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Management of gestational hypothyroidism: results of a Brazilian survey.
Arch Endocrinol Metab. 2016 Feb; 60(1):16-20.AE

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 (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (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.

Authors+Show Affiliations

Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.Universidade Federal do Espírito Santo, Vitória, ES, Brazil.PUC-Campinas, Campinas, SP, Brasil.Laboratório de Genética Molecular do Câncer, FCM, Unicamp, Campinas, SP, Brasil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26331227

Citation

Villagelin, Danilo, et al. "Management of Gestational Hypothyroidism: Results of a Brazilian Survey." Archives of Endocrinology and Metabolism, vol. 60, no. 1, 2016, pp. 16-20.
Villagelin D, Comarella AP, Tiago DB, et al. Management of gestational hypothyroidism: results of a Brazilian survey. Arch Endocrinol Metab. 2016;60(1):16-20.
Villagelin, D., Comarella, A. P., Tiago, D. B., & Ward, L. S. (2016). Management of gestational hypothyroidism: results of a Brazilian survey. Archives of Endocrinology and Metabolism, 60(1), 16-20. https://doi.org/10.1590/2359-3997000000069
Villagelin D, et al. Management of Gestational Hypothyroidism: Results of a Brazilian Survey. Arch Endocrinol Metab. 2016;60(1):16-20. PubMed PMID: 26331227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of gestational hypothyroidism: results of a Brazilian survey. AU - Villagelin,Danilo, AU - Comarella,Ana Paula, AU - Tiago,Douglas Bernal, AU - Ward,Laura Sterian, Y1 - 2015/08/28/ PY - 2015/04/08/received PY - 2015/05/12/accepted PY - 2015/9/3/entrez PY - 2015/9/4/pubmed PY - 2016/9/28/medline SP - 16 EP - 20 JF - Archives of endocrinology and metabolism JO - Arch Endocrinol Metab VL - 60 IS - 1 N2 - 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 (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (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. SN - 2359-4292 UR - https://www.unboundmedicine.com/medline/citation/26331227/Management_of_gestational_hypothyroidism:_results_of_a_Brazilian_survey_ L2 - http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972015005000069&lng=en&nrm=iso&tlng=en DB - PRIME DP - Unbound Medicine ER -