The Role of Clinical Guidelines in Patient Care: Thyroid Hormone Replacement in Women of Reproductive Age

Haymart, Megan R.

doi:10.1089/thy.2009.0321

Cited by 25 publications

(21 citation statements)

References 38 publications

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“…However, even with novel prospective studies, many controversies still exist regarding the most appropriate approach for the L-T 4 dose adjustment in pregnancy (7,8). This study aims to analyze the management approach for hypothyroidism during pregnancy in Latin America and compare with data from Europe.…”

Section: Introductionmentioning

confidence: 99%

An international survey of screening and management of hypothyroidism during pregnancy in Latin America

Medeiros

Cerqueira

Silva

et al. 2014

Arq Bras Endocrinol Metab

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Objective: To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods: In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results: Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion: Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol Metab. 2014;58(9):906-11 Keywords Hypothyroidism; thyroid; pregnancy RESUMO Objetivo: Determinar, na América Latina, como os endocrinologistas lidam com cenários clínicos relacionados ao hipotireoidismo durante a gravidez. Materiais e métodos: Em Janeiro de 2013, foi enviado, para 856 membros da Sociedade Latino-Americana de Tireoide (LATS), um questionário eletrônico sobre práticas relacionadas ao manejo do hipotireoidismo durante a gestação. Subsequentemente, as respostas foram analisadas. Resultados: Duzentos e noventa e três médicos, de 13 países, responderam ao questionário. Todos estavam diretamente envolvidos no manejo de hipotireoidismo materno e 90,7% eram endocrinologistas. As recomendações de iniciar terapia com levotiroxina para uma mulher com hipotireoidismo franco durante a gravidez e o manejo na fase de pré-concepção de pacientes eutireoidianas com conhecida autoimunidade em hiperestimulação ovariana variaram amplamente. Para mulheres com hipotireoidismo conhecido, apenas 34,6% dos respondedores aumentariam a dose de levotiroxina em 30-50% assim que a gravidez fosse confirmada. Em relação ao rastreamento, 42,7% dos respondedores realizam avaliação universal. Setenta por cento recomendam TSH < 2,5 mUI/L no primeiro trimestre e TSH < 3 mUI/L no terceiro trimestre como alvos. Conclusão: Observamos problemas no diagnóstico e manejo do hipotireoidismo durante a gestação, enfatizando a necessidade...

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Section: Introductionmentioning

confidence: 99%

An international survey of screening and management of hypothyroidism during pregnancy in Latin America

Medeiros

Cerqueira

Silva

et al. 2014

Arq Bras Endocrinol Metab

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“…22,67 Given that most clinicians undertaking early pregnancy assessment will not be endocrinologists or obstetric physicians, there is also concern that case finding guidelines may not be followed or that providers may not even be aware they exist. 68,69 Complex case finding rules (such as Box 3) may well limit uptake of guidelines in practice.…”

Section: Universal Screening Versus Case Findingmentioning

confidence: 99%

Subclinical hypothyroidism and related biochemical entities in pregnancy: implications and management

McLeod

McIntyre

2010

Obstet Med

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Summary: Subclinical hypothyroidism (SCH), thyroid autoimmunity and isolated maternal hypothyroxinaemia are diagnoses made on laboratory findings. The two former conditions are commonly identified in the general population, while the term isolated maternal hypothyroxinaemia was developed to highlight potential neurodevelopmental risks in progeny. Each entity has been associated with either obstetric, perinatal and/or child developmental harm in observational studies, although few interventional trials have been performed to guide diagnostic and therapeutic approaches. Once diagnosed, treatment of SCH is recommended by endocrine groups to limit potential risk, given that harm from appropriate therapy is unlikely. Screening for thyroid disorders in pregnancy has traditionally been controversial. Definitive trials are expected to report over coming years and updated consensus guidelines will hopefully resolve this issue.

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“…For women on LT4, the LT4 dose often needs to be increased by 4-6-week gestation and may require a 30%-50% increase (1,8). However, our previous work has revealed that 76% of obstetric care providers initially see patients after the optimal window for dose adjustment (18). The rate of miscarriage is high before 6 weeks of gestation (19), and many obstetric care providers schedule the initial prenatal visit close to 10 weeks of gestation when fetal heart beat can be confirmed.…”

mentioning

confidence: 99%

“…Although it may have been assumed that the issue of thyroid hormone replacement in pregnancy only pertains to obstetricians, a recent study has shown that most pregnant women are not under obstetric care until after the optimal 1 window for LT4 dose increase occurs (18). For women on LT4, the LT4 dose often needs to be increased by 4-6-week gestation and may require a 30%-50% increase (1,8).…”

mentioning

confidence: 99%

“…Although this is a logical and appropriate time to schedule prenatal visits for most patients, this missed window for LT4 dose adjustment is one explanation for why 49% of women on LT4 have thyroidstimulating hormone levels outside goal range during the first trimester (11). Given the risks of poorly treated hypothyroidism during pregnancy (1)(2)(3)(4)(5)(6) and that many of these patients are not under obstetric care at the preferred time of initial dose increase (18), prepregnancy counseling on LT4 changes during pregnancy is important. Education before conception enables a patient to be her own advocate and have thyroid function addressed at the time of confirmed conception instead of at the initial antenatal visit.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Thyroid Hormone Replacement in Women of Reproductive Age: Is Surgeon Knowledge Related to Operative Volume?

Haymart

Cayo

Chen

2010

Thyroid

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The Role of Clinical Guidelines in Patient Care: Thyroid Hormone Replacement in Women of Reproductive Age

Cited by 25 publications

References 38 publications

An international survey of screening and management of hypothyroidism during pregnancy in Latin America

An international survey of screening and management of hypothyroidism during pregnancy in Latin America

Subclinical hypothyroidism and related biochemical entities in pregnancy: implications and management

Thyroid Hormone Replacement in Women of Reproductive Age: Is Surgeon Knowledge Related to Operative Volume?

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