Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum

TLDR

Thyroid disease in pregnancy is common, and since the ATA guidelines were first published in 2011, significant clinical and scientific advances have been made. The guidelines aim to inform clinicians, patients, researchers, and policymakers about evidence for diagnosing and managing thyroid disease in women during pregnancy, preconception, and postpartum, addressing specific clinical questions derived from prior guidelines, stakeholder input, and task force expertise. The guideline development involved a task force trained in systematic review methods, conducting electronic database searches, selecting English‑language studies, critically appraising evidence with the American College of Physicians Guideline Grading System, and maintaining editorial independence while managing conflicts of interest, culminating in evidence‑based recommendations covering thyroid function testing, iodine nutrition, autoantibodies, pregnancy complications, infertility, hypothyroidism, thyrotoxicosis, nodules, cancer, fetal and neonatal considerations, lactation, screening, and future research directions. The guidelines present evidence‑based recommendations that, while allowing individualized care, offer optimal care paradigms for managing thyroid disease in pregnant and postpartum women.

Abstract

Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period.The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. 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. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.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.