• CMAJ · Jun 2020

    Thyroid function testing and management during and after pregnancy among women without thyroid disease before pregnancy.

    • Jennifer M Yamamoto, Amy Metcalfe, Kara A Nerenberg, Rshmi Khurana, Alex Chin, and Lois E Donovan.
    • Departments of Medicine (Yamamoto, Metcalfe, Nerenberg, Donovan), of Obstetrics and Gynecology (Yamamoto, Metcalfe, Nerenberg, Donovan), and of Pathology and Laboratory Medicine (Chin), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Yamamoto, Metcalfe, Donovan), Calgary, Alta.; and Departments of Medicine and of Obstetrics and Gynecology (Khurana), University of Alberta, Edmonton, Alta.
    • CMAJ. 2020 Jun 1; 192 (22): E596-E602.

    BackgroundScreening in pregnancy for subclinical hypothyroidism, often defined as thyroid-stimulating hormone (TSH) greater than 2.5 mIU/L or greater than 4.0 mIU/L, is controversial. We determined the frequency and distribution of TSH testing by gestational age, as well as TSH values associated with treatment during pregnancy and the frequency of postpartum continuation of thyroid hormone therapy.MethodsWe performed a retrospective cohort study of pregnancies in Alberta, Canada. We included women without thyroid disease who delivered between October 2014 and September 2017. We used delivery records, physician billings, and pharmacy and laboratory administrative data. Our key outcomes were characteristics of TSH testing and the initiation and continuation of thyroid hormone therapy. We calculated the proportion of pregnancies with thyroid testing and the frequency of each specific thyroid test.ResultsOf the 188 490 pregnancies included, 111 522 (59.2%) had at least 1 TSH measurement. The most common time for testing was at gestational week 5 to 6. Thyroid hormone therapy was initiated at a median gestational age of 7 (interquartile range 5-12) weeks. Among women with first TSH measurements of 4.01 to 9.99 mIU/L who were not immediately treated, the repeat TSH measurement was 4.00 mIU/L or below in 67.9% of pregnancies. Thyroid hormone was continued post partum for 44.6% of the women who started therapy during their pregnancy.InterpretationThe findings of our study suggest that current practice patterns may contribute to overdiagnosis of hypothyroidism and overtreatment during pregnancy and post partum.© 2020 Joule Inc. or its licensors.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…