title: Thyroid testing and management of hypothyroidism during pregnancy: a population-based study.
abstract: BACKGROUND
  There are international guidelines on thyroid function testing and management of hypothyroidism during pregnancy. Few studies have evaluated how they are implemented into clinical practice.
  
  
  OBJECTIVE
  In this descriptive study, we assessed the implementation of international guidelines in this field into local guidelines and also into clinical practice.
  
  
  METHODS
  In a nationwide survey, all guidelines in Sweden were collected (n = 29), and the adherence of the local guidelines to The Endocrine Society Guidelines 2007 was evaluated. In a follow-up in 1 district, 5254 pregnant women with an estimated date of delivery between January 1, 2009, and December 31, 2011, were included for subsequent review of their medical reports.
  
  
  RESULTS
  All but 1 district had guidelines on the subject. All local guidelines included fewer than the 10 listed reasons for thyroid testing recommended by The Endocrine Society Guidelines. Furthermore, most guidelines recommended additional types of thyroid function tests to TSH sampling and lower trimester-specific TSH upper reference limits for women on levothyroxine treatment (P < .001). In the follow-up, the thyroid testing rate was 20%, with an overall frequency of women with trimester-specific elevated TSH of 18.5%. More than half of the women (50.9%) who were on levothyroxine treatment at conception had an elevated TSH level at thyroid testing according to The Endocrine Society Guidelines.
  
  
  CONCLUSIONS
  The local guidelines are variable and poorly compliant with international guidelines. Performance of thyroid testing is not optimal, and rates of elevated TSH at testing are extremely high in subgroups.
authors.affiliation: Department of Women's and Children's Health, University Hospital, Uppsala University, SE 751 85 Uppsala, Sweden. michaela.granfors@kbh.uu.se
authors.forename: Michaela
authors.initials: M
authors.lastname: Granfors
authors.forename: Helena
authors.initials: H
authors.lastname: Åkerud
authors.forename: Anna
authors.initials: A
authors.lastname: Berglund
authors.forename: Johan
authors.initials: J
authors.lastname: Skogö
authors.forename: Inger
authors.initials: I
authors.lastname: Sundström-Poromaa
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Wikström
mesh_terms: D016903:Drug Monitoring; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D007390:International Agencies; D009313:National Health Programs; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D012041:Regional Medical Programs; D012958:Societies, Scientific; D013548:Sweden; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D013972:Thyrotropin; D013974:Thyroxine