Thyroid disease is a common and frequently dangerous clinical problem during pregnancy. Led by local experts at Boston University School of Medicine (BUSM) and Brigham and Women's Hospital, the American Thyroid Association (ATA) published new guidelines for the management of these disorders, seeking to improve the health of nearly 300,000 affected pregnant women in the United States each year.
Using all available published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception and the postpartum period, an expert task force has conducted a new and comprehensive analysis leading to over 100 clinical recommendations. These new guidelines appear in the current issue of the journal Thyroid. Given the complexity surrounding thyroid physiology and thyroid illness during pregnancy and the postpartum period, how and when to evaluate for thyroid dysfunction, as well as how and if to best treat thyroid illness during this period, remain challenging.
These revised guidelines include recommendations regarding the interpretation of thyroid function tests in pregnancy, optimal iodine nutrition, the impact of thyroid autoantibodies, important thyroid considerations in infertile women, the treatment of hypothyroidism, thyrotoxicosis, and thyroid nodules/cancer in pregnancy, while also discussing important fetal, neonatal and lactation considerations. Finally, a critical discussion surrounding the pros and cons of universal screening for thyroid dysfunction in pregnancy is available.
"These guidelines represents the best effort to create a useful, practical, and accurate document designed to help the practicing clinician, patients, researchers and health policy makers while also stimulating future research and discovery into this important and complex arena," explained co-chairperson and corresponding author Elizabeth Pearce, MD, MSc, associate professor of medicine at Boston University School of Medicine (BUSM)
Specific clinical questions addressed in these guidelines were based on stakeholder and task force member input, building off of prior versions of the guidelines. Reflecting the wealth of new evidence in this field, these 2017 ATA Guidelines address three new topics not discussed in prior versions, and expand by 10 the overall number of clinical recommendations. 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.
"With an estimated 300,000 pregnancies impacted by thyroid disease in the United States annually, these guidelines coalesce the best available evidence into clear clinical recommendations, and should improve the health of many mothers and newborns alike," said Erik K. Alexander, MD, co-chairperson and lead author of the Thyroid publication, and chief of the Thyroid Unit in the Division of Endocrinology at Brigham and Women's Hospital.
"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," added Pearce who is also an endocrinologist at Boston Medical Center.
Article: 2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum, Dr. Erik K. Alexander, Dr. Elizabeth N. Pearce, Dr. Gregory A Brent, Dr. Rosalind S. Brown, Dr. Herbert Chen, Dr. Chrysoula Dosiou, Dr. William Grobman, Dr. Peter Laurberg, Prof. John H. Lazarus, Dr. Susan J Mandel, Dr. Robin Peeters, and Dr. Scott Sullivan, Thyroid, doi:10.1089/thy.2016.0457, published online 6 January 2017.