Management of Thyroid Dysfunction during Pregnancy and Postpartum

 

The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org).

 

This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.

 

The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes.

 

Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.

Target Audience

This continuing medical education activity should be of substantial interest to endocrinologists and other health care professionals that treat patients with thyroid dysfunction during pregnancy and postpartum.

Learning Objectives

Upon completion of this educational activity, learners will be able to:

  • Describe the basis for of maintaining TSH in the desired range before and during pregnancy and emphasize the importance of checking, and if the patient is under treatment, maintaining an appropriate level.
  • Provide information on potential problems during antithyroid drug treatment, especially during pregnancy and fetal development, and recommend a preferred response.
  • Increase physician knowledge on the requirements foriodine during pregnancy, and appropriate supplementation.

Additional Information

Target Audience: 
Physician-in-practice
Fellow
Resident
Clinical researcher
Scientific researcher
Educator/Teacher
Pharmacist
Nurse/Nurse practitioner
Physician assistant
Allied health professional
Other
Competency Area: 
Professionalism
Patient Care and Procedural Skills
Medical Knowledge
Topic Area: 
General Endocrinology
Thyroid/HPT Axis
Women’s Health
Level of Outcomes: 
Level 1 (Participation)
Level 2 (Satisfaction)
Level 3A (Learning: Declarative Knowledge (Knows))
Level 3B (Learning: Procedural Knowledge (Knows How))
Level 4 (Learning: Competence (Shows How))
Activity summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credits
  • 2.00 CME Certificate of Participation
Course opens: 
08/01/2012
Course expires: 
08/31/2015
Rating: 
0

STATEMENT OF INDEPENDENCE

As a provider of continuing medical education (CME) accredited by the Accreditation Council for Continuing Medical Education, The Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous. The scientific content of this activity was developed under the supervision of The Endocrine Society's Clinical Guidelines Subcommittee.

DISCLOSURE POLICY

The faculty, committee members, and staff who are in position to control the content of this activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are related to the CME content. Financial relationships are defined by remuneration in any amount from the commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (e.g., stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers' bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent CME planners with relevant financial relationships from planning or delivery of content, but rather to provide learners with information that allows them to make their own judgments of whether these financial relationships may have influenced the educational activity with regard to exposition or conclusion.

The Endocrine Society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.

The following committee members who planned and/or reviewed content for this activity reported relevant financial relationships: Erik K. Alexander, MD : Co-principle investigator in ongoing thyroid nodule clinical trial for Veracyte, Inc; John Lazarus, MD: Paid speaker for Abbott Labs; Paid speaker for Merck-Serono.

The following committee members who planned and/or reviewed content for this activity reported no relevant financial relationships: Leslie De Groot, MD (chair); Marcos Abalovich, MD; Nobuyuki Amino, MD; Linda Barbour, MS, MSPH; Rhoda Cobin, MD; Creswell Eastman, MD; Dominique Luton, MD; Susan J Mandel, MD; Jorge Mestman, MD; Joanne Rovet, PhD; Scott Sullivan, MD.

Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.

Use of professional judgment:

The educational content in this activity relates to basic principles of diagnosis and therapy and does not substitute for individual patient assessment based on the health care provider’s examination of the patient and consideration of laboratory data and other factors unique to the patient. Standards in medicine change as new data become available.

Drugs and dosages:

When prescribing medications, the physician is advised to check the product information sheet accompanying each drug to verify conditions of use and to identify any changes in drug dosage schedule or contraindications.

POLICY ON UNLABELED/OFF-LABEL USE

The Endocrine Society has determined that disclosure of unlabeled/off-label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation. Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration (FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.

PRIVACY AND CONFIDENTIALITY STATEMENT

The Endocrine Society will record learner's personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties.

ACKNOWLEDGEMENT OF COMMERCIAL SUPPORT

This activity is not supported by educational grant(s) from commercial supporters.

Available Credit

  • 2.00 AMA PRA Category 1 Credits
  • 2.00 CME Certificate of Participation

Accreditation Period

Course opens: 
08/01/2012
Course expires: 
08/31/2015