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Guidelines for thyroid disease treatment during pregnancy released
Management of thyroid disease among pregnant women requires special considerations.
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The Endocrine Society recently released new clinical practice guidelines for the management of thyroid problems during and after pregnancy.
The guidelines were developed by an international task force created under the auspices of the society. Members of the task force included representatives from The Endocrine Society, American Thyroid Association, Association of American Clinical Endocrinologists, European Thyroid Association, Asia and Oceania Thyroid Association and the Latin American Thyroid Society.
The guidelines were published in the Journal of Clinical Endocrinology & Metabolism. The task force reviewed published, original and peer-reviewed literature from the last two decades.
Special considerations
“In the last 15 years, we have seen a rapid expansion of knowledge regarding thyroid disease and pregnancy,” Leslie DeGroot, MD, professor of medicine at Brown University and chair of the expert panel that developed the guidelines, said in a press release. “These guidelines take into account the rapidity of advances in this field and puts forth evidence-based recommendations for optimal detection and management of thyroid disease in the pregnant woman.”
Pregnant women may have a variety of known or undisclosed thyroid conditions, such as hypothyroidism and hyperthyroidism, the presence of thyroid autoantibodies, the presence of nodules or unsatisfactory iodine nutrition, according to the guidelines.
Clinical practice guidelines are critical as management of thyroid disease among pregnant women may require coordination among several health care professionals, including obstetricians, nurse midwives, family practitioners, endocrinologists and/or internists.
Issues addressed by the guidelines’ recommendations include: hypothyroidism and pregnancy, thyroid nodules and cancer, treatment with radioactive iodine and screening for thyroid dysfunction.
Careful treatment required
Maternal and fetal hypothyroidism need to be avoided, as this disorder can lead to damaged fetal neural development, an increased incidence of miscarriage and preterm delivery.
Among the recommendations for maternal and fetal aspects of hypothyroidism and pregnancy, two items were graded as strong recommendations with high values of evidence.
First, the dose of thyroxine needs to be incremented by four to six weeks gestation and may require a 30% to 50% increase in dosage, according to the guidelines.
In addition, if overt hypothyroidism is diagnosed, thyroid function tests need to be normalized as rapidly as possible, and serum thyroid stimulating hormone concentrations need to be maintained at 2.5 mcU/L during the first trimester.
When treating pregnant or breastfeeding women with thyroid nodules or cancer, radioactive iodine with iodine 131 should not be used. Furthermore, pregnancy should be avoided six months to one year in women with thyroid cancer who receive therapeutic radioactive iodine doses to ensure stability of thyroid function and confirm remission of thyroid cancer. Fine needle aspiration cytology should be performed for dominant thyroid nodules discovered in pregnancy.
Although researchers do not yet support universal thyroid disease screening of pregnant women, they strongly support conducting studies aimed at specific groups of patients who are at an increased risk for the disease.
For more information:
- Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2007;92:S1-S47.