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Thyroid dysfunction in pregnancy being overdiagnosed and overtreated
![Thyroid dysfunction in pregnancy being overdiagnosed and overtreated Thyroid dysfunction in pregnancy being overdiagnosed and overtreated](https://medicaldialogues.in/h-upload/2020/02/06/750x450_124016-hyperthyroidism-1.webp)
Screening in pregnancy for subclinical hypothyroidism, often defined as thyroid-stimulating hormone (TSH) greater than 2.5 mIU/L or greater than 4.0 mIU/L, is controversial.
The researchers determined the frequency and distribution of TSH testing by gestational age, as well as TSH values associated with treatment during pregnancy and the frequency of postpartum continuation of thyroid hormone therapy.
The current practice of testing most pregnant women for thyroid stimulating hormone (TSH) may be leading to overdiagnosis and overtreatment, according to new research in CMAJ (Canadian Medical Association Journal).
The study of more than 188 000 women in Alberta found that TSH testing was performed in more than half (111 522 or 59%) of all pregnant women who did not have thyroid disease before pregnancy. Testing was most commonly done around gestational week 5-6.
"The practice of TSH testing early in the first trimester may be resulting in overdiagnosis and unnecessary thyroid hormone therapy during and after pregnancy," writes Dr. Lois Donovan, an endocrinologist at the Cumming School of Medicine, University of Calgary, with coauthors.
The challenge with TSH screening in pregnancy is that it identifies many women with very minor elevations in TSH, which is known as subclinical hypothyroidism. The best evidence shows no benefit for the mother or child from treatment of pregnant women with subclinical hypothyroidism.
In 5050 (4.5%) pregnancies with TSH testing, women were started on thyroid hormone therapy; most (99%) received levothyroxine. Almost half of them (44.6%) continued with the treatment after giving birth, and almost one-third (31.5%) received 2 or more prescriptions in the first postpartum year.
"This raises concerns about overmedicalization during pregnancy, given that minor, untreated TSH elevation usually normalized, as indicated by repeat measurement," write the authors. "The frequent postpartum continuation of thyroid hormone therapy for those who started it during pregnancy adds to this concern."
Evidence-based clinical practice guidelines are needed to provide clinicians with the appropriate approach to decide whether and when TSH testing is required in pregnancy and when it is necessary to continue treatment in the postpartum period.
For more details click on the link: DOI: https://doi.org/10.1503/cmaj.191664
Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email:Â editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751