title: Controversies in the management of hypothyroidism during pregnancy.
abstract: OBJECTIVE
  In the last 3 years, we have witnessed the publication of multiple but conflicting guidelines on the management of hypothyroidism during pregnancy. Hypothyroidism is one of the most common endocrinopathies in reproductive-age and pregnant women. Given the prevalence of thyroid disease, it is highly likely that obstetricians will encounter and provide care for pregnant women with thyroid disease. Therefore, a review of current guidelines and management options is clinically relevant.
  
  
  OBJECTIVE
  Our goals are to review the changes in thyroid function during pregnancy, the options for testing for thyroid disease, the different categories of thyroid dysfunction and surveillance strategies among subspecialty societies, and the obstetric hazards associated with thyroid dysfunction and review the evidence for benefit of treatment options for thyroid disease.
  
  
  METHODS
  We reviewed key subspecialty guidelines, as well as current and ongoing studies focused on the treatment of hypothyroidism during pregnancy.
  
  
  RESULTS
  There are significant differences in the identification and management of thyroid disease during pregnancy among subspecialists. We present our recommendations based on the available evidence.
  
  
  CONCLUSIONS
  Evidence exists that obstetricians struggle with the diagnosis and treatment of hypothyroidism. According to recent surveys, the management of hypothyroidism during pregnancy is the number 1 endocrine topic of interest for obstetricians. A synopsis of recently published subspecialty guidelines is timely.
  
  
  CONCLUSIONS
  Recent, evidence-based findings indicate that obstetricians should consider modifying their approach to the identification and treatment of thyroid disease during pregnancy.
authors.affiliation: Professor of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Oregon Health & Science University, Portland, OR.
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Patton
authors.affiliation: Professor of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR.
authors.forename: Mary H
authors.initials: MH
authors.lastname: Samuels
authors.affiliation: Medical Student, Oregon Health & Science University, Portland, OR.
authors.forename: Rosen
authors.initials: R
authors.lastname: Trinidad
authors.affiliation: Professor and Chair, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D058070:Asymptomatic Diseases / Q000628:therapy; D001323:Autoantibodies / Q000097:blood; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D007455:Iodine / Q000172:deficiency; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D011264:Pregnancy Trimesters; D013961:Thyroid Gland / Q000502:physiology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use
chemical_list: D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; C006606:anti-thyroglobulin; C056626:thyroid microsomal antibodies; D013972:Thyrotropin; D007455:Iodine; D013974:Thyroxine