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Controversies in the Management of Hypothyroidism During Pregnancy

Patton, Phillip E. MD*; Samuels, Mary H. MD; Trinidad, Rosen; Caughey, Aaron B. MD, PhD§

Obstetrical & Gynecological Survey: June 2014 - Volume 69 - Issue 6 - p 346–358
doi: 10.1097/OGX.0000000000000075
CME Articles

Importance In the last 3 years, we have witnessed the publication of multiple but conflicting guidelines on the management of hypothyroidism during pregnancy. Hypothyroidism is one of the most common endocrinopathies in reproductive-age and pregnant women. Given the prevalence of thyroid disease, it is highly likely that obstetricians will encounter and provide care for pregnant women with thyroid disease. Therefore, a review of current guidelines and management options is clinically relevant.

Objectives Our goals are to review the changes in thyroid function during pregnancy, the options for testing for thyroid disease, the different categories of thyroid dysfunction and surveillance strategies among subspecialty societies, and the obstetric hazards associated with thyroid dysfunction and review the evidence for benefit of treatment options for thyroid disease.

Evidence Acquisition We reviewed key subspecialty guidelines, as well as current and ongoing studies focused on the treatment of hypothyroidism during pregnancy.

Results There are significant differences in the identification and management of thyroid disease during pregnancy among subspecialists. We present our recommendations based on the available evidence.

Relevance Evidence exists that obstetricians struggle with the diagnosis and treatment of hypothyroidism. According to recent surveys, the management of hypothyroidism during pregnancy is the number 1 endocrine topic of interest for obstetricians. A synopsis of recently published subspecialty guidelines is timely.

Conclusions Recent, evidence-based findings indicate that obstetricians should consider modifying their approach to the identification and treatment of thyroid disease during pregnancy.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this CME activity, physicians should be better able to identify the changes in thyroid function testing during pregnancy; choose the appropriate methods of testing thyroid function during the first, second, and third trimesters; and compare treatment options of the various forms of thyroid dysfunction and the evidence behind treatment recommendations.

*Professor of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility; and †Professor of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR; ‡Medical Student, Oregon Health & Science University, Portland, OR; and §Professor and Chair, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Phillip E. Patton, MD, 3303 SW Bond Ave, Mail Code CH10F, Portland, OR 97239. E-mail:

© 2014 by Lippincott Williams & Wilkins.