Controversies in thyroid disease management in pregnancy.

IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Clinical Medicine Pub Date : 2025-01-17 DOI:10.1016/j.clinme.2025.100287
Pushpa Singh, Kristien Boelaert
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Abstract

Adequate control of thyroid function is crucial for optimal pregnancy outcomes and neurodevelopment of the offspring, and testing for thyroid function is ideally performed using manufacturer- and gestation-specific reference ranges. While universal screening for thyroid dysfunction is not recommended, targeted case finding of women at risk of thyroid disease during pregnancy is advised. A number of controversies continue to fuel debate including: (i) the target range for thyroid stimulating hormone (TSH) in women with subfertility planning pregnancy, (ii) management of mild thyroid hypofunction before and during pregnancy, (iii) the treatment of thyroid peroxidase (TPO) antibody-positive euthyroid women with levothyroxine, (iv) the optimal choice of antithyroid treatment in women with hyperthyroidism. A significant body of evidence has accumulated in recent years, including large systematic reviews and meta-analyses of observational studies determining effects of thyroid dysfunction on pregnancy and fetal outcomes. In addition, outcomes from important randomised trials continue to inform current guidance on how to best care for women with thyroid dysfunction before and during pregnancy.

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妊娠期甲状腺疾病管理的争议。
甲状腺功能的适当控制对最佳妊娠结局和后代的神经发育至关重要,甲状腺功能的检测最好使用制造商和妊娠期特定的参考范围。虽然不建议对甲状腺功能障碍进行普遍筛查,但建议对怀孕期间有甲状腺疾病风险的妇女进行有针对性的病例发现。一些争议继续引发争论,包括:(i)低生育计划妊娠妇女促甲状腺激素(TSH)的目标范围(ii)妊娠前和妊娠期间轻度甲状腺功能减退的管理(iii) tpo抗体阳性的甲状腺功能正常妇女用左旋甲状腺素治疗(iv)甲状腺功能亢进妇女抗甲状腺治疗的最佳选择。近年来积累了大量证据,包括大型系统综述和观察性研究的荟萃分析,这些研究确定了甲状腺功能障碍对妊娠和胎儿结局的影响。此外,重要随机试验的结果继续为如何在孕前和孕期对甲状腺功能障碍妇女进行最佳护理提供指导。
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来源期刊
Clinical Medicine
Clinical Medicine 医学-医学:内科
CiteScore
7.20
自引率
0.00%
发文量
0
审稿时长
6-12 weeks
期刊介绍: Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector. Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired. ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year
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