Comparison of the American Thyroid Association with the Endocrine Society practice guidelines for the screening and treatment of hypothyroidism during pregnancy (original) (raw)
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Subclinical hypothyroidism (SCH) is defined as a normal serum FT4 and a high serum thyrotropin (TSH) concentration. Up to 30% of patients with SCH may have vague, non-specific symptoms of hypothyroidism, but attempts to identify the patients on the basis of clinical finding have not been successful, so the diagnosis can only be made with laboratory testing. The causes of SCH are the same as those of overt hypothyroidism. Most patients have Hashimoto's thyroiditis. The worldwide prevalence of SCH ranges from 1-10%. A substantial proportion of patients with SCH develop overt hypothyroidism. Serum TSH concentration and positive antithyroid antibodies (ATA) are significant predictors of progression to clinical hy-pothyroidism. Some patients with SCH have some symptoms of hypothyroidism, while some studies show significant improvement in hypo-thyroid symptom scores and psychometric testing ; others found no improvement in symptoms with levothyroxine therapy. There is consensus that SCH in pregnancy is a risk factor for poor developmental outcomes in the offspring and the condition should be treated in women who wish to become pregnant. There is also agreement that patients with SCH and TSH levels over 10 mU/L, or with goiter should be treated. Population-based screening for SCH is not warranted, but thyroid function should be tested in high risk groups, e.g. in women aged over 60 yr, persons with previous radiation therapy of thyroid gland or external radiation, those with previous thyroid surgery of thyroid dysfunction, type 1 diabetes mellitus patients and those with a family history of auto-immune disease. Evidence documenting routine determination of TSH in pregnant women or women planning to become pregnant are insufficient , and it would be reasonable to consider TSH measurement in those at high risk for thyroid dysfunction.
Review Article TSH Levels in Subclinical Hypothyroidism in the 97.5th Percentile of the Population
e debate regarding the cutoff point in the treatment of patients with subclinical hypothyroidism (Shypo) is ongoing. Generally, two different groups are identified for treatment by levels of 10 and 20 mIU/L. Nevertheless, the question remains, "what cutoff point should be chosen?" We have written a selective nonsystematic review focused on the 97.5 percentile reference value reported in healthy subjects in a number of countries and observed important disparities, which partly show the challenge of identifying a single cutoff point for those patients needing medication. We identified studies of TSH on the natural history of subclinical hypothyroidism from population-based prospective cohort studies, which follow up patients for several years. e evolution of TSH levels in these patients is variable. Some cases of TSH may return to lower levels at different stages over the years, but others may not, possibly even developing into overt thyroid failure, also variable. We analyzed factors that may explain the normalization of serum TSH levels. In addition, we found that thorough population-based prospective cohort studies following up on TSH levels, thyroid antibodies, and ultrasonography are important in decisions made in the treatment of patients. However, the 97.5 percentile reference value varies in different countries; therefore, an international cutoff point for subclinical hypothyroidism cannot be recommended.
TSH Levels in Subclinical Hypothyroidism in the 97.5th Percentile of the Population
International Journal of Endocrinology, 2020
The debate regarding the cutoff point in the treatment of patients with subclinical hypothyroidism (Shypo) is ongoing. Generally, two different groups are identified for treatment by levels of 10 and 20 mIU/L. Nevertheless, the question remains, “what cutoff point should be chosen?” We have written a selective nonsystematic review focused on the 97.5 percentile reference value reported in healthy subjects in a number of countries and observed important disparities, which partly show the challenge of identifying a single cutoff point for those patients needing medication. We identified studies of TSH on the natural history of subclinical hypothyroidism from population-based prospective cohort studies, which follow up patients for several years. The evolution of TSH levels in these patients is variable. Some cases of TSH may return to lower levels at different stages over the years, but others may not, possibly even developing into overt thyroid failure, also variable. We analyzed fac...
Hypothyroidism in Pregnancy: A Hospital based cross sectional study
Innovative publication, 2016
Introduction: Uncontrolled hypothyroidism is associated with serious maternal, fetal, and neonatal morbidity, and mortality. Overt hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with elevated TSH and decreased serum levels of T4 or T3. Subclinical hypothyroidism is defined as a condition without typical symptoms of hypothyroidism, elevated TSH (>5 µU/mL), and normal circulating thyroid hormone.
Five-Year Follow-Up for Women With Subclinical Hypothyroidism in Pregnancy
The Journal of Clinical Endocrinology & Metabolism, 2013
Context: Increasing numbers of women are being treated with L-thyroxine in pregnancy for mild thyroid dysfunction because of its association with impaired neuropsychological development in their offspring and other adverse obstetric outcomes. However, there are limited data to indicate whether treatment should be continued outside of pregnancy. Objectives: We aimed to determine whether subclinical hypothyroidism and maternal hypothyroxinemia resolve postdelivery. Design, Setting, and Participants: A total of 523 pregnant healthy women with no known thyroid disorders were recruited during routine antenatal care and provided blood samples at 28 weeks of pregnancy and at a mean of 4.9 years postpregnancy. Main Outcome Measures: TSH, free T 4 , free T 3 , and thyroid peroxidase antibody levels were measured in serum taken in pregnancy and at follow-up. Results: Subclinical hypothyroidism in pregnancy (TSH Ͼ3 mIU/L) was present in 65 of 523 (12.4%) women. Of these, 49 (75.4%) women had normal thyroid function postpregnancy; 16 of 65 (24.6%) had persistent high TSH (TSH Ͼ4.5 mIU/L postpregnancy) with 3 women receiving L-thyroxine treatment. A total of 44 of 523 (8.4%) women had isolated maternal hypothyroxinemia in pregnancy (free T 4 Ͻ10th centile and TSH Յ3 mIU/L). Only 2 of 44 (4.5%) had TSH Ͼ4.5 mIU/L outside pregnancy. Of the women with subclinical hypothyroidism in pregnancy with antibody measurements available, those with thyroid peroxidase antibodies in pregnancy were more likely to have persistently elevated TSH or be receiving L-thyroxine replacement after pregnancy (6 of 7 [86%] vs 10 of 57 [18%], P Ͻ .001). Conclusions: The majority of cases of subclinical hypothyroidism in pregnancy are transient, so treatment with L-thyroxine in these patients should be reviewed because it may not be warranted after pregnancy.
Management of subclinical hypothyroidism in pregnancy: are we too simplistic?
European Journal of Endocrinology, 2015
Guideline advice of many societies on the management of subclinical hypothyroidism in pregnancy suggests treatment when TSH serum levels exceed 2.5 mU/l. Justification of this procedure is based on limited experience, mainly from studies carried out in patients with positive thyroid-specific antibodies and higher TSH levels that classically define the condition in the non-pregnant state. Taking into account a lack of clear understanding of the regulation of thyroid hormone transport through the utero-placental unit and in the absence of foetal markers to monitor the adequacy of thyroxine treatment, this review attempts to discuss currently available data and suggests a more cautious approach.
Subclinical Hypothyroidism in Pregnancy And Outcomes
Background: Screening for subclinical hypothyroidism is essential in all pregnant women, especially in the Indian context, as Indian women have increased risk of developing iodine deficiency during pregnancy. Hence this study was undertaken to study the prevalence of subclinical hypothyroidism. Emphasis was put to know the need for universal screening and also the obstetric outcome in terms of perinatal morbidity and mortality and maternal morbidity were assessed. Methods: It is a retrospective study. Sample size consisted of 200 pregnant women admitted in KIMS,HUBLI during march 2016 to march 2017. Thyroid profile (serum TSH, FT3 and FT4) was done during first visit and in subsequent trimester of each pregnant woman. The results were analyzed taking into consideration recent endocrine society guidelines. Patients with normal thyroid levels were taken as controls. Detailed history taken, physical examination and routine laboratory investigations were done. Patients with SCH were started on Levothyroxine and serial monitoring of TSH done until delivery. The patients were followed up to assess the mode of delivery, maternal and fetal outcome and any associated co-morbidities to serve the secondary objective of the study. Babies of SCH mothers were screened as well to rule out congenital hypothyroidism. Results: Incidence of SCH was found to be 9.5% in the patients studied. Pregnant women with SCH had increased risks of developing anemia (31.5%), preeclampsia (15%), GDM (5%) and prematurity (10%), higher cesarean section rate (36.8%). Neonates of women with SCH had higher incidence poor APGAR score (47.36%), LBW (15%), NICU admission (10%), IUGR (5%). Increased maternal age and more BMI were associated with higher incidence of subclinical hypothyroidism. Conclusions: Prevalence of subclinical hypothyroidism among pregnant women is fairly high among Indians. Screening for subclinical hypothyroidism has to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcomes.
Observational Study of Subclinical Hypothyroidism in Pregnancy
Introduction: Maternal thyroid dysfunction is the second common endocrine disorder during pregnancy. Prevalence of subclinical hypothyroidism during pregnancy is increasing. It is associated with adverse maternal and foetal outcomes like pre-eclampsia, GDM, preterm, IUGR and miscarriage, anaemia, IUD. Objective: To study the prevalence of Subclinical hypothyroidism during pregnancy and its relation with adverse maternal and foetal outcomes. Methods and materials: It was an observational study undertaken at RRMCH from May-2013 to Feb 2014. Pregnant women were screened for thyroid dysfunction irrespective of gestational age. Women with raised Thyroid stimulating Hormone (TSH) were included in the study. Pregnancy outcome of women with raised TSH was compared with euthyroid pregnant women. Results: Study group included 1663 pregnant women. Among them 168 women had hypothyroidism, women with subclinical and overt hypothyroidism were 156 and 12 respectively. Prevalence of hypothyroidism in this study was 10.1%, Subclinical Hypothyroidism and Overt hypothyroidism was 9.3% and 0.72% respectively. Overall prevalence of autoimmunity was 19.04% (n=32) in women with hypothyroidism. Prevalence of autoimmunity in SCH and OH was 17.9% (n=28) and 33.3% (n=4) respectively. In women with SCH 81.4% developed complications like Pre-eclampsia (21.8%), GDM (6.4%), Preterm labor (7.1%) and IUGR (7.7%) anemia (5.8%) compared to euthyroid women (p value <0.001). Conclusions: Increasing prevalence of Subclinical Hypothyroidism during pregnancy and its association with adverse maternal and foetal outcome makes it a high risk factor. Subclinical hypothyroidism is like the bottom of the iceberg, hence prompt screening for thyroid dysfunction and early initiation of treatment can prevent adverse maternal and fetal morbidity.