2017 ATA Guidelines: Thyroid & Pregnancy (Part 2)

ATA has "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"

Part 2 of recommendations are listed with slightly modified wording for easier and succinct reading:

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Recommendations:

  • Intravenous immunoglobulin treatment of euthyroid women with a history of recurrent pregnancy loss is not recommended.
  • There is insufficient evidence to conclusively determine whether levothyroxine therapy decreases pregnancy loss risk in TPOAb positive, euthyroid women who are newly pregnant. However, administration of levothyroxine to TPOAb positive, euthyroid pregnant women with a prior history of loss may be considered given its potential benefits in comparison to its minimal risk. In such cases, 25-50 mcg of levothyroxine is a typical starting dose.
  • Evaluation of serum TSH concentration is recommended for all women seeking care for infertility.
  • Levothyroxine treatment is recommended for infertile women with overt hypothyroidism who desire pregnancy.
  • There is insufficient evidence to determine if levothyroxine therapy improves fertility in subclinically hypothyroid, thyroid auto-antibody negative women who are attempting natural conception (not undergoing ART). However, administration of levothyroxine may be considered in this setting given its ability to prevent progression to more significant hypothyroidism once pregnancy is achieved. Furthermore, low dose levothyroxine therapy (25-50 mcg daily) carries minimal risk.
  • There is insufficient evidence to determine if levothyroxine therapy improves fertility in nonpregnant, euthyroid, thyroid autoantibody positive women who are attempting natural conception (not undergoing ART). Therefore, no recommendation can be made for levothyroxine therapy in this setting.
  • Subclinically hypothyroid women undergoing IVF or ICSI should be treated with levothyroxine. The goal of treatment is to achieve a TSH concentration <2.5 mU/L.
  • There is insufficient evidence to determine whether levothyroxine therapy improves the success of pregnancy following ART in TPOAb positive, euthyroid women. However, administration of levothyroxine to TPOAb positive, euthyroid women undergoing ART may be considered given its potential benefits in comparison to its minimal risk. In such cases, 25- 50 mcg of levothyroxine is a typical starting dose.
  • Glucocorticoid therapy is not recommended for euthyroid, thyroid auto-antibody positive women undergoing ART.
  • When possible, thyroid function testing should be performed either before or 1-2 weeks after controlled ovarian hyperstimulation, since results obtained during the course of controlled ovarian stimulation may be difficult to interpret.
  • In women who achieve pregnancy following controlled ovarian hyperstimulation, TSH elevations should be treated according to the recommendations. In non-pregnant women with mild TSH elevations following controlled ovarian stimulation, serum TSH measurements should be repeated in 2-4 weeks, since levels may normalize.

ATA Guidelines: Thyroid Disease during Pregnancy and the Postpartum.

Thyroid

January 2017