Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Thyroid. 2021 Apr;31(4):669-677. doi: 10.1089/thy.2020.0629. Epub 2021 Jan 19.
The use of prescribed medications during pregnancy is a challenge and an underestimated source of treatment burden. Levothyroxine (LT4) for the treatment of overt and subclinical hypothyroidism is extensively prescribed during pregnancy. To this end, we aimed to explore the patients' perceived benefits and risks, knowledge, beliefs, attitudes, and related burden of LT4 therapy during pregnancy. In this cross-sectional study, we surveyed pregnant women who were treated with LT4 during pregnancy from January 1, 2019, to December 31, 2019, in a tertiary academic medical center of the United States. The anonymous online survey included questions to gather demographic data and multiple-choice questions regarding the benefits and risks, knowledge, beliefs, attitudes, and burden related to LT4 use during pregnancy. Sixty-four pregnant women (mean age 31.5 years) completed the study survey (response rate: 96%): 62% were diagnosed with hypothyroidism more than 12 months before pregnancy, 16% less than or about 12 months before pregnancy, and 22% during pregnancy. We found that one-third of pregnant women using LT4 had a feeling of uneasiness/anxiety due to their hypothyroidism diagnosis. About half of the respondents (45%) reported that they did not receive an explanation by their clinician regarding the maternal/fetal risks of uncontrolled hypothyroidism or the benefits of adequate control. Finally, two in three patients expressed various concerns of LT4-related treatment burden. Our findings support the need for increased effective communication and tailored counseling to address fears, anxiety, and uncertainties about the benefits and risks of LT4 use in pregnancy. For patients with clear benefits from LT4 treatment in pregnancy, it could help to overcome their concerns, promote adherence, and decrease adverse maternal/fetal outcomes. For patients with no clear benefits established, clinicians need to be aware of LT4-related treatment burden in pregnancy and implement patient-centered approaches in their clinical practices.
在怀孕期间使用规定的药物是一个挑战，也是治疗负担被低估的一个来源。左旋甲状腺素 (LT4) 被广泛用于治疗显性和亚临床甲状腺功能减退症。为此，我们旨在探讨孕妇在怀孕期间对 LT4 治疗的感知益处和风险、知识、信念、态度以及相关负担。
在这项横断面研究中，我们调查了 2019 年 1 月 1 日至 12 月 31 日期间在美国一家三级学术医疗中心接受 LT4 治疗的孕妇。匿名在线调查包括收集人口统计学数据的问题以及与怀孕期间使用 LT4 相关的益处和风险、知识、信念、态度和负担的多项选择问题。
64 名孕妇（平均年龄 31.5 岁）完成了研究调查（回复率：96%）：62%在怀孕前 12 个月以上被诊断为甲状腺功能减退症，16%在怀孕前 12 个月或左右，22%在怀孕期间。我们发现，三分之一使用 LT4 的孕妇因甲状腺功能减退症诊断而感到不安/焦虑。大约一半的受访者（45%）表示，他们没有从医生那里得到关于未控制的甲状腺功能减退症对母亲/胎儿的风险或充分控制的益处的解释。最后，三分之二的患者对 LT4 相关治疗负担表示了各种担忧。
我们的研究结果支持增加有效的沟通和量身定制的咨询，以解决对怀孕期间使用 LT4 的益处和风险的恐惧、焦虑和不确定性。对于怀孕期间 LT4 治疗有明确益处的患者，这有助于克服他们的担忧，促进依从性，并降低母婴不良结局的风险。对于没有明确益处的患者，医生需要意识到怀孕期间 LT4 相关治疗负担，并在临床实践中实施以患者为中心的方法。
