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

Medeiros, Manoel; Cerqueira, Taíse Lima de Oliveira; Silva, Joaquim Custódio; Amaral, Magali Teresópolis Reis; Vaidya, Bijay; Poppe, Kris; Carvalho, Gisah Amaral de; Gutiérrez, Sílvia; Alcaraz, Graciela; Abalovich, Marcos; Ramos, Helton Estrela

doi:10.1590/0004-2730000003382

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…A similar attitude was previously demonstrated by other surveys published between 2012 and 2018, all showing that keeping TSH < 2.5 mIU/L is a common attitude, especially when TPOAb are positive [10][11][12]. Since the publication of previous ATA guidelines in 2011, several studies have shown that the number of women defined as hypothyroid, and consequently treated, remarkably increased when considering 2.5 mIU/L as the cut-off value [32][33][34].…”

Section: Discussionsupporting

confidence: 77%

“…A previous survey among European Thyroid Association (ETA) members revealed that 42% of respondents screened all pregnant women and 43% adopted a case-finding approach; in another survey, 75% of Iranian endocrinologists opted for targeted screening, whilst universal screening was supported by 57% in Israel and by 43% in Latin America [9][10][11][12]. Two large-scale trials failed to demonstrate any benefit of LT4 on cognitive outcomes, and a recent study found a similar proportion of children with an IQ < 85 from women with normal and suboptimal gestational thyroid function [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

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A 2018 Italian and Romanian Survey on Subclinical Hypothyroidism in Pregnancy

et al. 2018

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Objectives: Pregnancy induces changes in thyroid function, and thyroid dysfunction during gestation is associated with adverse outcomes. We examined the management of subclinical hypothyroidism and chronic autoimmune thyroiditis in pregnancy among Italian and Romanian endocrinologists. Methods: Members of the Associazione Medici Endocrinologi (AME) and Romanian Society of Endocrinology (RSE) were invited to participate in a web-based survey investigating the topic. Results: A total of 902 individuals participated in the survey, 759 of whom completed all sections. Among the respondents, 85.1% were aware of the 2017 American Thyroid Association guidelines about thyroid disease and pregnancy, and 82.9% declared that thyroid-stimulating hormone (TSH) screening at the beginning of pregnancy should be warranted. In a patient negative for peroxidase antibodies, 53.6% considered 2.5 mIU/L and 26.2% considered 4.0 mIU/L as the upper normal limit of TSH, and 50% would treat a patient with TSH 3.5 mIU/L with levothyroxine. About 20% did not suggest iodine supplementation. Isolated hypothyroxinemia detected in the first trimester would be treated by 40.8%. In patients undergoing ovarian stimulation, a TSH < 2.5 mIU/L would be targeted by 70%. Conclusions: Respondents globally appeared well informed about the management of thyroid autoimmunity and subclinical hypothyroidism in pregnancy. A more aggressive attitude in implementing iodine supplementation would be desirable. Most endocrinologists were convinced about an evident association between mild thyroid impairment and adverse outcomes in pregnancy, thus using a TSH value of 2.5 mIU/L as the threshold for diagnosing hypothyroidism and starting levothyroxine in pregnant women.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

A 2018 Italian and Romanian Survey on Subclinical Hypothyroidism in Pregnancy

et al. 2018

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“…The Spanish Society of Endocrinology and Nutrition [ 13 ] and the Indian Thyroid Society [ 71 ] have advocated global screening in early stages of pregnancy or before pregnancy. A survey of members of professional associations showed that 42.7% of respondents in Latin America and 43% in Europe perform global screening [ 72 , 73 ], while only 21% of members of the Asia-Oceania Thyroid Association (AOTA) perform this [ 74 ], and 74% of ATA members support such an approach [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

Sepasi

Rashidian

Shokri

et al. 2020

BMC Pregnancy Childbirth

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Background: Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and fetus. The present meta-analysis was conducted to evaluate thyroid dysfunction in Iranian pregnant women. Methods: We registered this review at PROSPERO (registration number: CRD42020166655). The research steps in this systematic review and meta-analysis were performed according to the MOOSE protocol, and finally, reports were provided based on the PRISMA guidelines. The literature search was performed in October 2019 using the international online databases, including Web of Science, Ovid, Science Direct, Scopus, EMBASE, PubMed/Medline, Cochrane Library, EBSCO, CINAHL, Google Scholar as well as national databases were reviewed. Data were extracted after applying the inclusion and exclusion criteria and qualitative evaluation of the studies. I 2 index and Q test were used to assess differences in studies. All analyses were performed using Comprehensive Meta-Analysis Software. Pvalue less than 0.05 was considered statistically significant. We identified 1261 potential articles from the databases, and 426 articles remained after removing the duplicate and unrelated studies. After evaluating the full text, 52 articles were removed. Results: Finally, 19 eligible studies including 17,670 pregnant women included for meta-analysis. The prevalence of thyroid dysfunction in Iranian pregnant women was 18.10% (95%CI: 13.89-23.25). The prevalence of hypothyroidism, clinical hypothyroidism, and subclinical hypothyroidism in Iranian pregnant women was respectively estimated to be 13.01% (95%CI: 9.15-18.17), 1.35% (95%CI: 0.97-1.86) and 11.90% (95%CI: 7.40-18.57). The prevalence of hyperthyroidism, clinical hyperthyroidism, and subclinical hyperthyroidism in Iranian pregnant women was respectively estimated to be 3.31% (95%CI: 1.62-6.61), 1.06% (95%CI: 0.61-1.84) and 2.56% (95%CI: 0.90-7.05). The prevalence of anti-thyroperoxidase antibody was estimated to be 11.68% (95%CI: 7.92-16.89). Conclusion: The results of this meta-analysis showed a high prevalence of thyroid disorders, especially hypothyroidism. The decision to recommend thyroid screening during pregnancy for all women is still under debate, because the positive effects of treatment on pregnancy outcomes must be ensured. On the other hand, evidence about the effect of thyroid screening and treatment of thyroid disorders on pregnancy outcomes is still insufficient. Nevertheless, a large percentage of general practitioners, obstetricians and gynecologists perform screening procedures in Iran.

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“…This divergence is also observed in clinical practice. A Latin American study showed that 38.4% of responders use a universal screening strategy and 43% prefer a casefinding approach in high-risk groups (6). Finally, the recommendations for levothyroxine (L-T4) treatment were revised in the recent ATA/AACE guidelines (1).…”

Section: Introductionmentioning

confidence: 99%

Selective screening for thyroid dysfunction in pregnant women: How often do low-risk women cease to be treated following the new guidelines of the American Thyroid Association?

Rosário¹

2018

Archives of Endocrinology and Metabolism

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Objective: Universal screening for thyroid dysfunction in pregnant women is not recommended by the American Thyroid Association (ATA) or the American Association of Clinical Endocrinologists (AACE). This study evaluated the frequency of pregnant women that would have an indication for levothyroxine (L-T4) according to the new ATA/AACE guidelines among low-risk women without an indication for screening with TSH. Subjects and methods: The sample consisted of 412 pregnant women ranging in age from 18 to 30 years. These women were considered to be at low risk for thyroid dysfunction according to ATA/AACE and would not be candidates for screening with TSH. Anti-thyroid peroxidase antibodies (TPOAb) and TSH were measured. Women who had TSH > 2.5 mIU/L or TPOAb in the first trimester were submitted to subsequent evaluations in the second and third trimester. Results: In the first trimester, none of the pregnant women would have L-T4 therapy "recommended" and treatment would be "considered" in only two. In the second trimester, pregnant women with positive TPOAb or TSH > 2.5 mIU/L in the first trimester (n = 30) were reevaluated. L-T4 treatment would be "recommended" in only one woman and would be "considered" in two others. The 28 women that were not treated in the second trimester were reevaluated in the third trimester, but none of them would have L-T4 "recommended". Conclusion: The findings of the study suggest that selective screening, recommended by ATA/AACE does not result in a significant loss of pregnant women with an indication for L-T4 treatment.

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

Cited by 14 publications

References 9 publications

A 2018 Italian and Romanian Survey on Subclinical Hypothyroidism in Pregnancy

A 2018 Italian and Romanian Survey on Subclinical Hypothyroidism in Pregnancy

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

Selective screening for thyroid dysfunction in pregnant women: How often do low-risk women cease to be treated following the new guidelines of the American Thyroid Association?

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