The American Thyroid Association (ATA) has released new evidence-based recommendations to guide clinicians in diagnosing and managing thyroid disease during pregnancy and the postpartum period. 

The new guidelines contain 97 recommendations that layout current best practices for thyroid function testing, iodine nutrition, pregnancy complications, and treatment of thyroid disease during pregnancy and lactation. The international task force provides a foundation on the assessment and treatment of thyroid disease in women during pregnancy, preconception, and the postpartum period. 

Specific diagnosis and management recommendations for hypothyroidism, thyrotoxicosis, thyroid nodules, and thyroid cancer, in addition to thyroid considerations in infertile women, fetal, and neonatal considerations are all included in the guidelines. The guidelines also define areas for future research. 

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Some of the recommendations rated as Strong based on high-quality-evidence include:

  • All pregnant women should ingest approximately 250mcg iodine daily. 
  • All breastfeeding women should ingest approximately 250mcg of dietary iodine daily. 
  • Hypothyroid patients receiving LT4 treatment with a suspected or confirmed pregnancy should independently increase their dose of LT4 by ~20-30% and urgently notify their caregiver for prompt testing and further evaluation. One means of accomplishing this is to administer 2 additional tablets weekly of the patient’s current daily levothyroxine dosage.
  • Women taking methimazole or propylthiouracil should be instructed to confirm potential pregnancy as soon as possible. If the pregnancy test is positive, pregnant women should contact their caregiver immediately.
  • A combination regimen of levothyroxine and an antithyroid drug should not be used in pregnancy, except in the rare situation of isolated fetal hyperthyroidism.

The “2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum” has been published in Thyroid.

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