Practice Variation in the Care of Subclinical Hypothyroidism During Pregnancy: A National Survey of Physicians in the United States

Abstract

Evidence regarding the effects of subclinical hypothyroidism (SCH) on adverse pregnancy outcomes and the ability of levothyroxine (LT4) treatment to prevent them is unclear. Available recommendations for the management of SCH during pregnancy are inconsistent. We conducted a nationwide survey among physicians assessing their knowledge of and current practices in the care of SCH in pregnancy and compared these with the most recent American Thyroid Association (ATA) recommendations. In this cross-sectional study, an online survey was sent to active US members of the Endocrine Society. This survey included questions about current practices and clinical scenarios aimed at assessing diagnostic evaluation, initiation of therapy, and follow-up in pregnant women with SCH. In total, 162 physicians completed the survey. ATA guidelines were reviewed by 76%, of whom 53% indicated that these guidelines actually changed their practice. Universal screening was the preferred screening approach (54%), followed by targeted screening (30%). For SCH diagnosis, most respondents (52%) endorsed a TSH level >2.5 mIU/L as a cutoff, whereas 5% endorsed a population-based cutoff as recommended by the ATA. The decision to initiate treatment varied depending on the specific clinical scenario; however, when LT4 was initiated, respondents expected a small/very small reduction in maternofetal complications. In conclusion, despite recently updated guidelines, there is still wide variation in clinical practices regarding the care of women with SCH in pregnancy. Highly reliable randomized trials are required to evaluate the effectiveness of the most uncertain treatment practices on the care of pregnant women with SCH.

Use of levothyroxine among pregnant women with subclinical hypothyroidism in the United Kingdom: A population‐based assessment

“…In addition, this equipoise is reflected by the heterogeneity of practice patterns observed across geographic regions in our study. This is consistent with a US utilization study that showed variations in prescribing patterns across different specialists, 13 as well as studies examining clinical perceptions of practices for SCH management in pregnancy 31,32 . This heterogeneity may be explained by emerging concerns 33 about the harms of overtreating, and uncertainties about the benefits of treating SCH with levothyroxine during pregnancy 34‐36 .…”

“…This is consistent with a US utilization study that showed variations in prescribing patterns across different specialists, 13 as well as studies examining clinical perceptions of practices for SCH management in pregnancy. 31 , 32 This heterogeneity may be explained by emerging concerns 33 about the harms of overtreating, and uncertainties about the benefits of treating SCH with levothyroxine during pregnancy. 34 , 35 , 36 Future high‐quality studies are warranted to examine the safety and effectiveness of levothyroxine for women with SCH on health outcomes of mothers and their offspring.…”

Manejo del cáncer de tiroides durante el embarazo

“…La mayoría de los estudios establecen que el valor objetivo en embarazadas debe ser menor a 0,5 mUI/L. Para pacientes de alto riesgo, se recomiendan dosis que logren la supresión de TSH, como se realiza fuera del embarazo (48) . Los casos de cáncer de tiroides resistente a yodo radiactivo pueden ser tratados con inhibidores de tirosina quinasa.…”

Schilddrüse: Fertilität, Schwangerschaft und Laktation

“…Schilddrüsenerkrankungen sind bei Frauen präkonzeptionell, in der Schwangerschaft und der postpartalen Zeit häufig anzutreffen, wobei man akzeptieren muss, dass es noch immer wissenschaftliche Diskussionen um die jeweiligen Hormongrenzwerte in diesem Kontext gibt und das praktische Vorgehen in der klinischen Routine recht heterogen ist [36][37][38]. Diverse Beobachtungsstudien haben in der Vergangenheit einen Zusammenhang zwischen einer latenten Hypothyreose bzw.…”