Alexander Erik K, Pearce Elizabeth N, Brent Gregory A, Brown Rosalind S, Chen Herbert, Dosiou Chrysoula, Grobman William A, Laurberg Peter, Lazarus John H, Mandel Susan J, Peeters Robin P, Sullivan Scott
1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts.
2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts.
Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457.
Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period.
The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.
The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.
We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
妊娠期甲状腺疾病是常见的临床问题。自美国甲状腺协会（ATA）于2011年首次发布这些疾病的管理指南以来，该领域已取得了重大的临床和科学进展。这些指南的目的是为临床医生、患者、研究人员和卫生政策制定者提供有关妊娠期、孕前和产后女性甲状腺疾病诊断和管理的已发表证据。
这些指南中涉及的具体临床问题基于指南的先前版本、利益相关者的意见以及特别工作组成员的意见。特别工作组成员接受了知识综合方法的培训，包括电子数据库检索、相关文献的回顾与筛选以及对所选研究的批判性评价。符合纳入标准的是已发表的英文文章。采用美国医师协会指南分级系统对证据进行批判性评价并对推荐强度进行分级。指南特别工作组在编辑方面完全独立于ATA。指南特别工作组成员的利益冲突会定期更新、管理并告知ATA和工作组成员。
修订后的妊娠期甲状腺疾病管理指南包括关于妊娠期甲状腺功能测试解读、碘营养、甲状腺自身抗体与妊娠并发症、不孕女性的甲状腺问题、妊娠期甲状腺功能减退、妊娠期甲状腺毒症、孕妇甲状腺结节与癌症、胎儿和新生儿相关问题、甲状腺疾病与哺乳、妊娠期甲状腺功能障碍筛查以及未来研究方向的建议。
我们制定了基于证据的建议，为妊娠期和产后女性甲状腺疾病管理中的临床决策提供依据。虽然所有护理都必须个体化，但我们认为，这些建议为患有这些疾病的患者提供了最佳护理模式。
