American Thyroid Association statement: ID subclinical hypothyroidism before conception.(Obstetrics)

ALEXANDRIA, VA. -- A new statement published by the American Thyroid Association urges physicians to be aggressive in identifying and treating women with overt or subclinical thyroid dysfunction before they conceive.

The statement includes guidelines on identifying and treating women with thyroid insufficiency before and during pregnancy, as well as a research agenda for determining the risks and benefits of treating maternal subclinical hypothyroidism.

Until large trials assessing the impact of screening and treating maternal thyroid dysfunction are completed, clinicians can use this statement to guide management decisions for these patients, said Dr. Gregory Brent, who presented the document at a symposium sponsored by the American Thyroid Association.

"There is a lot we can do for these women while we're waiting for such trials," commented Dr. Brent of the University of California, Los Angeles. "Women with known thyroid disease should be carefully monitored and their thyroxine dose adjusted prior to pregnancy. We also need to identify women who are at high risk for thyroid disorders. There are women in these risk groups who are not being tested."

But some experts contend that the statement doesn't ask physicians, who are already identifying and treating women with active thyroid disease, to do anything new.

And many who attended the meeting pointed out that there's no proven evidence that widespread thyroid screening is necessary or that treating maternal subclinical hypothyroidism is beneficial for the patient.

"What physicians should do--and are already doing--is treat any woman who has a history or symptoms, screen those who have risk factors and treat those found to be abnormal," said Dr. Catherine Spong, chief of pregnancy and perinatology at the National Institute of Child Health and Human Development. "That's nothing new," she told this newspaper.