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Background: 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. A major and substantial change in the new guidelines includes raising the upper limit in the normal thyroid function tests. For Thyroid Stimulating Hormone (TSH), the upper limit was 2.5 mU/L in the 2011 guidelines. Normal upper limit in pregnancy is raised to 4.0 mU/L in 2017 revision. In the present study, we evaluated our pregnant patients according to the ATA 2017 criteria. Methods: All pregnant women previously followed-up by Internal Medicine, Endocrinology and General Surgery policlinics in one-year period from January 2018 to December 2018 were included in the study. The study was approved by our institution’s Ethics Committee (23.01.2019/B.10.1.TK H.4.34.H.GP.0.01/6). Regularly determined thyroid function tests (free T3: Triiodothyronine, free T4: Thyroxine, TPO Ab: Thyroperoxidase antibody, and TSH: Thyroid stimulating hormon) in all trimesters, medications started in case of necessity and the outcome of pregnancy were documented after a detailed computerized statistical HIS (Health Information System) research. Results: A total of 188 pregnant women (with newlydiagnosed thyroid disease-Group 1; n = 23, 12.2%, and with previously-known thyroid disease-Group 2, n = 165, 87.7%) were included. The normal ranges of thyroid tests for nonpregnant women set by our biochemistry laboratory were as follows: T3 (1.71-3.71 pg/mL), T4 (0.7-1.48 ng/dL), TSH (0.35-4.94 uIU/mL) and anti TPO (< 5.60 IU/mL). The pregnant women were evaluated according to the ATA guidelines published in 2017, and the normal upper limit in pregnancy was raised to 4.0 uIU/mL in our institution. The most common thyroid disorders according to ATA 2017 criteria were hypothyroidism (n = 20, 86.9% for Group 1 and n = 16, 9.6% for Group 2) and hyperthyroidism (n = 3, 13% for Group 1 and n = 4, 2.4% for Group 2). Most of the patients in Group 2 were seen to be euthyroid from the beginning of the pregnancy (n = 145, 87.8%), and they had no remarkable hormone change. Levothyroxine was started in Group 1 (for both clinic and subclinical hypothyroidism, regardless of anti TPO levels), and its dose was adjusted in Group 2 hypothyroidic patients. Propylthiouracil (PTU) was started or methymazol to PTU switch was done in hyperthyroid patients, respectively. There was no significant morbidity during pregnancy and in postpartum period. Conclusions: Recent studies in Asia, finding only a modest reduction in the upper reference limit of TSH for the typical patient in early pregnancy, with a gradual return to nonpregnant levels later have changed TSH set point as 4 mU/L. Although there might be a relative decrease in the number of pregnant women with thyroid disease regarding the new guidelines, close follow-up of patients and the use and/or adjustments in medications are still important, especially in iodine-deficient areas.

The Follow-Up of Thyroid Disease in 188 Pregnant Women According to the Guidelines of ATA (American Thyroid Association) 2017