Management of gestational hypothyroidism: results of a Brazilian survey

Abstract

Objectives: Evaluate the management of hypothyroidism in fertile-aged and pregnant women and compare these practices to the recommendations of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Latin American Thyroid Society, published in 2013. Materials and methods: In the first trimester of 2014, SBEM made available to all members an electronic questionnaire based on clinical scenarios in the management of gestational hypothyroidism. The responses of 406 physicians, most of them endocrinologists, were analyzed. Results: Eighty-one per cent of the endocrinologists screen all their pregnant patients for thyroid dysfunction, mostly during the pregestational period or after the first prenatal visit. Following screening, 82% of the respondents initiate treatment when TSH levels are > 2.5 mIU/L while 67% monitor their pregnant patients even if TSH was normal on first trimester screening. For hypothyroid women who are planning pregnancy, 96% of the clinicians are aware of the importance of adjusting the levothyroxine (LT 4 ) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT 4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT 4 are TSH and free T 4 (62%) or TSH alone (21%). Unanimously, the treatment goal is to achieve the target TSH level for each trimester of gestation. Conclusion: The recommendations of the consensus statements are incorporated into the respondents' clinical practice. It is noteworthy that the great majority of the clinicians favor universal screening. Arch Endocrinol Metab. 2016;60(1):16-20

Posthemithyroidectomy Pregnancy Thyroid Function Surveillance: Frequency, Adherence, and Guideline Impact

“…[4] Clinical practice surveys show variable results from 42-81% of responders, mostly endocrinologists and obstetricians, supporting routine serum TSH examination during pregnancy. [25,27,29] We found no studies examining the surveillance rates in post-hemithyroidectomy patients. In our study, most pregnancies were examined for serum TSH at least once (86.6%) during the rst trimester, which may be the result of a local tendency towards screening in pregnancy.…”

1H-NMR based metabolomic profiling of cord blood in gestational hypothyroidism

“…Besides the adverse effects during pregnancy, GHT also does harm to future health of mother and long-term development of the offspring (3,4). Comprehensive evaluations of the GHT prognosis is helpful in promoting public awareness of GHT (5), and is instrumental in guiding standard treatment of GHT (6).…”