Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline

University of Rhode Island, Providence, Rhode Island 02881, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 08/2012; 97(8):2543-65. DOI: 10.1210/jc.2011-2803
Source: PubMed


The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at
This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.
The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes.
Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.

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Available from: Joanne F Rovet, Dec 04, 2014
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    • "This information was in response to general questions about medical conditions; questions specifically about thyroid disease were not asked. We examined the association of craniosynostosis with the following factors related to maternal thyroid dysfunction: maternal age, race-ethnicity, parity, pre-pregnancy body mass index (BMI), fertility medications or procedures (as a proxy for fertility problems), previous miscarriages , diabetes, hypertension, intake of anti-depressants (a proxy for depression) or iron-only supplements (a proxy for anemia), smoking, and alcohol consumption [Glinoer 1998; Hollowell et al., 2002; Belin et al., 2004; Knudsen et al., 2005; Zimmermann et al., 2007; Ashoor et al., 2010; Carle et al., 2012a; Carle et al., 2012b; De Groot et al., 2012; Wu et al., 2013]. "
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    ABSTRACT: Thyroid disease is a common problem among women of reproductive age but often goes undiagnosed. Maternal thyroid disease has been associated with increased risk of craniosynostosis. We hypothesized that known risk factors for thyroid disease would be associated with risk of craniosynostosis among women not diagnosed with thyroid disease. Analyses included mothers of 1,067 cases and 8,494 population-based controls who were interviewed for the National Birth Defects Prevention Study. We used multivariable logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). After excluding women with diagnosed thyroid disease, younger maternal age (AOR 0.7, 95% CI 0.6-0.9, for <25 years versus 25-29), black or other race-ethnicity (AOR 0.3, 95% CI 0.2-0.4 and AOR 0.6, 95% CI 0.4-0.8, respectively, relative to non-Hispanic whites), fertility medications or procedures (AOR 1.5, 95% CI 1.2-2.0), and alcohol consumption (AOR 0.8, 95% CI 0.7-0.9) were associated with risk of craniosynostosis, based on confidence intervals that excluded 1.0. These associations with craniosynostosis are consistent with the direction of their association with thyroid dysfunction (i.e., younger age, black race-ethnicity and alcohol consumption are associated with reduced risk and fertility problems are associated with increased risk of thyroid disease). This study thus provides support for the hypothesis that risk factors associated with thyroid dysfunction are also associated with risk of craniosynostosis. Improved understanding of the potential association between maternal thyroid function and craniosynostosis among offspring is important given that craniosynostosis carries significant morbidity and that thyroid disease is under-diagnosed and potentially modifiable. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Full-text · Article · Feb 2015 · American Journal of Medical Genetics Part A
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    • "Thionamides Current guidelines by the American Thyroid Association, the American Association of Clinical Endocrinologists, and the Endocrine Society recommend the use of propylthiouracil (PTU) in the first trimester of pregnancy, and consideration to switch to methimazole after the first trimester [17] [18] [54]. These recommendations are based on concerns of rare congenital abnormalities associated with methimazole use during embryogenesis. "
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    ABSTRACT: Thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic hyperthyroidism. This review provides a summary of the differential diagnosis, clinical presentation, diagnostic options, potential adverse effects of maternal thyrotoxicosis to the fetus, and treatment recommendations for thyrotoxicosis arising in pregnancy.
    Full-text · Article · Dec 2014 · Journal of Clinical and Translational Endocrinology
    • "This may have a significant impact not only on the diagnosis but also monitoring of hypothyroidism, especially in situations where even marginal variations in TSH may be important like in pregnancy or sub-fertility. With recent guidelines for management of hypothyroidism during pregnancy stressing a target TSH of 2.5 mIU/L or less, the findings of our study may have more 0.[7] Further, lack of uniformity in the time of sampling for TSH may lead to unnecessary repetition of tests especially in a resource limited setting. With the above observations, we propose that a fasting TSH sample may be preferred to random or postprandial estimations as normal fasting values would obviate the need for retesting. "
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    ABSTRACT: Background: Thyroid stimulating hormone (TSH) levels vary with the time of the day and probably in relation to food. In this study, we addressed the question of whether a fasting or non-fasting sample would make a clinically significant difference in the interpretation of thyroid function tests. Materials and Methods: Fifty seven adult ambulatory patients were selected from our laboratory database and were divided into Group A [Normal free thyroxine (T4) and TSH], Group B (subclinical hypothyroid with increased TSH and normal free T4) and Group C (overt hypothyroid with low free T4 and high TSH). Thyroid functions (free T4 and TSH) were done in fasting state and 2 hours postprandially. Results: TSH was suppressed in all subjects after food irrespective of the fasting levels. Free T4 values did not change significantly. This resulted in reclassification of 15 out of 20 (75%) subjects as subclinical hypothyroidism (SCH) based on fasting values whose TSH values were otherwise within range in the postprandial sample. This may have an impact on the diagnosis and management of hypothyroidism especially where even marginal changes in TSH may be clinically relevant as in SCH and in pregnancy. Conclusion: TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.
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