Experts Release New International Guidelines for Thyroid Disease in Pregnancy

With help from local experts at BUSM and Brigham and Women’s Hospital, the American Thyroid Association (ATA) published new guidelines for the management of thyroid disorders, seeking to improve the health of nearly 300,000 affected pregnant women in the United States each year. Thyroid disease is a common and frequently dangerous clinical problem during pregnancy.

Using all available published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception and the postpartum period, an expert task force has conducted a new and comprehensive analysis leading to over 100 clinical recommendations. These new guidelines appear in the current issue of the journal Thyroid.

These revised guidelines include:

  • Recommendations regarding the interpretation of thyroid function tests in pregnancy
  • Optimal iodine nutrition
  • The impact of thyroid autoantibodies
  • Important thyroid considerations in infertile women
  • The treatment of hypothyroidism, thyrotoxicosis, and thyroid nodules/cancer in pregnancy
  • Important fetal, neonatal and lactation considerations
  • A critical discussion surrounding the pros and cons of universal screening for thyroid dysfunction in pregnancy is available

“These guidelines represents the best effort to create a useful, practical, and accurate document designed to help the practicing clinician, patients, researchers and health policy makers while also stimulating future research and discovery into this important and complex arena,” explained co-chairperson and corresponding author Elizabeth Pearce, MD, MSc, associate professor of medicine, BUSM.

Specific clinical questions addressed in these guidelines were based on stakeholder and task force member input, building off of prior versions of the guidelines. Reflecting the wealth of new evidence in this field, these 2017 ATA Guidelines address three new topics not discussed in prior versions, and expand by 10 the overall number of clinical recommendations. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies.

“We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders,” added Pearce, who is also an endocrinologist at BMC.

“With an estimated 300,000 pregnancies impacted by thyroid disease in the United States annually, these guidelines coalesce the best available evidence into clear clinical recommendations, and should improve the health of many mothers and newborns alike,” said Erik K. Alexander, MD, co-chairperson and lead author of the Thyroid publication, and chief of the Thyroid Unit in the Division of Endocrinology at Brigham and Women’s Hospital.