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Subclinical hypothyroidism during pregnancy: the Melbourne public hospitals consensus
Author(s) -
Hamblin Peter S.,
Sheehan Penelope M.,
Allan Carolyn,
Houlihan Christine A.,
Lu Zhong X.,
Forehan Simon P.,
Topliss Duncan J.,
Gilfillan Christopher,
Krishnamurthy Bala,
Renouf Debra,
SztalMazer Shoshana,
Varadarajan Suresh
Publication year - 2019
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14210
Subject(s) - medicine , subclinical infection , pregnancy , public health , consensus conference , intensive care medicine , medline , pediatrics , family medicine , nursing , genetics , biology , political science , law
Background Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal free T4, elevated thyroid‐stimulating hormone (TSH)) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association revised their diagnostic and management guidelines. Although welcome, these new guidelines contain recommendations that may cause confusion in clinical practice. Aim To ensure uniform practice in the diagnosis and management of subclinical hypothyroidism in pregnancy across all Melbourne public hospitals. Methods Endocrinology and obstetric representatives from all Melbourne public hospital networks reviewed the 2017 American Thyroid Association guidelines and other relevant literature to develop a consensus for diagnosing and treating subclinical hypothyroidism during pregnancy in Melbourne. The consensus guidelines were then referred to the Endocrine Society of Australia for comment and endorsement. Results Consensus was achieved and the guidelines were endorsed by the Council of the Endocrine Society of Australia. Trimester and assay‐specific TSH reference intervals derived from healthy local populations should be used, where available. When unavailable, a TSH cut‐off of 4 mU/L (replacing the previously recommended 2.5 mU/L) should be used to initiate treatment, irrespective of thyroid auto‐antibody status. The recommended starting dose of levothyroxine is 50 μg daily, with a therapeutic TSH target of 0.1–2.5 mU/L. Levothyroxine should generally be ceased after delivery, with some exceptions. Hospitals will ensure smooth transfer of care back to the woman’s general practitioner with clear documentation of pregnancy thyroid management and a recommended plan for follow‐up. Conclusion Fewer women will be classified as having subclinical hypothyroidism during pregnancy, which is likely to lead to reductions in emotional stress, hospital visits, repeated blood tests and financial costs. Uniform clinical practice will occur across Melbourne.