Treatment and screening of hypothyroidism in pregnancy: results of a European survey.
BACKGROUND
Maternal hypothyroidism in pregnancy is associated with several adverse outcomes. The Endocrine Society Guidelines for the management of thyroid diseases in pregnancy were published in 2007; however, impact of the guidelines in routine clinical practice is unknown. Therefore, we have carried out a survey of members of the European Thyroid Association (ETA) to study current practices relating to the management of hypothyroidism in pregnancy.


METHODS
In December 2010, we emailed an electronic questionnaire survey based on clinical case scenarios to 605 members of the ETA. Responses from 190 clinician members (from 28 European countries) were analyzed.


RESULTS
For a pregnant woman with newly diagnosed overt hypothyroidism, most responders initiated a full dose of l-thyroxine (l-T(4)). For a woman with hypothyroidism planning pregnancy, 50% recommended increasing the dose of l-T(4) as soon as pregnancy is confirmed, whilst 43% favored testing thyroid function before adjusting the dose. Responders used diverse combinations of tests to monitor the dose of l-T(4). The target of thyroid function tests that responders aimed to achieve with l-T(4) was also inconsistent. Forty-two percent responders or their institutions screened all pregnant women for thyroid dysfunction, 43% performed targeted screening of only the high-risk group, whilst 17% did not carry out systemic screening. Timing of the screening, tests used, and criteria for starting treatment and monitoring were variable.


CONCLUSIONS
There is wide variation in the clinical practice relating to the treatment and screening of hypothyroidism during pregnancy in Europe.
Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK. bijay.vaidya@pms.ac.uk
Bijay
B
Vaidya
Alicja
A
Hubalewska-Dydejczyk
Peter
P
Laurberg
Roberto
R
Negro
Francesco
F
Vermiglio
Kris
K
Poppe
D000328:Adult; D005060:Europe; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy; D012955:Societies, Medical / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013974:Thyroxine / Q000627:therapeutic use; D055815:Young Adult
D013974:Thyroxine