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 The Treatment of Hypothyroidism in Pregnancy

2017 ◽  
Vol 24 (2) ◽  
pp. 155-160
Author(s):  
Rucsandra Dănciulescu Miulescu ◽  
Andrada Doina Mihai
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Hormone Deficiency ◽  
Specific Reference ◽  
Overt Hypothyroidism ◽  
American Thyroid Association ◽  
Diagnosis And Management ◽  
Pregnancy And Postpartum ◽  
In Pregnancy

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.

Surgery of the Thyroid in Children: Current Trends in Practice

2016 ◽  
Vol 7 (2) ◽  
pp. 57-63
Author(s):  
Alanna M Windsor ◽  
Eleanor P Kiell ◽  
Eric E Berg ◽  
Ken Kazahaya
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Surgery ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Task Force ◽  
Pediatric Population ◽  
American Thyroid Association ◽  
Thyroid Function Tests ◽  
Current Trends

ABSTRACT Thyroid surgery in the pediatric population is performed for a variety of benign and malignant conditions, including thyroid nodules, hyperthyroidism, goiter, and thyroid cancer. Thyroid nodules, though uncommon in children, are more likely to be malignant than in adults and require careful evaluation with history, imaging, thyroid function tests and often ultrasoundguided biopsy to determine which nodules will require further interventions. The treatment of thyroid malignancy is primarily surgical, though the extent of surgery is an area of active debate. Moreover, thyroid surgery in children may have a higher rate of complications, and a number proposals have been suggested to mitigate these risks. The guidelines developed by the 2015 American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer are a helpful tool in directing the medical and surgical management of these complex patients, and provide a method for stratification of patient risk for recurrent disease. Children with thyroid disease are recommended to be cared for using a multidisciplinary approach and by providers and facilities experienced in management of pediatric patients. Surgery should be performed by surgeons experienced in pediatric cervical procedures. The objective of this review is to describe the range of thyroid disease affecting pediatric patients, examine current diagnostic algorithms, and discuss common treatment approaches, including the role for both surgery and adjunctive therapies. How to cite this article Windsor AM, Kiell EP, Berg EE, Kazahaya K. Surgery of the Thyroid in Children: Current Trends in Practice. Int J Head Neck Surg 2016;7(2):57-63.

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 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.

Diagnosis and Management of Thyroid Disease in Pregnancy

2010 ◽  
Vol 37 (2) ◽  
pp. 173-193 ◽  
Author(s):  
Diana L. Fitzpatrick ◽  
Michelle A. Russell
Keyword(s):  
Thyroid Disease ◽  
Diagnosis And Management ◽  
In Pregnancy

scholarly journals Management Thyroid Disease in Pregnancy: Preconception, and the postpartum complications

2017 ◽  
Vol 1 (3) ◽  
pp. 01-04
Author(s):  
R F Gross man
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Postpartum Period ◽  
Past History ◽  
First Trimester ◽  
Thyroid Function Tests ◽  
Specialist Referral ◽  
Thyrotropin Receptor Antibodies ◽  
History Of ◽  
In Pregnancy

Pregnancy has a profound impact on the thyroid gland and thyroid function since the thyroid may encounter changes to hormones and size during pregnancy. The diagnosis and treatment of thyroid disease during pregnancy and the postpartum is complex but knowledge regarding the interaction between the thyroids and pregnancy/the postpartum period is advancing at a rapid pace. For women known to have hypothyroidism, an increase in thyroxine dose by 20–40% when pregnancy is confirmed usually ensures they remain euthyroid. Treatment of subclinical hypothyroidism is recommended if the woman has antithyroid antibodies. Treatment of hyperthyroidism, unless it is related to human chorionic gonadotrophin, involves propylthiouracil in the first trimester. Carbimazole may be used in the second trimester. Thyroid function tests are checked every month and every two weeks following a change in dose. Women with a current or a past history of Graves’ disease who have thyrotropin receptor antibodies require early specialist referral as there is a 1–5% risk of fetal hyperthyroidism. Women with thyroid disorders in pregnancy should be followed up by their GP in the postpartum period. Postpartum thyroiditis may present months after delivery.

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.

Outcomes in Pregnant Patients with Subclinical Hypothyroidism and Thy-roid Autoimmunity: A Critical Appraisal of Recent Randomized Con-trolled Trials

2020 ◽  
Vol 20 ◽  
Author(s):  
Roberto Negro
Keyword(s):  
Subclinical Hypothyroidism ◽  
Birth Rate ◽  
Critical Appraisal ◽  
Thyroid Autoimmunity ◽  
Live Birth Rate ◽  
American Thyroid Association ◽  
Miscarriage Rate ◽  
Randomized Controlled ◽  
New Findings ◽  
In Pregnancy

Background:: The management of subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) in pregnancy is still uncertain. Over the years, several scientific societies published guidelines on the management of thyroid dysfunction before, during, and after pregnancy, the most recent ones being published by the American Thyroid Association (ATA) in 2017. Objective:: This study aimed to review the published literature in the field since 2017 onward to investigate whether new findings can change ATA recommendations. Methods:: Literature search was conducted in PubMed between March 2017 (date of the publication of the ATA guidelines) and March 2020. Research was restricted to randomized controlled trials (RCTs), having pregnancy-related complications in patients with SCH and TAI as the main focus. Results:: A total of 5 RCTs were retrieved, 2 of which investigated pregnant women with SCH and 3 with TAI. Selected studies displayed proofs against treating maternal SCH and hypothyroxinemia because no benefit from LT4 was demonstrated in offspring intelligence quotient and in pregnancy outcomes; moreover, they reported proofs against treating TAI patients because no benefit from LT4 was demonstrated in improving pregnancy rate or live birth rate or reducing miscarriage rate. Conclusion:: RCTs published from 2017 to 2020 might have a significant impact on current ATA guidelines. In particular, they suggested that isolated hypothyroxinemia and SCH should not be treated and that considering treatment in antibody-positive women, especially those with TSH of 2.5–4.0 mIU/L, would not be justified; they suggested that infertility and miscarriage rates are not decreased by LT4 treatment in euthyroid antibody-positive women seeking pregnancy.

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.

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