Management of Thyroid Dysfunction during Pregnancy and Postpartum

Full Guideline: Management of Thyroid Dysfunction during Pregnancy and Postpartum
JCEM August 2012

Leslie De Groot, Marcos Abalovich, Erik K. Alexander, Nobuyuki Amino, Linda Barbour, Rhoda H. Cobin, Creswell J. Eastman, John H. Lazarus, Dominique Luton, Susan J. Mandel, Jorge Mestman, Joanne Rovet, Scott Sullivan

Objective:

The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007.

Background:

This guideline is concerned with the management of pregnant women who may have a variety of known or undisclosed thyroid conditions, such as hypothyroidism and hyperthyroidism, the presence of thyroid autoantibodies, the presence of nodules, or inadequate iodine nutrition. Pregnancy may affect the course of these thyroid disorders, and conversely, thyroid diseases may affect the course of pregnancy. Moreover, the thyroid disorders (and their management) may affect both the pregnant woman and the developing fetus. Finally, pregnant women may be under the care of multiple health care professionals, including obstetricians, nurse midwives, family practitioners, endocrinologists, and/or internists, making the development of guidelines all the more critical.

Conclusions:

  • Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval.
  • These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease.
  • Indications and side effects of therapeutic agents used in treatment are also presented.

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