Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK.
Eur J Endocrinol. 2012 Jan;166(1):49-54. doi: 10.1530/EJE-11-0729. Epub 2011 Oct 24.
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.
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.
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.
There is wide variation in the clinical practice relating to the treatment and screening of hypothyroidism during pregnancy in Europe.
妊娠期间母体甲状腺功能减退与多种不良结局相关。2007 年发布了《内分泌学会妊娠期间甲状腺疾病管理指南》，但这些指南在常规临床实践中的应用效果尚不清楚。因此，我们对欧洲甲状腺协会（ETA）的成员进行了一项调查，以研究目前在妊娠期间管理甲状腺功能减退症的实践情况。
2010 年 12 月，我们以临床病例为基础向 ETA 的 605 名成员发送了电子问卷调查，对 28 个欧洲国家的 190 名临床医生成员的回复进行了分析。
对于新诊断的显性甲状腺功能减退症孕妇，大多数应答者开始给予全剂量左甲状腺素（l-T4）。对于计划妊娠的甲状腺功能减退症妇女，50%的应答者建议一旦确认怀孕，即增加 l-T4 的剂量，而 43%的应答者倾向于在调整剂量前检测甲状腺功能。应答者使用不同的测试组合来监测 l-T4 的剂量。应答者用于实现 l-T4 目标甲状腺功能的测试组合也不一致。42%的应答者或其机构对所有孕妇进行甲状腺功能障碍筛查，43%的机构仅对高危组进行针对性筛查，而 17%的机构不进行系统筛查。筛查的时机、使用的测试以及开始治疗和监测的标准存在差异。
欧洲在妊娠期间治疗和筛查甲状腺功能减退症的临床实践存在广泛差异。
