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Boston experts release new international guidelines for thyroid disease in pregnancy

January 09, 2017

(Boston) -- Thyroid disease is a common and frequently dangerous clinical problem during pregnancy. Led by local experts at Boston University School of Medicine (BUSM) and Brigham and Women's Hospital, the American Thyroid Association (ATA) published new guidelines for the management of these disorders, seeking to improve the health of nearly 300,000 affected pregnant women in the United States each year.

Using all available published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception and the postpartum period, an expert task force has conducted a new and comprehensive analysis leading to over 100 clinical recommendations. These new guidelines appear in the current issue of the journal Thyroid. Given the complexity surrounding thyroid physiology and thyroid illness during pregnancy and the postpartum period, how and when to evaluate for thyroid dysfunction, as well as how and if to best treat thyroid illness during this period, remain challenging.

These revised guidelines include recommendations regarding the interpretation of thyroid function tests in pregnancy, optimal iodine nutrition, the impact of thyroid autoantibodies, important thyroid considerations in infertile women, the treatment of hypothyroidism, thyrotoxicosis, and thyroid nodules/cancer in pregnancy, while also discussing important fetal, neonatal and lactation considerations. Finally, a critical discussion surrounding the pros and cons of universal screening for thyroid dysfunction in pregnancy is available.

"These guidelines represents the best effort to create a useful, practical, and accurate document designed to help the practicing clinician, patients, researchers and health policy makers while also stimulating future research and discovery into this important and complex arena," explained co-chairperson and corresponding author Elizabeth Pearce, MD, MSc, associate professor of medicine at Boston University School of Medicine (BUSM)

Specific clinical questions addressed in these guidelines were based on stakeholder and task force member input, building off of prior versions of the guidelines. Reflecting the wealth of new evidence in this field, these 2017 ATA Guidelines address three new topics not discussed in prior versions, and expand by 10 the overall number of clinical recommendations. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies.

"With an estimated 300,000 pregnancies impacted by thyroid disease in the United States annually, these guidelines coalesce the best available evidence into clear clinical recommendations, and should improve the health of many mothers and newborns alike," said Erik K. Alexander, MD, co-chairperson and lead author of the Thyroid publication, and chief of the Thyroid Unit in the Division of Endocrinology at Brigham and Women's Hospital.

"We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders," added Pearce who is also an endocrinologist at Boston Medical Center.
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About BUSM

Boston University School of Medicine began as the New England Women's Medical College in 1848 and was incorporated as Boston University School of Medicine in 1873. A leading academic and research institution with an enrollment of approximately 700 medical-degree students and 950 graduate students pursuing master's and doctoral degrees, the school has approximately 1,240 full- and part-time faculty members.

One of the major biomedical research institutions in the United States, it is renowned for its programs in cardiovascular disease, cancer, pulmonary and infectious diseases, dermatology, arthritis, pediatrics and geriatrics, among others. In the vanguard of research activities, BUSM faculty contribute to more than 668 active grants and contracts, and provide clinical leadership for the Framingham Heart Study, the largest epidemiological study in the world.

Its teaching affiliates include Boston Medical Center, the Boston VA Healthcare System, Kaiser Permanente in northern California and Roger Williams Medical Center in Rhode Island. For more information, please visit http://www.bumc.bu.edu/busm/

About Brigham and Women's Hospital

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 3,000 researchers, including physician-investigators and renowned biomedical scientists and faculty supported by nearly $666 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.

Boston University Medical Center

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