
Vol 16 (3) ◽  
pp. 12-15
Author(s):  
Elizabeth N. Pearce
Keyword(s):  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Thyroid Nodules ◽  
Russian Translation ◽  
Clinical Care ◽  
American Thyroid Association ◽  
Thyroid Function Testing ◽  
Similarities And Differences ◽  
Function Testing ◽  
In Pregnancy

Thyroid dysfunction is relatively common in pregnancy. The American Thyroid Association (ATA) published its most recent guidelines regarding the management of thyroid disorders in pregnancy in 2017. The American College of Obstetricians and Gynecologists (ACOG) has recently published an updated practice bulletin for thyroid disease in pregnancy that supersedes its previous guidance published in 2015. A comparison of the similarities and differences between the clinical guidelines from the ATA and ACOG can serve to highlight areas of uncertainty where additional studies are needed and may also demonstrate areas where endocrinologists and obstetricians may elect differing approaches to clinical care. The ACOG and ATA guidelines recommend similar approaches to the interpretation of thyroid function testing during gestation and to the management of thyroid cancer, thyroid nodules, gestational thyrotoxicosis, and postpartum thyroiditis Both strongly recommend levothyroxine (L-T4) treatment for overtly hypothyroid pregnant women, and both recommend against the use of T3-containing thyroid hormone preparations when treating hypothyroidism in pregnancy.

Thyroid disease during pregnancy

2011 ◽  
pp. 547-552 ◽  
Author(s):  
John H. Lazarus ◽  
L.D. Kuvera ◽  
E. Premawardhana
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Childbearing Age ◽  
Thyroid Function Testing ◽  
Appropriate Therapy ◽  
Function Testing ◽  
In Pregnancy

Thyroid disorders are common. The prevalence of hyperthyroidism is around 5/1000 in women and overt hypothyroidism about 3/1000 in women. Subclinical hypothyroidism has a prevalence in women of childbearing age in iodine-sufficient areas of between 4% and 8%. As these conditions are generally much more common in females, it is to be expected that they will appear during pregnancy. Developments in our understanding of thyroid physiology (1) and immunology (2) in pregnancy, as well as improvements in thyroid function testing (3), have highlighted the importance of recognizing and providing appropriate therapy to women with gestational thyroid disorders. Before considering the clinical entities occurring during and after pregnancy it is useful to briefly review thyroid physiology and immunology in relation to pregnancy.

scholarly journals Management of thyroid disease in pregnancy – Room for improvement in the first trimester

2016 ◽  
Vol 9 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Helen Robinson ◽  
Philip Robinson ◽  
Michael D’Emden ◽  
Kassam Mahomed
Keyword(s):  
General Practitioner ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
In Pregnancy ◽  
Stimulating Hormone

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.

scholarly journals SUN-425 Indiscriminate Thyroid Function Testing on Acute Hospital Admissions Reveals a High Abnormality Rate Requiring Follow Up

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Robert P McEvoy ◽  
Anthony O’Riordan ◽  
Mark J Hannon
Keyword(s):  
Thyroid Function ◽  
American Thyroid Association ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Patient Age ◽  
Function Tests ◽  
Patient Âgé ◽  
Thyroid Function Testing ◽  
Function Testing

Abstract The population attending the Medical Assessment Unit at our hospital comprises patients attending electively for investigation and acutely unwell patients presenting for unscheduled care. The standard panel of blood tests taken on arrival includes thyroid function tests (TFTs, i.e. TSH and free-T4), despite a recent review questioning the clinical utility of this practice [1]. We performed a retrospective audit to determine what proportion of our patients had abnormal thyroid function on presentation, and whether these abnormal test results were being followed up. Using the iSoft Clinical Manager software, a list was generated of all patients who attended the hospital between January 2018 and June 2018 inclusive. For each attendance, we recorded the date, medical record number, patient age, gender, and TFT result. Abnormal TFT results were classified as overt or subclinical hyper- or hypothyroid, or non-thyroid illness syndrome (NTIS), based on their admission TSH and free-T4. We then examined the hospital and primary care records of patients with abnormal TFTs to determine if they had ongoing thyroid follow up post discharge. In total, 2,298 patients attended over the 6-month study period. The mean patient age was 67.2 years, and 49% were female. Thyroid function tests were ordered on the day of attendance for 1,688 patients (73%). Of these, 181 results (11%) were abnormal: 20 overt hyperthyroid (11%), 72 subclinical hyperthyroid (40%), 12 overt hypothyroid (7%), 35 subclinical hypothyroid (19%), and 42 NTIS (23%). Twenty of these patients died within 3 months of the abnormal TFT result (4 overt hyperthyroid, 3 subclinical hyperthyroid, 3 overt hypothyroid, 6 subclinical hypothyroid, and 4 NTIS). Of the remaining 161 patients, 74 (46%) had not been followed up within 3 months (4 overt hyperthyroid, 34 subclinical hyperthyroid, 3 overt hypothyroid, 15 subclinical hypothyroid, and 18 NTIS). The low percentage of abnormal TFTs (11%) in this audit is in keeping with similar studies where thyroid function testing was performed on unselected hospital populations [1]. Subclinical hyperthyroidism was by far the most common abnormality found. A high percentage of abnormal tests (46%) were not followed up, with poor compliance with thyroid management guidelines [2]. Future work will investigate adoption of an ‘opt-in’ order system [3] and electronic alerts to flag abnormal results for follow-up. [1] Premawardhana LD. Thyroid testing in acutely ill patients may be an expensive distraction. Biochemia medica. 2017; 27(2): 300-307. [2] Ross DS et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct; 26(10):1343-1421. [3] Leis B et al. Altering standard admission order sets to promote clinical laboratory stewardship: a cohort quality improvement study. BMJ Qual Saf. 2019; 28(10): 846-52.

scholarly journals Advancements in Clinical Thyroidology in 2016

2016 ◽  
Vol 12 (02) ◽  
pp. 83
Author(s):  
Maria Brito ◽  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Thyroid Nodules ◽  
Adult Patients ◽  
Graves Disease ◽  
American Thyroid Association ◽  
Diagnosis And Management ◽  
In Pregnancy

In this article, we summarize the seminal highlights of clinical thyroidology literature published in 2016. The main focus of these articles were thyroid nodules, thyroid cancer, cubclinical hypothyroidism in pregnancy, Graves℉ disease in pregnancy, the American Thyroid Association guidelines for adult patients with thyroid nodules and differentiated thyroid cancer, and the American Thyroid Association guidelines for the diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis.

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

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.

scholarly journals Graves’ Disease Following Subacute Thyroiditis

2021 ◽  
Vol 6 (2) ◽  
pp. 67-70
Author(s):  
Young Sik Choi
Keyword(s):  
Thyroid Disease ◽  
Subacute Thyroiditis ◽  
Graves Disease ◽  
Thyroid Ultrasonography ◽  
Anterior Neck ◽  
Autoimmune Thyroid ◽  
Vascular Flow ◽  
Thyroid Function Testing ◽  
Swallowing Difficulty ◽  
Function Testing

Subacute thyroiditis is an inflammatory thyroid disease caused by viral infection. Graves’ disease is an autoimmune thyroid disease caused by thyrotropin (TSH) receptor antibody (TRAb). Graves’ disease following subacute thyroiditis is rare, and only a few cases have been reported. A 58-year-old woman presented with anterior neck pain and swallowing difficulty. Laboratory tests showed elevated FT4, low TSH, normal TRAb, and elevated erythrocyte sedimentation rate. Thyroid ultrasonography (US) revealed focal, ill-defined hypoechoic areas in both thyroid lobes. The patient was treated with corticosteroid, and symptoms subsided after 1 month. Three months later, she complained of tremor and palpitation. Thyroid function testing showed hyperthyroidism with the positive conversion of TRAb, indicating Graves’ disease. Doppler US showed increased vascular flow in both thyroid lobes. She started treatment for hyperthyroidism with methimazole.

scholarly journals Assessing the Outcome of Management of Thyroid Dysfunction in Pregnancy With Second Affiliated Hospital of Chongqing Medical University Guideline.

2021 ◽  
Author(s):  
Samuel Chigbo Obiegbusi ◽  
Xiao Jing Dong ◽  
Ming yu Deng ◽  
Chidera Nneji Obiegbusi ◽  
Yin Yang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Disease ◽  
Intrauterine Growth Restriction ◽  
Thyroid Dysfunction ◽  
Second Trimester ◽  
Intrauterine Growth ◽  
Chinese Medical Association ◽  
Significant Difference ◽  
Medical University ◽  
In Pregnancy

Abstract Introduction – Pregnancy comes with hormonal changes which, when not properly managed, could lead to complications. Thyroid hormone is one of the hormones that are affected during pregnancy, and it plays a significant role in pregnancy, from conception to delivery. In a bid to identify intended pregnant women and pregnant women with thyroid dysfunction, the Endocrinology Branch of Chinese Medical Association and Perinatal medicine branch of Chinese Medical Association set guidelines for diagnosis and treatment of thyroid diseases in pregnancy and postpartum women. The guideline recommends screening for all women who desire getting pregnant soon and pregnant women, which Second Affiliated Hospital of Chongqing Medical University is implementing.Purpose - To Identify the common thyroid disease found among pregnant women in Chongqing. Evaluate the effectiveness of the management guideline toward improving pregnancy outcome among women diagnosed with thyroid disease during their pregestational and gestational period, and ascertain the need for additional measures to be taken towards thyroid disease management during pregnancy in certain areas with unfavourable outcome.Method – A retrospective cohort study of 774 pregnant women diagnosed with thyroid dysfunction in the Second Affiliated Hospital of Chongqing Medical University from 2016 -2018 was extracted from the hospital computer patient’s record. Only 724 patients that met the inclusive criteria were analysed. Participants were grouped into four, according to the time they were diagnosed and managed. The Multiple logistic regression and binary logistic regression statistical analysis were done with SPSS, and we adjusted for potential confounders, including maternal age, parity, and gravida.Result – There is an association between maternal age and abortion among pregnant women diagnosed with subclinical hypothyroidism, P-0.018(OR 1.459, 95%CI 1.067-1.997) and significant difference in pregnant women who developed intrauterine growth restriction after being diagnosed with hypothyroidism in the second trimester, P-0.048(OR-0.152, 95%CI 0.024-0.981). There was also a significant difference in gravida, P-0.032(OR 1.368, 95%CI 1.028 1.821) and normal delivery mode, P-0.010(OR 2.521, 95%CI 1.246-5.100).Conclusion – The study shows a promising result as less complication is observed. However, more attention is needed toward managing subclinical hypothyroidism in pregnancy to curb abortion/miscarriage incidence. Hypothyroidism in second trimester could lead to intrauterine growth restriction. Multigravida increases the risk of complication among pregnant women with thyroid dysfunction.

scholarly journals Thyroid nodules: a review of current guidelines, practices, and prospects

2008 ◽  
Vol 159 (5) ◽  
pp. 493-505 ◽  
Author(s):  
H Gharib ◽  
E Papini ◽  
R Paschke
Keyword(s):  
Clinical Practice ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Rating Scale ◽  
Task Force ◽  
American Thyroid Association ◽  
Practice Recommendations ◽  
Joint Task ◽  
Joint Task Force ◽  
Current Guidelines

In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by: the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME); the American Thyroid Association (ATA); and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data, and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scale make a rapid comparison of the strength of both evidence and recommendations difficult for the use in current clinical practice. Some recommendations are based mostly on experts' opinion. Thus, a same recommendation may be based on a different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. Therefore, efforts are needed to produce a few high-quality clinical studies to close the evidence gaps in the still controversial fields of thyroid disease and to create a joint task force of the most authoritative societies in the field of thyroid disease in order to reach a common document for clinical practice recommendations.

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