title: 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children.
abstract: This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking.
authors.affiliation: Thyroid Research Group, Institute of Molecular Medicine, Cardiff University, University Hospital of Wales, Cardiff, Exeter, UK.
authors.forename: John
authors.initials: J
authors.lastname: Lazarus
authors.affiliation: Clinical Trials Research Division of Endocrinology, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA.
authors.forename: Rosalind S
authors.initials: RS
authors.lastname: Brown
authors.affiliation: Endocrinologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Daumerie
authors.affiliation: Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Hubalewska-Dydejczyk
authors.affiliation: Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Negro
authors.affiliation: Department of Endocrinology, Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK.
authors.forename: Bijay
authors.initials: B
authors.lastname: Vaidya
keywords: Child; Hypothyroidism; Iodine; Management; Pregnancy; Screening; Subclinical
references.citation: Arch Intern Med. 2000 Feb 28;160(4):526-34
references.pmid: 10695693
references.citation: Obstet Gynecol. 1991 May;77(5):701-6
references.pmid: 1901637
references.citation: Gynecol Obstet Invest. 2012;74(4):265-73
references.pmid: 23147711
references.citation: J Clin Endocrinol Metab. 2011 Aug;96(8):2422-9
references.pmid: 21632812
references.citation: Exp Clin Endocrinol Diabetes. 2011 Oct;119(9):530-5
references.pmid: 21811965
references.citation: Clin Endocrinol (Oxf). 2007 Jun;66(6):765-70
references.pmid: 17466012
references.citation: J Clin Oncol. 2000 Jan;18(2):348-57
references.pmid: 10637249
references.citation: J Med Screen. 2000;7(3):127-30
references.pmid: 11126160
references.citation: J Clin Endocrinol Metab. 2008 Sep;93(9):3341-7
references.pmid: 18544616
references.citation: Eur J Endocrinol. 2011 Apr;164(4):591-7
references.pmid: 21292920
references.citation: Clin Chem. 2007 Sep;53(9):1658-64
references.pmid: 17712003
references.citation: Eur J Endocrinol. 2009 Mar;160(3):417-21
references.pmid: 19074464
references.citation: Thyroid. 2011 Oct;21(10):1081-125
references.pmid: 21787128
references.citation: J Clin Endocrinol Metab. 2009 Apr;94(4):1338-41
references.pmid: 19190111
references.citation: Clin Obstet Gynecol. 2011 Sep;54(3):478-87
references.pmid: 21857178
references.citation: Obstet Gynecol. 1993 Mar;81(3):349-53
references.pmid: 8437784
references.citation: Pediatr Int. 2003 Oct;45(5):534-7
references.pmid: 14521527
references.citation: J Clin Endocrinol Metab. 2010 Apr;95(4):1699-707
references.pmid: 20130074
references.citation: Thyroid. 2009 Oct;19(10):1099-104
references.pmid: 19534625
references.citation: Matern Child Nutr. 2014 Jan;10(1):61-71
references.pmid: 23937433
references.citation: J Pediatr. 2000 Jan;136(1):53-6
references.pmid: 10636974
references.citation: Diabet Med. 1990 May;7(4):299-303
references.pmid: 2140081
references.citation: Clin Endocrinol (Oxf). 2014 Apr;80(4):598-606
references.pmid: 23992400
references.citation: J Clin Endocrinol Metab. 2004 Dec;89(12):5981-6
references.pmid: 15579747
references.citation: Thyroid. 2009 May;19(5):511-9
references.pmid: 19348584
references.citation: Clin Chem. 2011 Jun;57(6):913-5
references.pmid: 21343417
references.citation: Eur J Endocrinol. 1996 Apr;134(4):443-8
references.pmid: 8640295
references.citation: Arch Pediatr Adolesc Med. 1996 Mar;150(3):293-7
references.pmid: 8603224
references.citation: J Clin Res Pediatr Endocrinol. 2012 Mar;4(1):21-4
references.pmid: 22394701
references.citation: Thyroid. 2009 Apr;19(4):361-7
references.pmid: 19226198
references.citation: J Clin Endocrinol Metab. 2013 Apr;98(4):1417-26
references.pmid: 23408575
references.citation: Horm Res Paediatr. 2012;77(6):376-81
references.pmid: 22699818
references.citation: Pediatrics. 2008 Sep;122(3):e670-4
references.pmid: 18678601
references.citation: BMJ. 2008 Apr 26;336(7650):924-6
references.pmid: 18436948
references.citation: J Clin Endocrinol Metab. 2009 Feb;94(2):497-503
references.pmid: 19033373
references.citation: Ann Neurol. 2013 Nov;74(5):733-42
references.pmid: 23943579
references.citation: J Clin Endocrinol Metab. 2013 Dec;98(12):E1941-5
references.pmid: 24217906
references.citation: J Clin Endocrinol Metab. 2009 Jul;94(7):2414-20
references.pmid: 19417038
references.citation: Nutrients. 2013 Feb 06;5(2):424-40
references.pmid: 23389302
references.citation: Hum Reprod Update. 2012 Jan-Feb;18(1):12-28
references.pmid: 21896559
references.citation: J Clin Endocrinol Metab. 2013 Sep;98(9):3694-701
references.pmid: 23846819
references.citation: J Endocrinol Invest. 2012 Mar;35(3):281-5
references.pmid: 21623157
references.citation: Hum Reprod Update. 2012 Jul;18(4):360-73
references.pmid: 22431565
references.citation: Eur J Endocrinol. 2013 Feb 15;168(3):323-9
references.pmid: 23211576
references.citation: J Clin Endocrinol Metab. 2008 Mar;93(3):666-73
references.pmid: 18171699
references.citation: J Clin Endocrinol Metab. 2006 Jul;91(7):2587-91
references.pmid: 16621910
references.citation: J Clin Endocrinol Metab. 2010 Jul;95(7):3234-41
references.pmid: 20463094
references.citation: BMC Pediatr. 2006 Apr 19;6:12
references.pmid: 16623938
references.citation: N Engl J Med. 2004 Jul 15;351(3):241-9
references.pmid: 15254282
references.citation: J Trace Elem Med Biol. 2013 Oct;27(4):302-6
references.pmid: 23992867
references.citation: J Clin Endocrinol Metab. 2014 Jan;99(1):73-9
references.pmid: 24276458
references.citation: Thyroid. 1999 Jan;9(1):19-24
references.pmid: 10037071
references.citation: Clin Endocrinol (Oxf). 2011 Jun;74(6):762-8
references.pmid: 21521276
references.citation: J Clin Endocrinol Metab. 2012 Aug;97(8):2543-65
references.pmid: 22869843
references.citation: J Pediatr. 2001 Nov;139(5):738-40
references.pmid: 11713456
references.citation: Environ Health Perspect. 2009 May;117(5):745-50
references.pmid: 19479016
references.citation: Clin Chem Lab Med. 2001 Oct;39(10):973-9
references.pmid: 11758614
references.citation: Clin Endocrinol (Oxf). 2003 Sep;59(3):282-8
references.pmid: 12919150
references.citation: Horm Res. 2008;70(1):51-7
references.pmid: 18493150
references.citation: Ir J Med Sci. 2014 Mar;183(1):1-6
references.pmid: 23934377
references.citation: Thyroid. 2013 Aug;23(8):1022-8
references.pmid: 23405888
references.citation: Nutr Metab Cardiovasc Dis. 2013 Sep;23(9):898-902
references.pmid: 22748710
references.citation: N Engl J Med. 2006 Jun 29;354(26):2783-93
references.pmid: 16807415
references.citation: J Thyroid Res. 2013;2013:851326
references.pmid: 23762776
references.citation: Eur J Endocrinol. 2013 Mar 15;168(4):601-8
references.pmid: 23384709
references.citation: Clin Endocrinol (Oxf). 2011 Feb;74(2):262-9
references.pmid: 21044115
references.citation: J Endocrinol Invest. 2001 Nov;24(10):763-9
references.pmid: 11765045
references.citation: Pediatr Res. 2011 May;69(5 Pt 1):454-9
references.pmid: 21471776
references.citation: J Clin Endocrinol Metab. 2002 Jul;87(7):3209-14
references.pmid: 12107226
references.citation: Obstet Gynecol. 2007 May;109(5):1129-35
references.pmid: 17470594
references.citation: J Nutr. 2012 Apr;142(4):744-50
references.pmid: 22378324
references.citation: Clin Endocrinol (Oxf). 2012 Mar;76(3):394-8
references.pmid: 21981142
references.citation: Clin Endocrinol (Oxf). 2010 Jun;72(6):825-9
references.pmid: 19878506
references.citation: Eur J Endocrinol. 2013 Oct 02;170(1):R1-R15
references.pmid: 24088547
references.citation: J Clin Endocrinol Metab. 2010 Sep;95(9):4227-34
references.pmid: 20534757
references.citation: J Clin Endocrinol Metab. 2013 Jul;98(7):2725-33
references.pmid: 23744409
references.citation: J Clin Endocrinol Metab. 2012 Aug;97(8):E1363-9
references.pmid: 22669304
references.citation: J Pediatr. 2008 Jan;152(1):96-100
references.pmid: 18154908
references.citation: N Engl J Med. 1999 Aug 19;341(8):549-55
references.pmid: 10451459
references.citation: J Clin Endocrinol Metab. 2009 May;94(5):1678-82
references.pmid: 19240148
references.citation: Epidemiology. 2013 Jan;24(1):150-7
references.pmid: 23232616
references.citation: N Engl J Med. 2012 Feb 9;366(6):493-501
references.pmid: 22316443
references.citation: J Clin Endocrinol Metab. 2004 Dec;89(12):6054-60
references.pmid: 15579758
references.citation: Eur J Pediatr. 2006 Jul;165(7):481-3
references.pmid: 16557403
references.citation: Clin Endocrinol (Oxf). 1999 Feb;50(2):149-55
references.pmid: 10396355
references.citation: J Clin Endocrinol Metab. 2011 Oct;96(10):3234-41
references.pmid: 21832110
references.citation: Obstet Gynecol. 2005 Feb;105(2):239-45
references.pmid: 15684146
references.citation: BJOG. 2008 Apr;115(5):602-6
references.pmid: 18333941
references.citation: J Clin Endocrinol Metab. 2012 Mar;97(3):828-34
references.pmid: 22205713
references.citation: Arch Dis Child. 1989 Aug;64(8):1177-82
references.pmid: 2782933
references.citation: Thyroid. 2007 Apr;17(4):303-11
references.pmid: 17465859
references.citation: J Thyroid Res. 2011;2011:426427
references.pmid: 22132346
references.citation: Obstet Gynecol. 2006 Jan;107(1):205-6; author reply 206
references.pmid: 16394061
references.citation: Thyroid. 2013 Dec;23(12):1619-26
references.pmid: 23763592
references.citation: Obstet Gynecol. 2005 Oct;106(4):753-7
references.pmid: 16199632
references.citation: J Clin Endocrinol Metab. 2012 May;97(5):1536-46
references.pmid: 22399510
references.citation: Eur J Endocrinol. 2009 Jun;160(6):985-91
references.pmid: 19273570
references.citation: Thyroid. 2010 Oct;20(10):1175-8
references.pmid: 20860419
references.citation: J Trace Elem Med Biol. 2013 Jul;27(3):174-83
references.pmid: 23395294
references.citation: Nutrition. 2011 Oct;27(10):1029-33
references.pmid: 21621389
references.citation: Thyroid. 2011 Oct;21(10):1143-7
references.pmid: 21943136
references.citation: J Clin Endocrinol Metab. 2012 Jan;97(1):E22-8
references.pmid: 22031521
references.citation: Clin Endocrinol (Oxf). 2013 Sep;79(3):297-304
references.pmid: 23627986
references.citation: Endocr Rev. 2010 Oct;31(5):702-55
references.pmid: 20573783
references.citation: Ital J Pediatr. 2012 Oct 22;38:56
references.pmid: 23088718
references.citation: Clin Chim Acta. 2010 Sep 6;411(17-18):1348-53
references.pmid: 20510682
references.citation: Thyroid. 2007 Aug;17(8):729-39
references.pmid: 17725430
references.citation: Thyroid. 2013 Nov;23(11):1479-83
references.pmid: 23731335
references.citation: J Clin Endocrinol Metab. 2011 Aug;96(8):2395-7
references.pmid: 21816799
references.citation: J Clin Endocrinol Metab. 2012 Dec;97(12):4464-72
references.pmid: 23015651
references.citation: Eur J Endocrinol. 2013 Nov 29;170(1):R17-30
references.pmid: 24128429
references.citation: J Clin Endocrinol Metab. 2008 Jul;93(7):2679-85
references.pmid: 18445672
references.citation: Eur Thyroid J. 2013 Dec;2(4):215-28
references.pmid: 24783053
references.citation: Clin Chem Lab Med. 2012 Apr 19;50(5):885-90
references.pmid: 22628332
references.citation: Am J Obstet Gynecol. 2006 Feb;194(2):471-4
references.pmid: 16458648
references.citation: Ther Drug Monit. 2007 Oct;29(5):553-9
references.pmid: 17898643
references.citation: Diabet Med. 2002 Jan;19(1):70-3
references.pmid: 11869306
references.citation: Lancet. 2011 Jun 11;377(9782):2007-12
references.pmid: 21640375
references.citation: J Clin Endocrinol Metab. 2007 Jan;92(1):203-7
references.pmid: 17032713
references.citation: J Clin Endocrinol Metab. 2007 Jan;92(1):155-9
references.pmid: 17032720
references.citation: J Pediatr. 2006 Dec;149(6):827-32
references.pmid: 17137901
references.citation: Eur J Endocrinol. 2011 Feb;164(2):263-8
references.pmid: 21059864
references.citation: J Clin Endocrinol Metab. 2011 Aug;96(8):E1335-9
references.pmid: 21565790
references.citation: Mol Genet Metab. 2007 Jul;91(3):268-77
references.pmid: 17512233
references.citation: J Clin Endocrinol Metab. 2010 Apr;95(4):1575-7
references.pmid: 20375219
references.citation: Obstet Gynecol. 2012 May;119(5):983-8
references.pmid: 22525909
references.citation: J Clin Endocrinol Metab. 2009 Nov;94(11):4187-94
references.pmid: 19820021
references.citation: Clin Endocrinol (Oxf). 2009 May;70(5):798-802
references.pmid: 18771569
references.citation: Arch Dis Child Fetal Neonatal Ed. 2004 Sep;89(5):F436-9
references.pmid: 15321965
references.citation: Hum Reprod Update. 2011 Sep-Oct;17(5):605-19
references.pmid: 21622978
references.citation: Semin Cell Dev Biol. 2011 Aug;22(6):645-52
references.pmid: 21802524
references.citation: Thyroid. 2010 Jun;20(6):633-7
references.pmid: 20470201
references.citation: Obstet Gynecol. 2012 Feb;119(2 Pt 1):315-20
references.pmid: 22270283
references.citation: J Clin Endocrinol Metab. 2002 Feb;87(2):489-99
references.pmid: 11836274
references.citation: Clin Endocrinol (Oxf). 2009 Sep;71(3):451-4
references.pmid: 19094075
references.citation: Eur J Endocrinol. 2010 Oct;163(4):645-50
references.pmid: 20682632
references.citation: Endocr Rev. 1997 Jun;18(3):404-33
references.pmid: 9183570
references.citation: Obstet Gynecol. 2008 Jul;112(1):85-92
references.pmid: 18591312
references.citation: Clin Endocrinol (Oxf). 2013 Sep;79(3):424-8
references.pmid: 23311698
references.citation: Curr Opin Pediatr. 2011 Aug;23(4):415-20
references.pmid: 21430532
references.citation: Eur J Endocrinol. 2012 Jan;166(1):49-54
references.pmid: 22023792
references.citation: Br Med Bull. 2011;97:137-48
references.pmid: 21186204
references.citation: Pediatr Res. 2013 May;73(5):674-8
references.pmid: 23403803
references.citation: Endocr Pract. 2014 Jul;20(7):703-14
references.pmid: 24449677
references.citation: J Clin Endocrinol Metab. 2013 Nov;98(11):4382-90
references.pmid: 24037884
references.citation: Br J Nutr. 2013 Sep 14;110(5):831-9
references.pmid: 23375074
references.citation: Pediatrics. 2006 Jan;117(1):161-7
references.pmid: 16396874
references.citation: J Clin Endocrinol Metab. 2013 Sep;98(9):3678-86
references.pmid: 23836936
references.citation: Thyroid. 2010 Sep;20(9):989-93
references.pmid: 20718684
references.citation: Thyroid. 2004 Aug;14(8):610-5
references.pmid: 15320974
references.citation: Cochrane Database Syst Rev. 2013 May 31;(5):CD007752
references.pmid: 23728666
references.citation: J Clin Endocrinol Metab. 2010 Sep;95(9):E44-8
references.pmid: 20534758
references.citation: BMC Endocr Disord. 2006 Mar 20;6:2
references.pmid: 16549027
references.citation: Public Health Nutr. 2007 Dec;10(12A):1606-11
references.pmid: 18053287
references.citation: J Clin Endocrinol Metab. 1996 Jan;81(1):9-14
references.pmid: 8550800