Azizi Fereidoun, Mehran Ladan, Amouzegar Atieh, Alamdari Shahram, Subetki Imam, Saadat Navid, Moini Siamak, Sarvghadi Farzaneh
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Medical Research Development Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Int J Endocrinol Metab. 2015 Nov 7;14(1):e29601. doi: 10.5812/ijem.29601. eCollection 2016 Jan.
Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy.
The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy.
Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed.
There were minor differences in treatment preferences for Graves' disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists.
There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately.
孕期母体甲状腺疾病会对母亲和胎儿都产生不良影响。美国甲状腺协会和内分泌学会最近都发布了孕期甲状腺疾病管理指南。
本调查的目的是评估和比较东亚各国医生在孕期甲状腺疾病筛查和管理方面的当前做法。
收集了来自东亚六个国家的112名医生填写完整的调查问卷。该调查基于临床病例情景，询问有关孕期甲状腺疾病诊断和管理的临床实践问题。分析了76名内分泌科医生以及33名内科医生和全科医生（通科医生）的回复。
内分泌科医生和通科医生在孕期格雷夫斯病的治疗偏好以及监测抗甲状腺药物的检查方面存在细微差异；主要差异在于，大多数内分泌科医生将目标游离甲状腺素以及甲状腺素设定在正常范围上限，而通科医生则将其设定在正常范围内。与通科医生相比，内分泌科医生进行的针对性筛查更多，并且更熟悉其风险因素。与通科医生相比，内分泌科医生主要在确诊怀孕后增加甲状腺功能减退女性的左甲状腺素剂量，并且还会对被诊断为显性甲状腺功能减退的孕妇指示使用全剂量，以及对甲状腺过氧化物酶抗体呈阳性或阴性且促甲状腺激素水平为（2.5 - 5 mU/L）的孕妇进行治疗。
东亚地区在孕期甲状腺疾病筛查和管理的临床实践方面存在很大差异，不幸的是，许多临床医生，尤其是全科医生，并未遵循临床实践指南。
