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Guidelines on Thyroid Disease and Pregnancy - An Obstetric Viewpoint

This article provides guidelines on managing thyroid disease during pregnancy, with a focus on preventing maternal, fetal, and neonatal death and morbidity. The importance of close monitoring and treatment of overt and subclinical thyroid conditions is emphasized, along with the need for sufficient iodine intake. The impact of thyroid disease on offspring IQ is also highlighted.

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Guidelines on Thyroid Disease and Pregnancy - An Obstetric Viewpoint

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  1. Guidelines on Thyroid Disease and Pregnancy- An Obstetric Viewpoint Michael S Marsh MD FRCOG Consultant/Senior Lecturer in Obstetrics Department of Obstetrics and Gynaecology King’s College Hospital London

  2. RCOG Greentop Guidelines for Thyroid disease in Pregnancy Mr MS Marsh FRCOG, London (Lead developer) Dr K Boelaert, Honorary Consultant Endocrinologist, University of Birmingham Dr S Chan FRCOG, National University of Singapore Ms SM Chang, Specialist Midwife and Nurse Prescriber, King's College Hospital NHS Foundation Trust Dr C Evans, Clinical Biochemist, University Hospitals Cardiff and Vale NHS Trust Dr J Gilbert MRCP, Consultant Endocrinologist, King's College Hospital NHS Foundation Trust

  3. RCOG greentop guidelines for Thyroid disease in Pregnancy

  4. What are guidelines for ?

  5. What are obstetricians for ?

  6. What are obstetricians for ? Prevent maternal, fetal and neonatal death

  7. Elizabeth of York (1503), queen of Henry VII of England, mother of Henry VIII Jane Seymour (1537), third wife of Henry VIII of England, after delivering Edward VI Catherine Parr (1548), sixth wife of Henry VIII of England

  8. WHY MOTHERS DIE IN THE UK Causes of maternal mortality (numbers per 100,000)

  9. Thyroid cancer in pregnancy 10% of thyroid cancers occurring in reproductive years are diagnosed during pregnancy / in the first year after birth Usually slow-growing well differentiated papillary or follicular carcinomas A good prognosis in this age group

  10. www.ons.gov.uk

  11. What are obstetricians for ? Prevent maternal, fetal and neonatal death

  12. What are obstetricians for ? Prevent maternal, fetal and neonatal death Prevent maternal, fetal and neonatal morbidity

  13. Overt hyperthyroidism in pregnancy Stagnaro-Green 2011

  14. Overt hyperthyroidism in pregnancy Effect of treatment Author Year Effect of treatment vs no/inappropriate/ineffective treatment Davis et al 1989* Preterm delivery reduced (33kw vs 39wk, p<0.05) Gestational weight increased (2Kg vs 3kg, p<0.05) Reduce stillbirth rate (from 80%) Millar 1994* Reduce low birth rate (OR 9) Preeclampsia (OR 5) * Cases since 1974

  15. Overt hypothyroidism in pregnancy Stagnaro-Green 2011

  16. Overt hypothyroidism in pregnancy Effect of treatment Author Year Effect of treatment vs no/inappropriate/ineffective treatment Abalovich 2002 Reduce miscarriage rate (from 60%) Jones 1969 Reduce preterm delivery/fetal death (20% vs 13%, p<0.025) Leung 1993 Reduce hypertension in pregnancy (22% vs 15%) Reduce birthweight <2.5Kg (22% vs 9%)

  17. Subclinical hypothroidism and pregnancy outcome 18 cohort studies eligible, 3995 pregnant women Maraka et al. Thyroid 2016

  18. Subclinical hypothroidism and pregnancy outcome * *Miscarriage,intrauterine death, fetal loss Maraka et al. Thyroid 2016

  19. Subclinical hypothroidism and pregnancy- treatment Recommend treatment of pregnant women with SCH and positive TPO antibodies (Level B, fair evidence—USPSTF) Insufficient evidence to recommend for or against universal levothyroxine treatment in pregnant women with SCH and negative TPO antibodies (Level I—USPSTF) Recommend levothyroxine replacement in all pregnant women with SCH (women with negative TPO antibodies, Obstetric outcome Level C, neurological Level I —USPSTF)

  20. Subclinical hypothroidism and pregnancy- treatment SCH arising before conception or during gestation should be treated with levothyroxine. (GRADE: level 2 Strong) Trials ongoing- NICHD, TABLET and others

  21. What are obstetricians for ? Prevent maternal, fetal and neonatal death Prevent maternal, fetal and neonatal morbidity

  22. What are obstetricians for ? Prevent maternal, fetal and neonatal death Prevent maternal, fetal and neonatal morbidity Reduce maternal disability and disability of offspring

  23. What are obstetricians for ? Prevent maternal, fetal and neonatal death Prevent maternal, fetal and neonatal morbidity Reduce maternal disability and disability of offspring Increase the IQ of the whole population

  24. The benefits of a high IQ Better educationalachievement Well-paid employment Enhanced socialstatus Less criminal behaviour Longer life

  25. The benefits of a high IQ Better educationalachievement Well-paid employment Enhanced socialstatus Less criminal behaviour Longer life The costs of a low IQ EveryIQ point lost from the US average is estimated to have an annual cost of US$71 billion Muir T, Zegarac M. Environ Health Perspect 2001

  26. Maternal free thyroxine and offspring IQ Korevaar et al 2016

  27. Maternal free thyroxine and offspring brain morphology Korevaar et al 2016

  28. What are obstetricians for ? Closely control thyroid disease in pregnancy Ensure sufficient iodine intake in pregnancy Increase the IQ of the whole population

  29. Thank you

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