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Title: Subclinical Hypothyroidism During Pregnancy: The Melbourne Public Hospitals Consensus.
Austin Authors: Hamblin, Peter S;Sheehan, Penelope M;Allan, Carolyn;Houlihan, Christine A ;Lu, Zhong X;Forehan, Simon P;Topliss, Duncan J;Gilfillan, Christopher;Krishnamurthy, Bala;Renouf, Debra;Sztal-Mazer, Shoshana;Varadarajan, Suresh
Affiliation: Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
Department of Endocrinology & Diabetes, Eastern Health, Box Hill, Victoria, Australia
Department of Medicine, Eastern Clinical School, Monash University, Box Hill, Victoria, Australia
Werribee Mercy Hospital, 300 Princes Highway, Werribee, Victoria, Australia
St Vincents Institute of Medical Research, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Department of Endocrinology & Diabetes, Peninsula Health, Frankston, Victoria, Australia
Department of Endocrinology & Diabetes, Western Health, Sunshine Hospital, 176 Furlong Road, St Albans 3021
Department of Medicine - Western Precinct, The University of Melbourne, St Albans, VIC, 3021
Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
University of Melbourne Department of Obstetrics & Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
Endocrine Services in Pregnancy, Monash Health, Clayton, Victoria, Australia
Hudson Institute of Medical Research Clayton, Victoria, Australia
Mercy Hospital for Women, Heidelberg, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
Department of Chemical Pathology, Melbourne Pathology, Collingwood, Victoria, Australia
Department of Medicine, Monash University, Clayton, Victoria, Australia
Department of Endocrinology & Diabetes, The Alfred, Commercial Road, Melbourne, Victoria, Australia
Department of Medicine, Central Clinical School, Monash University, The Alfred, Commercial Road Melbourne, Victoria, Australia
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Endocrinology & Diabetes, Northern Health, Epping, Victoria, Australia
Issue Date: 2019 2018-12-18
Publication information: Internal Medicine Journal 2019; 49(8): 994-1000
Abstract: Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal Free T4, elevated TSH) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association (ATA) revised their diagnostic and management guidelines. While welcome, these new guidelines contain recommendations which may cause confusion in clinical practice. To ensure uniform practice in the diagnosis and management of subclinical hypothyroidism in pregnancy across all Melbourne Public Hospitals. Consensus was achieved and the guidelines were endorsed by the Council of the Endocrine Society of Australia. Trimester and assay specific TSH reference intervals derived from healthy local populations should be used, where available. When unavailable, a TSH cut-off of 4 mU/L (replacing the previously recommended 2.5 mU/L) should be used to initiate treatment, irrespective of thyroid autoantibody status. The recommended starting dose of levothyroxine is 50 ug daily, with a therapeutic TSH target of 0.1 mU/L to 2.5 mU/L. Levothyroxine should generally be ceased after delivery, with some exceptions. Hospitals will ensure smooth transfer of care back to the woman's general practitioner with clear documentation of pregnancy thyroid management and a recommended plan for follow-up. Fewer women will be classified as having subclinical hypothyroidism during pregnancy, which is likely to lead to reductions in emotional stress, hospital visits, repeated blood tests and financial costs. Uniform clinical practice will occur across Melbourne. This article is protected by copyright. All rights reserved.
DOI: 10.1111/imj.14210
ORCID: 0000-0002-6280-865X
PubMed URL: 30561039
Type: Journal Article
Subjects: Hypothyroidism
Subclinical hypothyroidism
Appears in Collections:Journal articles

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