Pregnancy

Congenital malformations in Grave's disease

Congenital malformations in Grave's disease

Traditional approach is to use propylthiouracil (PTU) for Grave's disease during the first trimester. This article points otherwise, that both methimazole and PTU can increase the risk of congenital malformations when used in the first three months of pregnancy. I suspect more research would be needed before changing guidelines or standard of care.

GT

Low dose aspirin can help with pregnancy

Low dose aspirin can help with pregnancy

An important study showing that low-dose aspirin (LDA) 81 mg/day can increase fertility and successful pregnancy in women with mild chronic inflammation and prior miscarriage. Chronic inflammation is documented by elevated hsCRP.

A clinical implication could be checking hsCRP in women with history of pregnancy loss, and if elevated to prescribe low-dose aspirin. LDA has been found safe during pregnancy, while full-dose aspirin should be avoided during the third trimester.

GT

Subclinical Hypothyroidism and Hypothyroxinemia during pregnancy

Subclinical Hypothyroidism and Hypothyroxinemia during pregnancy

This is any important investigation if thyroid hormone supplementation in pregnant women with subclinical hypothyroidism or hypothyroxinemia improves cognition in children. Although results are negative, I believe the study is not complete for two reasons:

1.  Levothyroxine was not initiated until around week 17 of gestation. For more meaningful results, thyroid hormone should be started before pregnancy or very early in the first trimester.

2.  Longer follow up of 10-15 years would be more appropriate in evaluating children's cognition and IQ scores.

GT

2017 ATA Guidelines: Thyroid & Pregnancy (Part 2)

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:

GT

2017 ATA Guidelines: Thyroid & Pregnancy (part 1)

2017 ATA Guidelines: Thyroid & Pregnancy (part 1)

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

GT