Treatment and Screening of Hypothyroidism in Pregnancy: Results of a European Survey

Background: Maternal hypothyroidism in pregnancy is associated with several adverse outcomes. The Endocrine Society guidelines for the management of thyroid diseases in pregnancy were published in 2007; however, impact of the guidelines in the routine clinical practice is unknown. Therefore, we have carried out a survey of members of the European Thyroid Association to study current practices relating to the management of hypothyroidism in pregnancy.Subjects and methods: In December 2010, we emailed an electronic questionnaire survey based on clinical case scenarios to 605 members of the ETA. Responses from 190 clinician members (from 28 European countries) were analysed.Results: For a pregnant woman with newly diagnosed overt hypothyroidism, most responders initiated a full dose of L-thyroxine. For a woman with hypothyroidism planning pregnancy, 50% recommended increasing the dose of L-thyroxine as soon as pregnancy is confirmed, whilst 43% favoured testing thyroid function before adjusting the dose. Responders used diverse combinations of tests to monitor the dose of L-thyroxine. The target of thyroid function tests that responders aimed to achieve with L-thyroxine was also inconsistent. Forty-two percent responders or their institutions screened all pregnant women for thyroid dysfunction, 43% performed targeted screening of only the high-risk group, whilst 17% did not carry out systemic screening. Timing of the screening, tests used, and criteria for starting treatment and monitoring were variable.Conclusions: There is wide variation in the clinical practice relating to the treatment and screening of hypothyroidism during pregnancy in Europe.