The New American Thyroid Association Guidelines for Thyroid Disease During Pregnancy and Postpartum: A Blueprint for Improving Prenatal Care

Abstract

The current issue of Thyroid is highlighted by the publication of ‘‘Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum’’ (1). Led by Alex StagnaroGreen, the authors of this document are members of a task force appointed by the American Thyroid Association (ATA) and charged with developing clinical guidelines for the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force is to be commended, along with all who supported them in this ambitious and highly successful effort. Why do I like the new ATA Guidelines in this issue of Thyroid so much? To begin with, the task force has deconstructed the multifaceted subject of thyroid disease during and after pregnancy into 84 discrete questions, the answers to which are rated for strength of evidence, thereby forming the basis for reasoned recommendations. In spite of the document’s length (necessary to do justice to the global topic), the information is readily accessible and understandable. A further praiseworthy feature is the provision for dissenting views to be expressed, allowing the reader to better understand the extent and nature of disagreement. All of this should serve as a starting point for those of us involved with diagnosing and/ or managing thyroid disease in pregnancy to explore how to do better. The Guidelines offer an unusual opportunity to improve the identification and management of a broad spectrum of thyroid disorders in pregnancy and during the postpartum period. While the authors make a disclaimer that there will inevitably be a need for revisions (due to the dynamic nature of the field), the fact is that much of the content reflects areas that are likely to offer good practice advice for many years. All too often, important scholarly activities of this type with a genuine prospect for improving medical practice fall short of their potential, due to absence of mechanisms for promoting systematic implementation. One important step in such implementation would be to assure that these Guidelines are made available either in print or online to every practice in North America that offers either primary prenatal care or specialty endocrine services to women during and after pregnancy. Distribution might be made possible through joint sponsorship by professional groups, such as the American College of Obstetricians and Gynecologists, the American Academy of Family Practice, and, of course, the ATA. Having these Guidelines at hand would be especially valuable as a reference source for thyroid disorders encountered only occasionally in primary prenatal care (e.g., Graves’ disease, nodules, or cancer), but they should also prove useful in reminding caregivers about how to approach everyday problems, such as hypothyroidism. The potential for these Guidelines to improve the management of such everyday situations is particularly interesting to me. To accomplish this, a companion strategy might be devised in which selected topic areas are extracted from the Guidelines to serve as a platform for encouraging universal application. Either a public health organization (e.g., the U.S. Centers for Disease Control and Prevention [CDC]) or the professional coalition described above might take the lead in this effort. The following are examples of some everyday management situations that might be favorably influenced by such an initiative. One can only imagine how much benefit could be gained by widespread acceptance and application of even these few.