New guidelines on managing thyroid disease in pregnancy

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The American Thyroid Association (ATA) has issued new guidelines on the diagnosis and management of thyroid disease during pregnancy and the postpartum period.

The guidelines, published online in Thyroid, are an update of the original 2011 guidelines and include 97 individual recommendations on the diagnosis and management of hypothyroidism, thyrotoxicosis, thyroid nodules and cancer, in pregnant women. It also addresses the issues of iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, and foetal and neonatal complications of maternal thyroid disease. Advice is provided regarding the interpretation of thyroid function tests in pregnancy, screening for thyroid dysfunction in pregnancy, and directions for future research.

The ATA acknowledges that “given the complexity surrounding thyroid physiology and thyroid illness during pregnancy and the postpartum period, how and when to evaluate for thyroid dysfunction, and how and if to treat thyroid illness during this period, remains challenging”.

The guidelines taskforce highlight the paucity of high-quality double-blinded placebo-controlled trials in the field of thyroid and pregnancy. Only one in four of the 97 recommendations is supported by evidence considered to be of high quality, based on the American College of Physicians grading system.