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Statement on early maternal thyroidal insufficiency.

Here are some key points of the interim management guidelines and research agenda put forth by the American Thyroid Association. The full statement is scheduled to be posted this month at

* Physicians should optimize the treatment of women with overt hypothyroidism before they conceive and monitor their thyroxine levels through the pregnancy.

Because a surge in thyroxine production usually occurs at about week 8 in gestation, women on thyroxine should be counseled to increase their intake 30%-50% when they become pregnant.

* Physicians should screen women who are at risk for thyroid disease before they become pregnant and shortly after they conceive.

Risk factors include personal or family history of thyroid disease, thyroid autoimmunity, type 1 diabetes, or other autoimmune disorders, including rheumatoid arthritis and systemic lupus erythematosus.

* Women with subclinical hypothyroidism should have their thyroid status monitored during pregnancy.

* Physicians should counsel women about adequate iodine intake during pregnancy and lactation.

Although most women in the United States already receive adequate iodine nutrient, pregnant women are vulnerable to deficiencies because they need and excrete more iodine than nonpregnant women. Pregnant women should be counseled to take prenatal vitamins that include adequate iodine levels--at least 200 mg/day. A recent Boston University study found that only 15% of prenatal vitamins contain more than 150 mg/day.

* A public education campaign should be instituted to teach women and clinicians about the importance of thyroid health, thyroid testing for high-risk individuals, and iodine nutrition.

Over-the-counter pregnancy detection kits should include a recommendation for pregnant women to immediately begin taking a prenatal vitamin with iodine. They should also include a list of risk factors for maternal thyroid dysfunction with a recommendation to seek a TSH test if those risk factors are present.

* A future research agenda should include studies of the prevalence of overt and subclinical maternal hypothyroidism and the pregnancy outcomes associated with each; the prevalence of iodine deficiency in women in the United States; possible revision of iodine dietary guidelines; and the impact of iodine nutrition on breast-feeding.
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Title Annotation:Obstetrics
Publication:OB GYN News
Date:May 1, 2004
Previous Article:American Thyroid Association statement: ID subclinical hypothyroidism before conception.
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