1 Unit of Internal Medicine and Endocrinology, ICS-Maugeri, Laboratory for Endocrine Disruptors and Chair of Endocrinology University of Pavia , Pavia, Italy .
2 Department of Medical, Surgical, and Neurological Sciences, University of Siena , Siena, Italy .
Thyroid. 2018 May;28(5):551-555. doi: 10.1089/thy.2017.0424.
The 2017 American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum were published six years after the previous ones. They provide comprehensive clinical recommendations for the whole spectrum of thyroid diseases, as well as for optimal iodine intake during pregnancy, postpartum, and lactation. The present position statement mainly regards the recommended flow chart for therapeutic decision making in pregnant women being diagnosed with subclinical hypothyroidism. Here, we comment on the major biochemical and clinical situations and the corresponding therapeutic recommendations. In particular, we welcome the critical revision of the thyrotropin (TSH) reference range in pregnancy, and we agree that there is no need to treat thyroid peroxidase antibody-negative women with a serum TSH ranging from 2.5 μIU/mL to the upper limit of the reference range. This recommendation will hopefully reduce the huge proportion of healthy pregnant women in whom, according to the previous guidelines, levothyroxine therapy had to be initiated. On the other hand, we are concerned with the recommendation to only "consider treatment" in thyroid peroxidase antibody-negative pregnant women with a serum TSH ranging from the upper limit of the reference range to 10.0 μIU/mL. This is because thyroid antibodies may be falsely negative during gestation, and serum negative chronic autoimmune thyroiditis is a well-known clinical entity even outside pregnancy. Based on these and other arguments, we recommend treatment with levothyroxine in pregnant women with TSH levels ranging between the upper limit of the reference range and 10.0 μIU/mL independently from their thyroid antibody status.
2017 年美国甲状腺协会关于妊娠和产后甲状腺疾病诊断和管理的指南是在前一版发布六年后发布的。它们为整个甲状腺疾病谱以及妊娠、产后和哺乳期的最佳碘摄入量提供了全面的临床建议。本立场声明主要针对诊断为亚临床甲状腺功能减退症的孕妇的治疗决策推荐流程图。在这里，我们对主要的生化和临床情况及相应的治疗建议进行评论。特别是，我们欢迎对妊娠时促甲状腺激素（TSH）参考范围的严格修订，并且我们同意对于甲状腺过氧化物酶抗体阴性、血清 TSH 范围在 2.5μIU/mL 至参考范围上限的女性，无需进行治疗。这一建议有望减少大量健康孕妇被启动左甲状腺素治疗的情况，这是根据前一版指南必须采取的治疗措施。另一方面，我们对甲状腺过氧化物酶抗体阴性、血清 TSH 范围在参考范围上限至 10.0μIU/mL 的孕妇仅建议“考虑治疗”的建议表示关注。这是因为在妊娠期间甲状腺抗体可能会出现假阴性，并且血清阴性慢性自身免疫性甲状腺炎即使在妊娠之外也是一种已知的临床实体。基于这些和其他论点，我们建议在 TSH 水平在参考范围上限至 10.0μIU/mL 之间的孕妇中，无论其甲状腺抗体状态如何，都应用左甲状腺素进行治疗。
