02 Jun Are Too Many Pregnant Women Being Diagnosed and Treated for Thyroid Disease?
MedicalResearch.com Interview with:
Dr. Donovan
Lois Donovan MD FRCPC
Clinical Professor
Cumming School of Medicine
Division on Endocrinology and Metabolism and
Department of Obstetrics and Gynecology
University of Calgary
MedicalResearch.com: What is the background for this study?
1) We observed in our clinical practices that minor TSH elevations in early pregnancy frequently normalized without intervention.
2) Recent randomized control trials have failed to show benefit of treating women with levothyroxine with minor TSH elevations in pregnancy
MedicalResearch.com: What are the main findings?
1) TSH screening is frequently being done very early in pregnancy at just 5 or 6 weeks gestation
2) It is well established that TSH is rapidly falling in the 1st trimester due to normal physiologic changes. Thus applying a TSH reference range that was established at a later gestational timing in the first trimester, to a TSH sample that was collected earlier in the first trimester can lead to over diagnosis of “subclinical hypothyroidism” in pregnancy.
MedicalResearch.com: What should readers take away from your report?
1) If a pregnant woman without thyroid disease is found to have a minor TSH elevation in early pregnancy, we recommend a repeat TSH since this frequently normalizes.
2) The practice of TSH screening in pregnancy may be contributing to unnecessary treatment of women during pregnancy, postpartum and for years to come.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Follow up studies to see if this information results in change in practice patterns and guidelines.
No disclosures
Citation:
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
CMAJ June 01, 2020 192 (22) E596-E602; DOI: https://doi.org/10.1503/cmaj.191664
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Last Updated on June 2, 2020 by Marie Benz MD FAAD