New Guidelines Released for Managing Thyroid Disease Throughout Pregnancy

New clinical guidelines concerning the diagnosing and managing of thyroid disease during pregnancy have been created and released.

This action is the result of new information relating to the hazards insufficient thyroid activity throughout pregnancy can have on the health of both the mother and the fetus, as well as the impact it can have on the future intellectual growth of the child.

The guidelines were developed by an American Thyroid Association (ATA) expert task force.

"Thyroid disease in pregnancy is common, clinically important, and time-sensitive, and our knowledge about it is rapidly changing,” reported Richard T. Kloos, MD, Professor, The Ohio State University and Secretary/Chief Operating Officer of the ATA.

“This ATA Guideline will disseminate this new information both widely and rapidly to improve patient care, establish what we believe is optimal care for the pregnant woman and her unborn child, and drive future research to further improve our understanding and patient outcomes," Kloos added.

Current clinical studies have been uncovering vital information which exhibits the detrimental effects not only of overt hypothyroidism and hyperthyroidism on pregnancy, but also of subclinical thyroid disease and maternal and fetal health.

Ongoing research is in the process of conducting further examination on the connection between miscarriage and preterm delivery in women with normal thyroid function who are thyroid peroxidase antibody positive.

Other investigations are presently focusing on and exploring the long-term effects of postpartum thyroiditis.

"Pregnancy has a profound impact on the thyroid gland and thyroid function…. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency," stated Alex Stagnaro-Green, George Washington University School of Medicine and Health Sciences (Washington, DC), and coauthors representing the ATA task force.

There are many recommendations made in the new guidelines, including:

• Oral levothyroxine should be used to treat pregnant women who suffer from overt hypothyroidism or with subclinical hypothyroidism who are TPO antibody positive.
• Other thyroid preparations such as triiodothyronine or desiccated thyroid are strongly recommended against for treating maternal hypothyroidism.
• Physicians should monitor women with subclinical hypothyroidism in pregnancy who are not initially treated for progression to overt hypothyroidism with serum TSH and free T4 measurements about every four weeks until sixteen to twenty weeks gestation, and at least once between twenty-six and thirty-two weeks gestation.

These new recommendations concentrate on several important sections in the diagnosis and management of thyroid disease during pregnancy and postpartum, such as:

• Thyroid function tests
• Hypothyroidism
• Thyrotoxicosis
• Iodine
• Thyroid antibodies and miscarriage/preterm delivery
• Thyroid nodules and cancer
• Postpartum thyroiditis

These guidelines also include further recommendations for screening for thyroid disease during pregnancy, as well as potential areas for future research.

The President of the ATA, Gregory A. Brent, said that "these important guidelines were developed by a panel of international experts representing the disciplines of endocrinology, obstetrics and gynecology, and nurse midwives.”

“This broad representation of providers that care for pregnant women will significantly increase the impact of these guidelines and translation of findings from the most recent research to clinical practice," continued Brent, who is also the Professor of Medicine and Physiology at David Geffen School of Medicine at the University of California Los Angeles.

The guideline are presented in Thyroid and are available free online at www.liebertpub.com/thy